Urinary Tract Infection Flashcards
Tell me about Urinary tract infection
is the commonest bacterial infection managed in GP.
3% of F aged 20 then raises 1% for each decade
What is covered under the umbrella of urinary tract infection
Cystitis
Pyelonephritis
urethritis
Prostitis
Symptoms of Cystitis
Cystitis is the infection of the bladder
Frequency
Dysuria
Urgency (inflamed bladder wall)
Haematuria
Suprapubic pain
What is micturition
is the ejection of urine from the urinary bladder through the urethra to the outside of the body.
UTI symptoms
frequency hesitancy urgency dribbling blood (Haematuria) Dysuria incontinence, fever.
What is nocturia
Wake up and pass urine at night
Symptoms of prostitis
flu-like symptoms
backache
swollen/tender prostate on PR
few urinary symptoms
Signs of UTI
- Fever
- Abdo or loin tenderness
- Foul smelling urine and cloudy
- Distended bladder maybe
- Enlarged prostate
- Vaginal discharge
How to investigate UTI
• Urine dip stick
• MC&S urine + culture
• USS
Blood test –> FBC and U&E
What is cytoscopy
Tube into urethra to bladder to see inside
What will you look for in suspected UTI dip stick
if nitrates or leukocytes are positive then most likely it is of bacterial cause
In UTI when would you send sample to MC&S urine and culture
o Send if dip -ve but symptomatic and male child
o Or pregnant, immunocompromised, or VERY ILL
In UTI, when is further imaging or cytoscopy is indicated
o Persistent not responding to Tx
o History of renal tract disease
o Haematuria
o Men with 2 or more episodes in 3 months. Or Any men with obstruction suggestions
Differentials of UTI
Urethritis caused by an STI
Reiter’s syndrome - arth+conjuc+urethritis occur at same time
Causative organisms of UTI
Escherichia coli from GI tract is 75%
enterobacter (Proteus mirabilis, Klebsiella pneumoniae)
Staphylococcus saprophyticus.
urethritis
Gonococcal (Gonorrohoea)
non-gonococcal
Medical Management of UTI
Abx therapy, start broad with trimethorpim initially and after MC&S give narrow according to results. Ideally treat with ABx for 3 days only
steps
trimethorpim, nitrofurantoin or Amoxicillin
cephalosporin or 2nd line co-amoxiclav
Other lifestyle management of UTI
Lots of fluids
cranberry juice
How to manage presisten or recurrent UTI
Look for other causes if MC&S is already done
Incomplete bladder emptying (prostatic disease, neurological problems)
Foreign body (catheter, stone)
Failure of host defences (diabetes, post-menopausal atrophic urethritis)
Simple measure that may aid in preventing recurrent UTI
Fluid intake > 2 L/day
Regular complete bladder emptying
Good personal hygiene
Emptying of bladder before and after sexual intercourse
Cranberry juice.
Tell me about acute pyelonephritis
It is an ascending infection from the bladder
rarely complicates into perinephric abscess or papillary necrosis
Presentation of acute pyelonephritis
sudden onset pain on 1 or both loins +- radiation to the illiac fossaand suprapubic region
associated with fevers (more than 38) rigors, vomiting and hypotension
lumbar tenderness and guarding
dysuria because of cystitis involvement in 30%
Differentials of acute pyelonephritis
acute appendicitis
diverticulitis
cholecystitis
What findings you expect to see in a urine dipstick when acute pyelonephritis is suspected
Neutrophils and organisms (bacteria), with presensce of symptoms will confirm diagnosis
red cells
tubular epithelial cells in urine
Why would you want to use renal tract USS or CT in acute pyelonephritis
to exclude perinephric collection and obstruction
How to manage acute pyelonephritis
adequate fluid intake is necessary even if it is IV fluids
Abx treatment with first-line co-amoxiclav and ciprofloxacin for 7-14 days
How to manage severe acute pyelonephritis
Severe cases require initial IV therapy, with a cephalosporin, quinolone or gentamicin
What else you should do when managing acute pyelonephritis
Urine should be cultured during and after treatment.
A 33 yr old F presents with fever and right sided flank pain for one day. Denies frequency, urgency, dysuria, or hematuria and bowel symptoms?
What is the most likely diagnosis
acute pyelonephritis
Gram -ve vs gram +ve
blue +ve
more susceptible to Abx, penicillin and vancomycin Vgood
streptococcus, staphylcoccus, clostridium
steroptomycin and tetracyclines dnt do shit
red -ve
More resistant to Abx Penicillin and vancomycin Bad
E coli
H. influenzae
pesuedomonas
neisseria meningitidis
steroptomycin and tetracyclines killsem
