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Urology > Urinary infections > Flashcards

Urinary infections Flashcards

1
Q

Infection types of the urinary tract

A

Acute cystitis
Acute pyelonephritis
Interstitial cystitis
Urethritis

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2
Q

Child w/ UTI prior to toilet training consider?

A

Vesicoureteral reflex

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3
Q

If considering Vesicoureteral reflex what study should be performed?

A

VCUG + refer

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4
Q

Kids w/ fevers HCP should consider?

A

UTI as source of fever

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5
Q

Intrinsic defense mechanisms

A 
Bladder emptying
Glycosaminoglycan layer
Antimicrobial properties
- high osmo
- extreme pH
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6
Q

Natural defenses of females

A

NL vaginal flora

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7
Q

Things altering normal flora of vagina

A 
pH changes 
Estrogen changes
ABX
Diaphragms
Spermicidal creams
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8
Q

Natural defenses of males

A

Prostatic fluid contains zinc (antimicrobial) which PVTs ascending infection

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9
Q

UTI RFs of females

A

Short urethra

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10
Q

UTI RFs of males

A

Uncircumscribed and anal intercourse

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11
Q

Other RFs not specific to M/F?

A 
UA retention, stasis, reflux
Anatomic/fx ABNLs
-obstruction
-neuro Dz efx lower Gu
-DM
-preg
-FOB (complicated UTIs)
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12
Q

MC route of UTI spread is

A

Ascending (esp F’s w/ short urethras)

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13
Q

MC infection ascent is?

A

Pyelonephritis - ascending up ureter

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14
Q

Other UTI modes of infection?

A

UC - hematogenous
Rare - lymphatic
Direct extension from other organs/sites.
- intraperitoneal abscess

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15
Q

Acute UTI are usually caused by how many pathogens?

A

One pathogen

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16
Q

Chronic UTI are usually caused by how many pathogens

A

> =2 pathogen

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17
Q

MC uncomplicated UTI?

A 
E. Coli
—others
-klebsiella
-proteus
-enterobacter/enterococci
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18
Q

Nosocomial/hospital acquired UTIs organisms?

A

Pseudomonas

Staphylococcus

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19
Q

Does asymptomatic bacteriuria req TXT?

A

No (except pregnancy, invasive urologic procedure req)

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20
Q

Acute cystitis def?

A

Bladder infection

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21
Q

Acute cystitis MC organism?

A 
Coliform bacteria (like E.coli)
Occ. GP (like enterococci)
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22
Q

Acute cystitis MC pop?

A

Female

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23
Q

Acute cystitis common S/S?

A

Irritative voiding S/S
-freq, urgency, dysuria
Suprapubic discomfort
+- gross hematuria

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24
Q

Acute cystitis S/S often appear when?

A

After sexual intercourse

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25
Q

Acute cystitis PE

A

+- suprapubic TTP

26
Q

Acute cystitis W/U

A

UA + Cx
-pyuria, bacteriuria, hematuria
Imaging - males only PRN
-VUR

27
Q

Acute cystitis Uncomplicated vs complicated UTI

A 
Uncomplicated UTI
- healthy nonpregnant adult woman
Complicated UTI
- everyone else
- no admit
28
Q

Acute cystitis uncomplicated TXT

A

TMX-SMZ 160-800mg BID x3Ds
Nitrofurantoin 100mg BID x5d
Fosfomycib 3g single dose

Fluoroquinolone -

  • Ciprofloxacin 250mg BID x3d
  • Levofloxacin 750mg QD x5d
29
Q

DOC Acute cystitis on pregnant females

A

Nitrofurantoin 100mg BID x7d

30
Q

Acute cystitis Analgesic TXT

A

Phenazopyridine 200mg TID

Hot sitz bath

31
Q

Phenazopyridine SEs

A

Discolors urine

Stains fabric/contact lenses (keep out)

32
Q

Acute cystitis In men W/U?

A 
Eval potential causes
-anatomic defect
-infected stones
-prostatitis
-chronic urinary retention
-uncircumcused
Req good sexual hx
33
Q

Acute cystitis PRPH pop?

