Urinary tract infection Flashcards
4 general predisposing factors
immunosuppression
diabetes
malnutrition
steroids
Predisposing factors
female - short urethra sex and poor voiding habits congenital abnoramalities foreign object eg catheter, stone oestrogen deficiency - post menopause bladder and bowel fistula stasis of urine wiping back to front
UTU causative organisms
usually bowel
ecoli, proteus, klebsiella, enterococci
Clinical features in children
diarrhoea nausea and vomiting not eating excessive crying fever
Clinical features in adults
flank pain dysuria frequency child cloudy offensive urine confusion - elderly
Clinical features of acute pyelonephritis
pyrexia poor localisation loin tenderness signs of dehydration turbid urine
Ward and microbiology testing of MSSU
ward - blood, protein, leucocytes, nitrites
microbiology - bacteriuria, microscopy, gram stain
What investigations may you want to do in men, children or recurrent UTI?
USS or IVU
isotope studies rules out reflux and scarring
2 first steps in management
identify organism and treat
identify causative factors and treat
Treatment of UTI
fluids
antibiotics = amoxicillin, trimethoprim, cephalosporin
Treatment of severe infection
IV antibiotics
Reflux nephropathy investigation
micturating cystogram
How is damage caused in reflux nephropathy?
reflux and infection
Assessing progression of reflux nephropathy
USS and biochemistry
Who do reflux nephropathy affect?
children
3 top tips for those with recurrent infections
drink 2l a day
void every 2-3 hours
void before bed and before and after sex
Bacteriuria value
> 10 to the power of 5
How is chronic pyelonephritis diagnosed?
radiologically
How does chronic pyelonephritis appear radioogically?
scarring and clubbing of calyces
