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Genitourinary > Urinary Tract Infection (Exam 4) > Flashcards

Urinary Tract Infection (Exam 4) Flashcards

1
Q

Men or women are at greater risk of UTI

A

Women - shorter urethra

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2
Q

how do UTI’s often happen to women

A

Bacteria colonizes the vaginal introitus (opening).

Bacteria ascends the urethra to bladder

Not urinating after sexual intercourse

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3
Q

Kids often get UTI’s by what mechanisim

A

-Uncircumcised pts
-catheter placement
-reflux / anatomical abnormalities
-Bladder not working correctly or constipation
(BBD- bladder and bowel dysfunction)

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4
Q

Mechanism of Pyelonephritis

A

Develops when pathogens ascend up the ureters to the kidneys

can also occur by seeding- the kidneys from bacteremia or bacteria in lymphatics

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5
Q

Uncomplicated Cystitis

A

Confined to the bladder in a non-pregnant woman

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6
Q

Complicated Cystitis

A 
Fever
chills
rigors
flank pain
CVA tenderness
Infections past the bladder
any other underlying condition
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7
Q

Epidemiology of Cystitis

A 
most common in women
recent sexual intercourse
History of UTI's 
Urinary tract abnormalities 
Catheter
Obesity
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8
Q

Etiology of Cystitis

A

Most commonly - E. Coli
other bacterias are common
increased resistance common
contaminated urine - can show lactobacilli, enterococci, Group B strep, Coagulase neg staph.
How do we tell if contaminated- epithelial cells

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9
Q

Clinical Presentation and Pathophysiology for cystitis in children under 2

A

fever, vomiting, diarrhea, irritable, not growing or eating well.

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10
Q

Clinical Presentation and Pathophysiology for cystitis in children over 2

A

Dysuria, frequency, pain in lower abdomen or back, fever

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11
Q

Clinical presentation and pathophysiology for cystitis in Adults

A

Dysuria, frequency, urgency, suprapubic pain, hematuria possible, possible fever, they can be asymptomatic

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12
Q

In older individuals with little or varied or no symptoms but what do we worry about with geriatrics

A

Delirium

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13
Q

Always always always check for what in women with abdominal pain

A

Blood HCG for pregnancy

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14
Q

DDX for Cystitis

A 
Vaginitis
Urethritis
Pyelonephritis
Pregnancy
Pelvic Inflammatory Disease
STI's
Muscle strain
Malignancy
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15
Q

What should be evaluated for Diagnostics of Cystitis

A 
HPI
ROS
UA w/ dipstick
LABS- UA most accurate 
Pyuria abn >10 leukocytes
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16
Q

Management of Cystitis

A

-Important to consider antimicrobial selection
- First line meds- Macrobid, Bactrim, Fosfomycin, Pivmecillinam, etc.
Alternative meds- other bata-lactams, Augmentin, or fluoroquinolones

17
Q

what is needed if there is a suspected or high risk for resistance

A

Get a C&S and treat with meds empirically

18
Q

Potential Complications of Cystitis

A

Pylonephritis
sepsis
Hospitalization
Death

19
Q

Referral Considerations for Cystitis

A

Anytime it is a male pt
recurring UTI’s
Not responding to Antibiotics

20
Q

Comorbidities of cystitis

A

Pregnancy, Older age, Chemotherapy, DM, Etc.

21
Q

Most common cause of Urethritis in men

A

STI’s - Gonorrhea and chlamydia are the most common causes

22
Q

How do we diagnose N. Gonorrhea

A

Easily seen on gram stain

23
Q

Clinical Presentation of Urethritis

A

Dysuria #1 complaint
Can have discharge noted
ay have inflamed meatus on exam

24
Q

Differential Diagnosis

A

Adults typically STI related- you must confirm

25
Q

Potential Complications of Urethritis

A

Epididymitis and prostatitis in men.

Extragenital signs or symptoms

26
Q

Referral Considerations of Urethritis

A

Typically can treat on own, may need referrals with refractory and/or more serious sx.
Any other sexual contact within the past 60 days should be assessed and treated.

27
Q

Urethritis Response to past treatment

A
  • Patients with confirmed GC/Chlamydia should be rechecked in 3-6 months (bpth w/wo sx)
  • Test for cure 1-2 wks after tx recommended with culture or nucleic acid amplification test (NAAT)- typically only done if you use alternatie treatment or are worried about pt cure
28
Q

Epidemiology of Pyelonephritis

A

15-17 cases per 10,000
females and 3-4 cases per 10000 males

Estimated costs of pyelonephritis- at least 2.14 billion/yr

29
Q

Etiology of Pyelonephritis

A

Infection of upper urinary tract
typically comes one of 3 ways- ascending infection from bladder up ureters, infection from bacteremia called seeding, and possibly infection from bacteria in lymphatics to the kidneys

30
Q

Clinical Presentation of pyelonephritis

A

Similar to UTI/Cystitis

-Adults- Dysuria, frequency, urgency, suprapubic pain, hematuria possible, possible fever

31
Q

Clinical presentation of Pyelonephritis

A

Fever, chills, flank pain, NV, CVA tenderness, mental status change, what about protein in urine

32
Q

Differential Diagnosis of Pyelonephritis

A

UTI, STI, Kidney Stones, Hematuria, Lumbar injury, PID, etc.

33
Q

Diagnostic evaluation of Pyelonephritis

A 
Clean catch urine
Suprapubic needle aspiration
Catheterization
Cultures if suspected 
CT
MRI
US
PE/HPI/PMH
34
Q

Management of Pyelonephritis

Uncomplicated

A

outpt
single dose parenteral abx
Oral abx
Follow up in first 48 hours

35
Q

Management of complicated Pyelonephritis

A

Inpt- Supportive care

  • follow results of urine and blood cultures
  • Monitor comorbid conditions
  • maintain hydration
  • Sx may be necessary- due to abscesses, necrosis, calculi related uti, and possibly needed nephrectomy
36
Q

Potential complications of Pyelonephritis

A 
Hospitalizations
morbidity 
mortality 
sepsis
acute renal failure
scarring
transplant pyelonephritis
37
Q

How many cases or pyelonephritis are diagnosed in US alone per year

A

250,000 cases per year.

38
Q

big differences from Pyelonephritis to UTI

A

Typically one side not both, Nausea and vomiting more prevalent in pye.

39
Q

Referral Considerations for Pyelonephritis

A

Urology- ureteral obstruction, stones, urogenital abnomality, recurrent pyelo, first episode in a child or infant

  • renal specialist- acute renal failure or advanced chronic renal renal failure, all neonates and infants.
  • Infectious disease- unusual or resistant pathogen, immunocompromised pt, persistent fever (>48 hrs) or toxicity (>72 hrs) (+) blood culture results for more than 48 hours

OB- consult if pt pregnant

Genitourinary (11 decks)

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