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PEDIATRIE > ITU > Flashcards

ITU Flashcards

1
Q

ce afecteaza itu?

A

tract si sau interstitiu

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2
Q

care este criteriul obligatoriu de itu?

A

bacteriuria >100.000 germeni/ml din jet mijlociu

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3
Q

care este criteriul neobligatoriu de itu?

A

piuria/leucocituria : f >25 leucocite/mm3, b >50 leuco/mm3 - urina proaspata si NEcentrifugata

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4
Q

daca avem piurie, dar nu si bacteriurie, este ITU?

A

NU

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5
Q

daca avem bacteriurie, dar nu si piurie, este ITU?

A

DA

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6
Q

care sunt GERMENII implicati in itu?

A
  1. bacterii
  2. virusuri
  3. micelii - candida albicans
  4. protozoare - trichomonas vaginalis
  5. paraziti - bilharzia
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7
Q

care sunt cele mai frecvente BACTERII implicate?

A

gram negativ:
1. e coli
2. proteus mirabilis
3. pseudomonas
4. klabsiella
5. haemophillus

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8
Q

cel mai frecvent gram negativ implicat?

A

e coli

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9
Q

gram pozitivi implicati?

A

strepto fecalis si hemofilus si stafilococ aureus si albus

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10
Q

virususri implicate?

A
  1. adeno
  2. herpes
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11
Q

ce da adenovirusul?

A

cistita acuta hemoragica

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12
Q

ce da herpesvirusul?

A

sd uretral acut

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13
Q

cei 3 factori patogeni e coli?

A
  1. ag polizaharidice k1-k13
  2. fimbrii -organite filamentoase
  3. endotoxine
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14
Q

ce fac ag polizaharidice?

A

rezistenta la opsonizare si fagocitoza

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15
Q

ce fac fimbrii?

A

recunosc rec specifici uroteliu si rezista la jetul de spalare urinar

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16
Q

ce fac endotoxine?

A

scad persiatltica ureterului si fav ascensiunea germenilor
det febra si frison

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17
Q

care elemente patogene ale e coli sunt specifice tuplinilor nefritigene?

A

ag si fimbrii

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18
Q

cum se numeste infectie de tract urinar joasa si la nivelul carui segment se produce?

A

cistita - vezica urinara

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19
Q

cum se numeste infectia de tract urinar inalta, la nivelul carui segm se prod si ce conditie necesita?

A

pielonefrita acuta
bazinet, interstitiu renal
fact fav pt ascensiunea din vezica urinara catre ureter

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20
Q

care este momentul patogenic cel mai important in itu pe cale ascendenta?

A

colonizarea vezicii urinare

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20
Q

care este primul moment/conditia in itu pe cale asc si ce f fav prezinta?

A

colonizarea perineului
f fav fct de SEX

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21
Q

care esteCONDITIA in itu pe cale desc?

A

sa existe un focar infectios primitiv

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21
Q

care este CALEA DE DISEMINARE in itu pe cale desc?

A

BACTERIEMIA

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22
Q

cum punem dg pt reflux vezicoureteral?

A

uretrocistografie

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23
Q

cauza primitiva de RVU?

A

defect implantare ureter in VU

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24
Q

cauze secundare de RVU?

A
  1. interv chir
  2. obstacol subvezical
  3. inflamatia vezicii
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25
Q

RVU grd 1

A

sc urca f putin

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26
Q

RVU grd 2

A

sc urca pana la bazinet

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27
Q

RVU grd 3-4

A

sc dilata sist pielocaliceal

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28
Q

RVU grd 5

A

ureter tortuos

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29
Q

ce factori fav GENERALI pt itu exista?

A
  1. def imun
  2. tulb metab congen/dob: dz, acidoza tubulara
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30
Q

este dz f fav pt itu?

A

DA

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31
Q

este acidoza tubulara f fav pt itu?

A

DA

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32
Q

f fav locali?

A
  1. t urina = 37
  2. anomalii anato -rvu
  3. anomalii funct -flux desc, vezica neurogena
  4. anomalii imuno -bact nu mai sunt atacate de pmn, cuplate cu Ac si lizate
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33
Q

ce este SD HINMNAN ?

A

vezica neurogena nonneuropatica - anomalie funct

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34
Q

ce inseamna vezica neurogena neuropatica ?

A

incoordonare intre contractia detrusorului vezical si relaxarea sfincterului exter din cauza leziunilor nervoase
imposibilitatea controlului voluntar al mictiunii, vezica se goleste prin prea-plin(presional)

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35
Q

ce inseamna vezica neurogena nonneuropatica?

