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Block 9 Week 5 > Urinary Tract Infections - Hunter > Flashcards

Urinary Tract Infections - Hunter Flashcards

1
Q

what is the most common upper UTI?

A

pyelonephritis

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2
Q

what two structures does pyelonephritis involve?

A

kidney and ureter

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3
Q

What is the more serious version of pyelonephritis?

A

perinephric abscess

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4
Q

What is the ratio of UTIs in women to men?

A

30:1

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5
Q

what percent of females have at least one UTI in their life?

A

40%

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6
Q

the incidence of UTI increases with what two factors?

A

age and sexual activity

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7
Q

why do postmenopausal women have higher rates of UTI?

A

bladder or uterine prolapse and other hormonal changes

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8
Q

Males will get more UTIs in their fifties because of..

A

BPH

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9
Q

What is the most common cause of uncomplicated UTI in all age groups?

A

E. Coli

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10
Q

What is the second most common cause of UTI, especially in sexually active females 13-40

A

Staph saprophyticus

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11
Q

What are the infectious causes of complicated UTI from catheterization or obstructions?

A 
E. coli
Proteus mirabilis
Klebsiella pneumoniae
Enterococcus
Pseudomonas aeruginosa
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12
Q

T/F: Fungal UTIs are much more serious that bacterial

A

true, but less common

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13
Q

Nosocomial UTIs are caused by (blank) resistant organisms

A

multi-drug resistant

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14
Q

What are the two anatomic reasons females develop UTIs more frequently than males?

A

shorter urethra

urethra closer to anus

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15
Q

Intercourse promotes contamination of the female urethra with….

A

fecal organisms

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16
Q

T/F: any cause of incomplete emptying can lead to UTI

A

true; BPH, neurogenic bladder

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17
Q

What type of reflux is a risk factor for UTI?

A

vesicoureteral reflux

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18
Q

Calculi, catheters, and pregnancy are all risk factors for ….

A

UTIs

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19
Q

In what substance do you find the organisms that cause UTIs?

A

feces

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20
Q

Contamination of the periurethral region with fecal organisms leads to (blank)

A

urethral colonization

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21
Q

ascension of bacteria up the urinary tract is aided by bacterial (blank) which bind to uroepithelial cells

A

fimbrae

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22
Q

What are the natural factors which protect against UTI?

A

normal urine flow
uroepithelial cell sloughing
large numbers of lactobacilli in the the vaginal mucsosa (leading to vaginal pH)

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23
Q

T/F: blood-borne causes of UTI are common

A

false

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24
Q

T/F: staph aureus is a common causative agent of UTI

A

false

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25
Q

type 1 fimbrae are encoded by what gene?

A

fimH

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26
Q

P fimbrae are encoded by what gene?

A

papGAP

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27
Q

what type of fimbrae bind to mannose-containing host epi receptors?

A

type 1 fimbraie

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28
Q

type 1 fimbrae leads to (cystitis/pyelonephritis)

A

cystitis

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29
Q

what type of fimbraie bind to glycosphingolipid host epithelial receptors?

A

P fimbrae

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30
Q

P fimbrae strains cause (pyelonephritis/cystitis) and bateremia

A

pyelonephritis

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31
Q

Most uropathogenic strains have a (hemolysin/streptolysin) that can damage uroepithelium

A

hemolysin

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32
Q

genes for UTI virulence factors are carried on (blank) in the E. coli

A

pathogenicity islands

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33
Q

pts who have cystitis also have symptoms of…

A

urethritis

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34
Q

What are the signs of cystitis?

A

-urgency and frequency of urination
- voiding small volumes of urine (oliguria)
- painful urination (dysuria)
suprapubic tenderness just before or immediately after voiding

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35
Q

What is the standard treatment for an uncomplicated UTI?

A

TMP-SFX

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36
Q

what will you see on UA in an uncomplicated UTI?

A

leukocytes and blood

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37
Q

Does an uncomplicated UTI present with back pain, CVA tenderness, or fever?

