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PAEP Renal > Urinary Tract Infections > Flashcards

Urinary Tract Infections Flashcards

1
Q

What organs are involved in an upper UTI?

A

kidney and ureter(s)

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2
Q

what organs are involved in a lower UTI?

A

bladder and urethra

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3
Q

how would you explain UTI to a pt?

A

it’s an infection in your urinary tract. Your urinary tract consists of your kidneys, ureters, bladder, and urethra.

when you have a UTI, one or multiple parts of your urinary tract have an infection

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4
Q

what factors make a UTI complicated?

A
  • adult males
  • elderly
  • immunocompromised (cancer, active HIV, DM, immunosuppressive therapy)
  • pregnancy
  • stones
  • indwelling catheters
  • pts with structure abnormalities
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5
Q

what factors make a UTI uncomplicated?

A
  • no structural or functional abnormalities
  • young
  • nonpregnant
  • premenopausal women
  • no comorbidities
  • no stones
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6
Q

what is the criteria/number of episodes needed to dx recurrent UTI?

A

> = 3 episodes of symptomatic, culture-proven UTI in one year
OR
= 2 episodes in 6 months, culture-proven UTI

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7
Q

what is asymptomatic bacteriuria?

A

presence of bacteria in urine w/o s/s of UTI

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8
Q

what is a persistent/relapsed UTI?

A

persistence of s/s and positive cultures w/ same bacteria despite culture-adjusted antibiotic tx

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9
Q

what is one ddx for UTIs in male?

A
  • urethritis/STI
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10
Q

what is one ddx for UTIs in general?

A
  • interstitial cystitis/painful bladder syndrome
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11
Q

what is painful bladder syndrome?

A

pts with recurrent UTI s/s w/o an identifiable cause

basically chronic pain related to the bladder

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12
Q

in what sex is UTI more common?

A

females > males

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13
Q

tell me about the epidemiology of UTI in children

A

boys <7Y UTI is more common

UTI more common in uncircumcised infant boys, premature, young children w/severe constipation

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14
Q

what are some RF for developing UTI in adults?

A
  1. being female
  2. older age
  3. menopause
  4. incontinence
  5. FH of UTI
  6. catheterization
  7. kidney/bladder stones
  8. DM
  9. urinary tract procedures
  10. immunocompromised status
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15
Q

what are some RF for UTI in children/adolescents?

A
  1. structural abnormalities, vesicoureteral reflux
  2. prematurity
  3. indwelling urinary catheters
  4. lack of circumcision
  5. bladder and bowel dysfunction (constipation, Hirschsprung)
  6. DM
  7. Trauma/neglect (not changing diapers)
  8. sexual intercourse
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16
Q

whats the most common uropathogen for UTI?

A

E. coli

17
Q

general pathophys of UTI

A

Retrograde movement of pathogen, urinary stasis, obstruction, vesicoureteral/vesicourethral reflux → infection and inflammation → S/S

18
Q

what s/s would you see in adult bacterial cystitis?

A

frequency, urgency, dysuria, hematuria, pain, foul-smelling urine

19
Q

what is the triad youd see in pyelonephritis?

A

fever, flank pain, and positive urine cultures

20
Q

what is the most common sign in newborns >3M? and others?

A

fever!

crying while urinating, irritability, and vomiting

21
Q

how would a pyelonephritis pt present? s/s?

A

classic triad: fever, flank pain, positive culture

general malaise, chills/sweats/rigors, N/V, DLOC, flushed, diaphoretic, sepsis

22
Q

what bloodwork would you do for a suspected UTI?

A
  1. CBC
  2. creatinine and BUN
  3. electrolytes
  4. potential blood culture if sepsis s/s
23
Q

what urine tests would you get for a suspected UTI? and what parts of them are important?

A

Urine culture and sensitivity ➔ academically good to get all the time, realistically done when suspected complicated

Urine dipstick
- nitrites
- leukocyte esterase activity
- microscopic blood
- protein

pregnancy test

24
Q

when would you consider imaging for a UTI in adults?

A

for complicated pyelonephritis – CT

for pregnant and for sus of stones - u/s

could consider endoscopy for complicated w/stones ➔ urethrocystoscopy (lower) or ureterorenoscopy (upper)

25
Q

why would you get imaging for a child with UTI?

A

determine if there are any structural abnormalties

26
Q

what kind of imaging pipeline would you follow for child with UTI? and what age?

A

for 3M - 2Y, if >2Y only get imaging for recurrent UTI

  1. KUB U/S - looks for inflammation/dilation of ureter, obstruction and abnormalties, unlikely will see vesicourethral reflex
  2. voiding cystourethrogram - looks for the vesicourethral reflex, done after the UTI is resolved
  3. nuclear cystogram - looks for the vesicourethral reflex
27
Q

tx for UTI?

A

abx!
supportive care: stay hydrated, discuss bathroom hygiene, NSAIDs/tylenol for pain

28
Q

how manage recurrent UTI?

A
  • consider low-dose prophylactic abx
  • preemptive abx prescriptions to fill
29
Q

what type of bacteria converts urinary nitrate to nitrite that we can see on dipstick?

A

gram negative
most common: E. coli

PAEP Renal (11 decks)

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