Urinary tract infections Flashcards

1
Q

epidemiology of UTIs

A

girls>boys due to poor wiping technique and short urethra

most common in sexually active females

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2
Q

pathophys of UTIs

A
via urethra bacteria ascends up urethra
-fecal bacteria
-lowered host defenses
-residual urine
nosocomial: instrumentation
via blood/lymph/fistual
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3
Q

etiology of UTIS

A

E. coli most common,

proteus, klebsiella, serratia, enterobacter, staph saprophyticus, pseudomonas

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4
Q

risk factors for UTIs

A
  • recurrent/previous UTI
  • FH
  • Intercourse
  • indwelling catheter
  • pregnancy
  • personal hygiene
  • contraceptive use
  • atrophy
  • obstruction
  • incontinence
  • urinary retention
  • anatomic variant
  • antibiotic use
  • DM/immunosuppression
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5
Q

signs and symptoms of UTI

A

frequency, urgency, dysuria, suprapubic pain/tenderness, hematuria, odiferous urine

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6
Q

evaluation of UTI

A

physical: ab exam, CVA tenderness, pelvic exam, GU and DRE

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7
Q

labs for uti

A

UA/UC: clean catch, suprapubic aspiration, catheterization

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8
Q

Urinalysis findings UTI

A

positive leukocyte esterase
positive nitrites
micro: pyuria

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9
Q

UC findings

A

gold standard: 10^5 colonies or single species

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10
Q

indications for UC

A

young, old, recurrent, pregnant, immunosupression, pyelonephritis, prolonged sxs, recent abx use

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11
Q

other diagnostic tests for UTI

A

excretion urography (IVP): determines functional/anatomic abnormalities.
KUB w US: to define emptying, stones/obstructions
VCUG: determines abnl bladder emptying, reflux
cystoscopy: to exclude bladder lesions

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12
Q

patient education

A
describe ds
pharm: OTC/abx
fluids
frequent/postcoital void
proper wiping
avoid constipation
return if..
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13
Q

complicated UTI

A

abnormality -structure or function
can cause severe sequelae
septicemia more common
increased risk treatment failure

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14
Q

UTI sequelae

A
recurrent UTI-morbidity, renal disease
urosepsis
pyelonephritis
proteinuria/HTN/renal function decline
pregnancy complications
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15
Q

when do you refer UTI

A
recurrent childhood infections
any UTI in males
certain females
-relapsing/recurrent/persistent
-painless hematuria
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16
Q

recurrent UTI

A
sexually active female
>2 UTIs/6 mos
>3 UTIs/12 mos
review nonpharm
prophylactic abx (continuous vs. postcoital)
17
Q

pyelonephritis

A

acute: infection of upper urinary system (kidneys)
chronic: progressive inflammation with destructive changes

18
Q

pathophys of acute pyelo

A

extension of UTI: ascending bacterial spread ureters

hematogenous spread

19
Q

Pathogens for pyelo

A

e. coli, proteus, kelbsiella, pseudomonas, enterococcus, mycoplasma, staph aureus/saprophyticus, anaerobes

20
Q

risk factors for pyelo

A
  • ureterovesicular reflux
  • dilated/hypotonic ureters
  • indwelling catheters
  • nephrolithiasis
  • immunosuppression
  • intrarenal reflux
  • previous pyelo
  • elderly, instituitionalized
  • pregnancy
  • neurogenic conditions
21
Q

signs and symptoms of pyelo

A
F/C, N/V
dysuria, frequency, urgency
flank/loin/back pain/tenderness
may have rapid onset
Fever, CVA tenderness, tender abdomen
22
Q

UA/UC findings for pyelo

A

LE, nitrites, proteinuria, hematuria, pyuria, WBC casts

23
Q

treatment acute pyelo

A

outpatient abx otc analgesics

inpatient: always pregnancy, elderly, comorbidities

24
Q

pyelo sequelae

A

sepsis, pregnancy complications, scarring/inflammation of renal cortex, ARF/CRF, perinephritic abscess, emphasematous pyelo, chronic pyelo

25
Q

urethritis

A

sexually transmitted infection in men: Gon/chlamydia/trichomonas/HSV
SXS: dysuria, pruritis, discharge
DX: urethral swab, first void urine