Neph Flashcards
What are the bugs for acute cystitis?
e coli enterococcus klebsiella pseudomonas enterobacter
How does the bacteria grow?
colonizes in the urethra and works its way down the bladder
Child has acute cystitis - PE?
strong smelling urine
suprapubic pain
bloody urine
What are acute cystitis PE for adult?
increase freq Burning Itching Dysuria Suprapubic pain
What to expect on urine dipstick for acute cystitis?
(+) uluekocyte esterase
(+) nitrite
What does leukocyte esterase mean? nitrite?
leukocyte esterase - pyruia - WBC present
nitrite - bacteria present
When should you do a urine C&S?
acute cystitis suspicion is HIGH but sx are not classic
When should you do a US in acute cystitis?
MALE children w/UTI
GU anomalies
When should you do a VCUG in acute cystitis?
recurrent in FEMALE CHILDREN
How to tx acute cystitis- uncomplicated?
bactrim DS BID x3days
cipro/levofloxacin - fluoroquinolone
ceftriaxone - 3rd gen
How to acute cystitis -complicated/pregnant?
nitrofurantoin BID x5-7days
ampicillin
amoxicillin
oral cephalosporin
How to acute cystitis - complicated/men?
bactrim DS BID x7days
What should ALWAYS be added when tx acute cystitis?
pyridium (phenazopyridine) x2-3days to control BURNING/pain
What should be warned about pyridium?
urine turning orange - shows that meds are working
How to prevent acute cystitis?
cranberry juice
pee after sex
shower>bath
What are bugs for pyelonephritis? Why?
e coli klebsiella enterobacter pseudomonas same as acute cystitis b/c it is a bug that works UP from the bladder to KIDNEY
What are the types of pyelonephritis?
emphysematous
xantogranulomatrous
What is emphysematous in pyelonpehritis?
gas in renal tissues
What is xantogranulomatrous?
occurs w/ obstruction
leads to tissue destruction
What PE to expect in pyelonephritis?
FEVER
N/V
CVA tenderness
What labs to run in pyelonephritis?
UA - WBC casts + proteins
UA+C&S
BC
How to tx uncomplicated pyelonpehritis?
fluroquinolone x5-7days
augmentin x14days
How to tx complicated pyelonephritis?
IV fluids
ampicillin + gentamicin/cipro
Pt has bladder pain that is relieved w/ urination? What to expect on UA and C&S?
interstitial cystisis
neg urine dipstick
neg culture
How to tx interstitial cystisis?
lifestyle changes
bladder training
refer
Pt has post dribbling of urine and decrease force?
urinary track obsturction-post renal
What is post renal problems?
stones
strictures
tumor
FB
What labs to run for urinary tract obstruction?
KUB
CT
US
UA w/ C&S
Tx urinary tract obstruction?
surgery
What are the types of nephrolithiasis?
hypercalcicuria
hyperoxaluria
urate/cystine
struvite/staghorn
What is hypercalcicuria?
secondary prob to hyperparathyroidism
renals are unable to reabsorb Ca
How to tx hypercalcicuria- parathyroid? -renals?
resect parathyroid
renals: TZD longterm
Pt had stones as a child-Type of nephrolithaisis? Tx?
hyperoxaluria-primary
tx: low fat, oxalate diet
Pt had gastric bypass w/chronic diarrhea-type of nephrolithasis? Tx?
hyperoxaluria-enteric
tx: ca supplements
Pt has gout w/ stones-type of nephrolithiasis? Expect pH to be? Tx?
gout
pH
Pt has recurrent UTI-type of nephrolithiasis? pH?
struvite/staghorn
ph> 7.2
Pt is in fetal position + flank pain radiating to groin?
nephrotlithiasis
When to admit nephrolithiasis?
vomiting UTI pain Stone is >6mm via US impaired renal fxn