A

nope

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38
Q

A low urine pH argues against which infectious agent?

A

proteus mirabilis

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39
Q

Gram negative rods in a UA are consistent with which bug?

A

E. coli

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40
Q

If the pH of the urine is >7.9 and it contains bacteria and WBCs, the patient has a infx due to UREASE-PRODUCING bugs such as…

A

proteus mirabilis

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41
Q

what are the methods for determining pyuria?

A
  1. wet mount of SPUN urine
  2. cell counting
  3. dipstick for leukocyte esterase
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42
Q

Which two bugs convert nitrates to nitrites?

A

E. coli and proteus mirabilis

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43
Q

what type of urine sample should be used for culture?

A

clean-catch

44
Q

What is the result that is sig. for bacteriuria?

A

> 100,000 CFUs

45
Q

T/f: Asymptomatic bacteriuria is uncommon

A

false! commmon!

46
Q

Which three groups of patients with ASYMPTOMATIC bacteruria should get abx?

A
  1. pregnant women
  2. renal transplant pts
  3. GU surgery pts
47
Q

why do you give preggerz abx for asymptomatic UTI?

A

likely to develop pyelonephritis or preterm delivery following an asymptomatic bacteriuria

48
Q

A complication of pyelonephritis is (blank); This can also occur secondary to bacterermia

A

perinephric abscess

49
Q

Patients with pyelonephritis usually experience symptoms of (blank)

A

cystitis

50
Q

what are the symptoms of pyeloephritis?

A 
fever >38C
N/V
flank pain and tenderness
CVA tenderness
urinary frequency
FOUL SMELLING urine
51
Q

What is a major risk factor for pyelonephritis?

A

previous UTI

52
Q

what is the cause of pyelonephritis in 90% of cases?

A

E. coli

53
Q

What is the Tx for pyelonephritis?

A

Bactrim (TMP/SFX) for 14 days

54
Q

Desribe the appearance of the kidney in acute pyelonephritis?

A

somewhat enlarged, and discrete, yellowish, raised abscesses are apparent on the surface

55
Q

What is the pathognomonic feature on the kidney for pyelonehritis?

A

suppurative necrosis or abscess formation within the renal substance

56
Q

in chronic pyeloneph, one or both kidneys will have (blank),

A

gross scars

57
Q

Describe the changes to the pelvic wall in chronic pyeloneph?

A
  1. inflamm changes

2. papillary atrophy and blunting

58
Q

What would the kidney parenchyma show on chronic pyeloneph?

A

interstitial fibrosis with an inflammatory infiltrate of lymphocytes, plasma cells, and occasionally neutrophils

59
Q

what will blood work show with perinephric abscess?

A

elevated WBC with left shift
elevated ESR
negative blood culture

60
Q

what will UA show in perineprhic abscess?

A

leukocyte esterase
nitrites
pos. urine culture

61
Q

What is the cause of perinephric abscess?

A

smoldering E. coli infx which accessed the perinephric space

62
Q

T/F: you can palpate a perinephric abscess

A

true sometimes. think about this if you see (palpable mass on the lower back or abd)

63
Q

T/f: perinephric abscess can be seeded by a blood infx

A

true

64
Q

what is the most common blood-borne pathogen that causes perinephric abscess?

A

staph aureus

65
Q

What is the treatment for perinephric abscess?

A

surgical drainage

IV abx

66
Q

What is the mortality rate of perinephric abscess?

A

45%

67
Q

a motile, gram negative rod with SWARMING GROWTH on agar is most likely….

A

proteus mirabilis

68
Q

Proteus causes stones because it produces (blank) which catalyzes the breakdown of urea into ammonia and CO2

A

urease

69
Q

What kind of stones are formed by proteus?

A

struvite caliculi; aka magnesium ammonium phosphate

70
Q

explain the relationship between kidney stones and UTI

A

Kidney stones can serve as a location in which bacteria can escape antibiotics and cause recurrent UTI (it’s a NIDUS)

71
Q

what is the major risk factor for a proteus UTI?