A

Women w/ >3 episodes/yr

34
Q

Acute cystitis PRPH consideration/TXT

A 
Urology refer (exclude ABNL anatomy 1st)
- TMP-SMX 40/200
- Nitrofurantoin 100
- Cephalexin 250
At bed/intercourse
35
Q

Other Acute cystitis PVT actions

A

Educate
-hygiene
-hydration
& post-coital voiding habits

36
Q

Inection of renal parenchyma & renal pelvis

A

Acute pyelonephritis

37
Q

MC organism of acute pyelonephritis

A

GNB

  • E coli
  • proteus
  • klebsiella
  • Enterobacter
  • pseudomonas
38
Q

Acute pyelonephritis usually occurs by

A

Ascending from lower urinary tract

39
Q

Acute pyelonephritis S/S

A

Fever and Shaking chills

  • flank pain
  • irritative voiding S/S
  • n/v/d
40
Q

Acute pyelonephritis PE

A

Fever
Tachy-c
Pronounced CVA TTP

41
Q

Acute pyelonephritis Lab

A 
Urinalysis + Cx*
-pyuria
-bacteriuria
-hematuria
-WBC cell casts*
CBC - ^wbc (left shift)
Blood Cx*
42
Q

Acute pyelonephritis Complications

A

Sepsis w/ shock
Abscess
DM > emphysematous pyelonephritis (gas producing organisms)

43
Q

Emphysematous pyelonephritis is due to?

A

Gas producing organisms

44
Q

Acute pyelonephritis- when is it TXT outpt?

A

Nonpregnant compliant pts w/ mild uncomplicated Dz but w/ *close F/U (48hr max)

45
Q

Majority of Acute pyelonephritis is TXTd where?

A

Outpt
ABX - 1st quinolone
Pain control
Close F/U

46
Q

Acute pyelonephritis TXT

A 
Fluroquinolones
-levofloxacin 750 QD x5d
-Ciprofloxacin 750 BID x7d
Alternatives
-TMP-SMX DS BID 14d
-Amoxicillin-clavulanate 875mg BID 14d
47
Q

Acute pyelonephritis pts w/ persistent fever 72hrs refrac to ABX req

A

CT or U/S to exclude complicating factors like abscess or obstruction.

48
Q

Post Acute pyelonephritis TXT requirement

A

F/U UA Cx - test of cure

Confirm eradication

49
Q

Acute pyelonephritis Admit criteria

A 
Severe/complicated inf
-(sepsis, parenteral Rx, Rad)
Obstructive uropathy (pvt azotemia)
*DM
Rensk failure
MDR organisms 
Pregnant
Uncontrolled S/S - >48hr
50
Q

Acute pyelonephritis Inpt TXT

A

IV options
-1st line until Cx-susc -Ampicillin + gentamicin
-Ceftriaxone
-Levofloxacin
-Piperacillin-tazobactam
(Run ABX 24h after fever resolves then (PO)
At least 2wks TXT

51
Q

Interstitial cystitis is AKA

A

Painful bladder syndrome

52
Q

Interstitial cystitis is Dx how?

A

Dx of exclusion

53
Q

Interstitial cystitis MC pop

A

Women 40yo avg

54
Q

Interstitial cystitis Pathophys

A

Disruption of Glycosaminoglycan layer lining the bladder

55
Q

Interstitial cystitis S/S

A

Pain w/ bladder filling relieved w/ urination

+- urgency, freq, nocturia

56
Q

Interstitial cystitis Hx

A

Pelvic radiation exposure
Prev TXT w/ cyclophosphamide
Hx genital herpes, vaginitis, urethral diverticulum

57
Q

Interstitial cystitis labs

A 
UA, Cx + Urine cytology
- R/O infectious/malig
Urodynamic testing 
-assess bladder sensation, compliance, 
-R/O detrusor instability

Cystoscopy w/ Bx

58
Q

Interstitial cystitis TXT

A 
Symptomatic (no cure)
hydrodustention (dx)
-1st L- Amitriptyline
-2nd L - Nifedipine
Intravesical dimethyl sulfoxide (DMSO)
Trans-Q electric nerve stim
Acupuncture 
Last resort - surgery
-Cystourethrectomy w/ urinary diversion
59
Q

Urethritis is typically due to?

A 
Infection  (STI usually)
-gonococcal
-Non-gonococcal
—chlamydia
—Trichmonas
—Ureaplasma
—Herpes
60
Q

Urethritis S/S

A 
Young sexually active
Urethral D/C
— mucoid
— purulent (N. Gono)
Obstructive S/S
40% asymptomatic
61
Q

Urethritis W/U

A

Hx
Urethral Cx or PCR
STI panel

62
Q

Urethritis TXT for gono/Chlamydia

A

Gono-
Ceftriaxone 250 IM once

Chlamydia -
Azithromycin 1g PO once
Doxycycline 100mg BID x7d

JUST TXT BOTH

Urology (7 decks)

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