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3B week 4 - haematuria etc. > urinary tract infections > Flashcards

urinary tract infections Flashcards

1
Q

are women or men more at risk of UTIs?

A

women

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2
Q

what are the defence mechanisms of the urinary tract

A
  1. commensal bacteria (e.g. vaginal lactobacilli)
  2. general immune system
  3. urine -> pH, chemical content and flushing mechanism
  4. uriteric peristalsis
  5. emptying of bladder
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3
Q

what can severe UTI result in

A

loss of renal function

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4
Q

how does UTI infectionn spread

A

ascending route -> from urethra to bladder

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5
Q

what is the most common pathogen implicated in UTI

A

E.coli

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6
Q

uncomplicated vs complicated UTI

A

uncomplicated - normal urinary tract
complicated - functional or anatomical abnormality, presence of catheter

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7
Q

what is an isolated UTI

A

no previous UTI for 6 month

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8
Q

what is a recurrent UTI

A

> 2 infections in 6 months or >3 in 12 months

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9
Q

acute lower UTI presentaiton

A
  1. dysuria
  2. urgency
  3. frequency
    in elderly or those with indwelling catheters it may be asymptomatic
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10
Q

causes for recurrent UTIs (2)

A
  1. relapses caused by the same strain of organism (inadequate mgx)
  2. re-infection by different organisms
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11
Q

what can reccurent UTIs result in

A

chronic inflammatory changes in the bladder, prostate and periurethral glands

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12
Q

what is cystitis

A

an infection of the bladder

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13
Q

symptoms of cystitis (5)

A
  1. Frequency and urgency
  2. Suprapubic pain on postponing
  3. Dysuria
  4. Foul smelling discoloured urine
  5. Mild systemic upset
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14
Q

cystitis mgx (6)

A

non pharmacalogical:
1. fluids
2. alkalinisation of urine (potassium citrate)
pharma:
3. trimethoprim 200mg qds
4. nitrofurantoin 5-100mg qds
5. fosfomycin
6. cefalexin 250mg TDS

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15
Q

what bacteria are commonly implicated in complicated UTIs (4)

A
  1. enterobacteria e.g. proteus spp, klebsiella spp, citrobacter spp, enterobacter spp
  2. pseudomonas aeruginosa
  3. GBS
  4. candida spp (yeast)
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16
Q

what bacteria are commonly implicated in uncomplicated UTIs

A
  1. E.coli
  2. enterobacteria (K.pneumoniae)
  3. S.saprophyticus
17
Q

what abx should NOT be given in UTIs

A

amoxicillin -> due to risk of resistance

18
Q

what abx can be given in cystitis (4)

A
  1. nitrofurantoin
  2. trimethoprim
  3. cephalexin
  4. fosfomycin
19
Q

what abx should not be given in pyelopnephritis

A
  1. nitrofurantoin
  2. fosfomycin
  3. pivmecillinam
  4. cephalexin
20
Q

what abx should be used for pyelonephritis

A

IV gentamicin

21
Q

what abx can be used in pseudamonas urinary tract infection (6)

A
  1. IV gentamicin
  2. IV piperacillin/tazobactam
  3. IV aztreonam
  4. IV meropenem
  5. IV ceftazidime
  6. IV/PO ciprofloxacin
22
Q

what must be done prior to starting abx

A

take specimins for culture and urinanalysis

23
Q

can a pt with a catheter have a UTI

A

YES - all pts with catheters will have bacteriuria after 3 days or so -> make sure to take catheters into consideration when a pt presents with fever and confusion

24
Q

mgx for recurrent UTI (10)

A

conservative:
1. good hygiene practices
2. drink plenty
3. void bladder after sex
4. timed voiding

medical:
5. cranberry capsules
6. D-mannose
7. topical oestrogen
8. Hiprex with vit C
9. intravesical glycosaminoglycans
10. low dose abx prophylaxis for 6 months

25
Q

infected obstructive kidney mgx

A

urgent decompression -> ureteric stent or nephrostomy

26
Q

pyelonephritis presentation

A
  1. sepsis
  2. pain in loin to groin
  3. urinary symtpoms (dysuria, frquency etc.)
27
Q

what is Epididymoorchitis

A

the epididymis (at the back of the testicles) becomes swollen and painful

28
Q

Epididymoorchitis ddz

A
  1. torsion
  2. STI
29
Q

Epididymoorchitis zbx

A
  1. ceftriaxone
  2. doxycycline
  3. cipro?
30
Q

where is the sample taken from if prostatitis suspected

A

the urethra with a prostate massage

31
Q

prostatisis mgc

A
  1. IV gentamycin in acute settings
  2. extended course of quinolone (4-6wks) as out pt
  3. tamsulosin
  4. NSIADs (avoid if giving quinolones)
32
Q

what is the most frequent cause of haematuria in the world

A

schistomiasis

33
Q

complications of prostatitis

A
  1. prostatic abscess
  2. chronic pelvic pain syndrome
34
Q

what is fournier’s gangrene

A

rare but deadly infection of the genital and perineum -> necrotising fasciitis of scrotum and perineum which can spread to lower abdo

35
Q

risk factors for fournier’s gangrene

A
  1. diabetese mellitus
  2. hypertension
  3. immunosuppression
  4. poor nutrition
36
Q

what can urinary TB present with (2)

A
  1. fever
  2. night sweats
  3. loin pain
  4. haematuria
37
Q

what areas does urinary TB affect

A

kidnet, ureter, bladder, prostate, epididymis

38
Q

TB mgx

A

RIPE
R- rifampicin
I - isoniazide
P - pyrazinamide
E - ethambutol

39
Q

schistomiasis mgx (4)

A
  1. prazquantel
  2. steroids
  3. surgery
  4. reconstruction

3B week 4 - haematuria etc. (5 decks)

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