A

catherization!!

also recurrent UTI, anatomical weirdness

72
Q

why do you order imaging when suspecting a proteus infx?

A

to rule out stones;

73
Q

what abx do you use to treat proteus?

A

ceftriaxone

74
Q

what are the types of UTI that people present with with a proteus infection?

A

cystitis
pyelonephritis
prostatitis

75
Q

Moderate pyeloneph. is treated outpatient with…

A

bactrim (TMP/SFX) for 14 days

76
Q

what ist the Tx for someone who is septic from pyeloneph?

A

IV abx like ceftriaxone or fluoroquinolone for 24 hours after the fever breaks

77
Q

After giving IV abx after the fever breaks, how do you treat severe pyeloneph?

A

bactrim 14 days

78
Q

when do you give long term low dose abx for UTI?

A

women with recurrent infections to prevent future urinary tract infections

79
Q

What two things do you drink to prevent UTI?

A

1-2 quarts of water and cranberry juice

80
Q

what is in cranberry juice that prevents UTI?

A

tannins which prevent binding of the bacteria to the uroepithelial cell surface receptors

81
Q

what types of foods should people avoid to prevent UTI?

A

spicy foods, alcohol, or beverages containing caffeine that may irritate the bladder

82
Q

What type of contraceptive should women avoid to not get UTI?

A

spermicide containing contraceptives

83
Q

What can postmenopausal women do to lower the chance of getting a UTI?

A

oral or vaginal estrogen; shifts flora to lactobacilli

84
Q

How does lactobacilli help prevent UTI?

A

lower the vaginal pH, which reduces colonization of the vagina by uropathogens

85
Q

T/F: prostatitis can be caused by infection or chronic pain syndromes

A

true; its an umbrella term

86
Q

what is the most common cause of bacterial prostaitis?

A

E. coli

87
Q

what are the less common bacterial causes of prostatitis?

A

Klebsiella, Pseudomonas, Enterobacter, Serratia, Proteus, and Enterococcus

88
Q

what is the most common cause of prostate issues in men under 35?

A

prostatitis

89
Q

T/F: prostatitis is more common in sexually active males

A

true

90
Q

T/F: one episode of bacterial prostatitis predisposes you to future episodes

A

true

91
Q

T/F: prostatitis most often follows a blood infection

A

false; from ascension from the urethra

92
Q

T/F: the e. coli that causes prostatitis has the same virulence factors as the ones that cause other UTIs

A

true

93
Q

Infected urine refluxes into the glandular prostatic tissue via the (blank) ducts

A

the ejaculatory and prostatic ducts

94
Q

Infiltrating neutrophils around the acini are associated with….

A

intraductal desquamation and cellular debris

95
Q

what types of cells makes up the tissue infiltrate in prostatitis?

A

lymphs
plasma cells
macrophages

96
Q

is prostatitis Dx’d clinically or with labs?

A

clinically

97
Q

T/F: prostatitis will also present with urethritis, cystitis, or pyeloneph

A

true

98
Q

What will a rectal exam show you if someone has prostatitis?

A

boggy, swollen, warm, and tender to the touch

99
Q

Asymptomatic prostatitis will show with elevated (blank) in the blood

A

PSA

100
Q

what are the symptoms associated with prostatitis?

A

painful urination
urinary frequency
suprapubic and abd tenderness
distended bladder

101
Q

How do you Dx prostatitis?

A

midstream catch

102
Q

what would you look for on UA for prostatitis?

A

pH
leukocyte esterase
nitrites

103
Q

How many CFUs and WBCs would you see for prostatitis?

A

> 100,000 CFUs

>10 WBC per HPF

104
Q

What is the Tx for bacterial prostatitis?

A

TMP/SFX or cipro for 10-14 days

105
Q

T/f: treat asymptomatic bacterial prostatitis with abx

A

TRUE

106
Q

T/F: using a condom can prevent prostatitis

A

true

Block 9 Week 5 (3 decks)

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