A

incoordonare intre contractia detrusorul vezical si relaxarea sfincterului extern din cauza unei tulburari psihogene

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36
Q

cea mai frecventa cauza de vezica neurogena neuropatica la copii?

A

mielomeningocel

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37
Q

cauze de vezica neurogena neuropatica?

A
  1. mielomeningocel
  2. spina bifida
  3. traumatism CV
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38
Q

leziune in itu pe cale desc?

A

microabcese interstitiu renal si necroza papilara

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39
Q

ce este sd prune-belly?

A

anomalie structurala

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40
Q

care sunt cele 7 anomalii anato in itu?

A
  1. rvu
  2. valva uretr
  3. duplicatie rinichi, ureter
  4. calculi
  5. staza - hipotonie sau dilatari
  6. jonct- bazin ureter
  7. SD PRUNE-BELLI
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41
Q

cele 3 consecinte fiziopat in itu?

A
  1. scade concentrarea urinei
  2. hta
  3. febra si frison
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42
Q

scaderea conc urinei - mec

A

modif grd osmotic

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43
Q

hta - mec

A

tulb fct tubulare - retentie sodiu - sist renina, angiotensina, aldosteron

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44
Q

cele 5 forme clinice de itu

A
  1. nn
    2.sugar si copil mic
  2. copil mare
  3. obstructive -recidivante, cronice
  4. asimptomatice
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45
Q

care sunt cele 4 principii de tratament in itu?

A
  1. dg corect
  2. localizarea
  3. germeni
  4. sb la atb si chimio - atbgrama
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46
Q

cele 2 categorii de tratament in itu

A
  1. antiinfectios
  2. adjuvant
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47
Q

cat dureaza tratamentul episodului acut?

A

10-14 zile

48
Q

cat dureaza trat intretinere?

A

3-6 luni SAU pana la rezolvarea malformatiei

49
Q

cum se face controlul tratamentului in ep acut?

A

urocultura la 72 ore si la sf terapiei

50
Q

cum se face controlul terapei in tratamentul de intretinere?

A

urocultura lunar

51
Q

care sunt cele 4 indicatii ale trat de INTRETINERE?

A
  1. infectii frecv peste 2-3 pusee/an
  2. rvu
  3. PNcr
  4. manevre urologice
52
Q

cum se adm trat de intretinere?

A

jumatate sau un sfert din doza obisn
o data pe seara

53
Q

trat empiric?

A
  1. ampicilina(penicilina) + gentamicina(aminoglicozida)
  2. cefalosporine(incep cu cef) + gentamicina
  3. chinolone oral/iv - ciprofloxacin
54
Q

trat fct de atbgrama?

A
  1. nitrofurantoin
  2. acid nalidixic
  3. trimetoprim
  4. amoxicilina + acid clavulanic = augmentin
55
Q

prognostic ITU

A

daca exista malformatii

56
Q

care parametrii sunt normali in cistita?

A
  1. ta
  2. cilindrii
  3. azotemie
  4. imagistic
57
Q

care este singurul param normal din PNcr?

A

febra

58
Q

febra in cistita

A

sub 38,5

59
Q

febra in PNac

A

peste 38,5

60
Q

febra in PNcr

A

fara valoare

61
Q

vsh in cistita

A

sub 25mm/h

62
Q

vsh in PNac

A

peste 25mm/h

63
Q

vsh in PNcr

A

crescut in general

64
Q

TA in cistita

A

normala

65
Q

TA in PNac

A

crescuta uneori

66
Q

TA in PNcr

A

crescuta in general

67
Q

cilindrii in cistita

A

nu

68
Q

cilindrii in PNac

A

da

69
Q

cilindrii in PNcr

A

da

70
Q

azotemie in cistita

A

nu

71
Q

azotemie in PNac

A

crescuta tranzitor

72
Q

azotemie in PNcr

A

crescuta permanent

73
Q

imagistic cistita

A

normal

74
Q

imagistic PNac

A

modificari

75
Q

imagistic PNcr

A

dg

76
Q

cate din cazurile de bcr provin din PNcr?

