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Urinary infections Flashcards

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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
Acute cystitis PE
+- suprapubic TTP
26
Acute cystitis W/U
UA + Cx -pyuria, bacteriuria, hematuria Imaging - males only PRN -VUR
27
Acute cystitis Uncomplicated vs complicated UTI
``` Uncomplicated UTI - healthy nonpregnant adult woman Complicated UTI - everyone else - no admit ```
28
Acute cystitis uncomplicated TXT
TMX-SMZ 160-800mg BID x3Ds Nitrofurantoin 100mg BID x5d Fosfomycib 3g single dose Fluoroquinolone - - Ciprofloxacin 250mg BID x3d - Levofloxacin 750mg QD x5d
29
DOC Acute cystitis on pregnant females
Nitrofurantoin 100mg BID x7d
30
Acute cystitis Analgesic TXT
Phenazopyridine 200mg TID | Hot sitz bath
31
Phenazopyridine SEs
Discolors urine | Stains fabric/contact lenses (keep out)
32
Acute cystitis In men W/U?
``` Eval potential causes -anatomic defect -infected stones -prostatitis -chronic urinary retention -uncircumcused Req good sexual hx ```
33
Acute cystitis PRPH pop?
Women w/ >3 episodes/yr
34
Acute cystitis PRPH consideration/TXT
``` Urology refer (exclude ABNL anatomy 1st) - TMP-SMX 40/200 - Nitrofurantoin 100 - Cephalexin 250 At bed/intercourse ```
35
Other Acute cystitis PVT actions
Educate -hygiene -hydration & post-coital voiding habits
36
Inection of renal parenchyma & renal pelvis
Acute pyelonephritis
37
MC organism of acute pyelonephritis
GNB - E coli - proteus - klebsiella - Enterobacter - pseudomonas
38
Acute pyelonephritis usually occurs by
Ascending from lower urinary tract
39
Acute pyelonephritis S/S
Fever and Shaking chills - flank pain - irritative voiding S/S - n/v/d
40
Acute pyelonephritis PE
Fever Tachy-c Pronounced CVA TTP
41
Acute pyelonephritis Lab
``` Urinalysis + Cx* -pyuria -bacteriuria -hematuria -WBC cell casts* CBC - ^wbc (left shift) Blood Cx* ```
42
Acute pyelonephritis Complications
Sepsis w/ shock Abscess DM > emphysematous pyelonephritis (gas producing organisms)
43
Emphysematous pyelonephritis is due to?
Gas producing organisms
44
Acute pyelonephritis- when is it TXT outpt?
Nonpregnant compliant pts w/ mild uncomplicated Dz but w/ *close F/U (48hr max)
45
Majority of Acute pyelonephritis is TXTd where?
Outpt ABX - 1st quinolone Pain control Close F/U
46
Acute pyelonephritis TXT
``` Fluroquinolones -levofloxacin 750 QD x5d -Ciprofloxacin 750 BID x7d Alternatives -TMP-SMX DS BID 14d -Amoxicillin-clavulanate 875mg BID 14d ```
47
Acute pyelonephritis pts w/ persistent fever 72hrs refrac to ABX req
CT or U/S to exclude complicating factors like abscess or obstruction.
48
Post Acute pyelonephritis TXT requirement
F/U UA Cx - test of cure | Confirm eradication
49
Acute pyelonephritis Admit criteria
``` Severe/complicated inf -(sepsis, parenteral Rx, Rad) Obstructive uropathy (pvt azotemia) *DM Rensk failure MDR organisms Pregnant Uncontrolled S/S - >48hr ```
50
Acute pyelonephritis Inpt TXT
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
Interstitial cystitis is AKA
Painful bladder syndrome
52
Interstitial cystitis is Dx how?
Dx of exclusion
53
Interstitial cystitis MC pop
Women 40yo avg
54
Interstitial cystitis Pathophys
Disruption of Glycosaminoglycan layer lining the bladder
55
Interstitial cystitis S/S
Pain w/ bladder filling relieved w/ urination | +- urgency, freq, nocturia
56
Interstitial cystitis Hx
Pelvic radiation exposure Prev TXT w/ cyclophosphamide Hx genital herpes, vaginitis, urethral diverticulum
57
Interstitial cystitis labs
``` UA, Cx + Urine cytology - R/O infectious/malig Urodynamic testing -assess bladder sensation, compliance, -R/O detrusor instability ``` Cystoscopy w/ Bx
58
Interstitial cystitis TXT
``` 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
Urethritis is typically due to?
``` Infection (STI usually) -gonococcal -Non-gonococcal —chlamydia —Trichmonas —Ureaplasma —Herpes ```
60
Urethritis S/S
``` Young sexually active Urethral D/C — mucoid — purulent (N. Gono) Obstructive S/S 40% asymptomatic ```
61
Urethritis W/U
Hx Urethral Cx or PCR STI panel
62
Urethritis TXT for gono/Chlamydia
Gono- Ceftriaxone 250 IM once Chlamydia - Azithromycin 1g PO once Doxycycline 100mg BID x7d JUST TXT BOTH

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