A

1/3

77
Q

urocultura pozitiva

A

peste 100.000 germeni/mm3

78
Q

urocultura negativa

A

sub 1000 germ/mm3

79
Q

interpretarea trebuie facuta fct de contextul clinic dupa urocultura de:

A

10.000-100.000germ/mm3

80
Q

etape dg itu - 3

A
  1. dg poz, etiologie, localizare
  2. f fav
  3. rasunet functional asupra rinichiului
81
Q

prin ce metode se dg f fav locali? 2

A
  1. eco
  2. cistografie mictionala
82
Q

prin ce metode se dg rasunetul funct pe rinichi?

A

scintigrafie - tc99, DMSA/DTPA, MAG3

83
Q

teste screening - 2

A

1.coloratie gram frotiu urine proaspata si necentrifugata
2. stickuri enzimatice

84
Q

teste dg -2

A
  1. urocultura
  2. leucociturie semnif
85
Q

test pt leucociturie?

A

ADDIS

86
Q

de cate ori trb repetata urocultura?

A

de 3 ori

87
Q

urocultura positiva prin cateterism vezical

A

peste 50.000 germ/mm3

88
Q

urocultura pozitiva prin aspirat suprapubian

A

orice nr

89
Q

permit doar manifestarile CONFIRMAREA DG?

A

nu, permit doar SUSPICIUNEA DG

90
Q

cu ce se trat ITU asimpt?

A

nu cu atb!!!

91
Q

la cine sunt frecv itu asimpt?

A

sex feminin, varsta scolara

92
Q

factori care tin de prognostic in itu asimpt - 2

A
  1. varsta debut
  2. rezistenta germeni
93
Q

dg itu asimpt - 2

A
  1. leucociturie
  2. urocultura poz
94
Q

factori care tin de prognostic in itu obstructive/recidivante/cronice? - 2

A
  1. tipul malf
  2. durata evol pana la dg
95
Q

cum evol itu obstr?

A

recidive, cronicizre, BCR

96
Q

ce avem specific la ex clinic in itu obstructive?

A
  1. rinichi palpabili - hidronefroza
  2. vezica urinara palapabila dupa mictiune - reziduu vezical
97
Q

cand apare intarzierea proc de crestere?

A

itu obstructive

98
Q

etiologie itu obstr?

A
  1. e coli
  2. proteus, klebsiella, staf auriu
  3. POLIMICROBIENE - atbterapie dificila
99
Q

la ce varsta asociaza itu cel ami des maolformatii?

A

sugar si copil mic - 80% - frecv sex masc
copil mare - 40%

100
Q

incidenta itu copil mare

A

sex fem

101
Q

etiologie itu copil mare

A

e coli frech
proteus
klebsiella
enterococ

102
Q

evolutie itu sugar si copil mic

A

tend la recidiva

103
Q

progn itu sugar copil mic

A

fav - dep de malf si nr recidive

104
Q

cum se prefera adm trat la sugar si copil mic?

A

iv

105
Q

cau trb adm trat la sugar si copil mic?

A

10-14 zile

106
Q

incidenta itu sugar si copil mic

A

fetite

107
Q

etiologie itu sugar si copil mic

A

e coli frecg=v
proteus
klebsiella
coci gram poz

108
Q

prognostic imediat la itu nn

A

sever - exitus in 20% cazyri

109
Q

prognostic tardiv la itu nn

A

bun, nu recidiveaza sau cronicizeaza

110
Q

trat itu nn

A

mai intai se corecteza tulb bio si apoi atbterapie

111
Q

cat se adm atb la nn?

A

14 zile

112
Q

cum sea adm atb la nn sugar si copil mic?

A

iv

113
Q

tablou sever itu nn - 4

A
  1. acidoza metabolica
  2. azotemie
  3. CID
  4. anemie hemolitica
114
Q

incidenta itu nn

A

baoeti prematuri, NN cu antecedente
1. travaliu prel
2. rupere prematura mb
3. febra la mama

115
Q

etiologiafrecv itu nn

A

e coli

116
Q

mec prod itu nn

A

cale hematogena

117
Q

forme clinice itu 5

A
  1. nn
  2. copil mic si sugar
  3. copil mare
  4. asipt
  5. obstr , recidiv, cronic
118
Q

simpt nespecif itu nn - 8

A
  1. hiper sau hipotermie
  2. sd dispeptic - varsaturi si diaree
  3. sd diareic acut
  4. sd hemoragipar
  5. semne neuro - somnolenta hipotonie convulsii coma
  6. soc infectios
  7. icter
  8. lipsa cresterii ponderale
119
Q

tablou bio itu nn -4

A
  1. leucocitoza +neutrofilie
  2. teste inflam poz
  3. bacteriemie
  4. uroculturi poz

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