Urinary Tract Issues Flashcards
What is another word for a lower UTI?
- cystitis
- bladder infection
What are complicating factors of a lower UTI?
- age > 65
- DM
- immunocompromised
- male
- pregnancy
How is pyelonephritis differentiated from lower UTI?
-lower UTI has no white cell casts and usually no fever
What are some risk factors for lower UTI?
- female
- pregnancy
- instrumentation (eg catheter)
- incontinence
- sexual activity
- DM
- recent abx
- poor hygiene
- abnormal anatomy
What is the symptom triad for lower UTIs?
- frequency
- urgency
- dysuria
Aside from frequency, urgency, dysuria - what are other possible sxs of lower UTI?
- hematuria
- abdominal pain
- subrapubic tenderness
- odor
- nocturia
What findings are common on a UA in a lower UTI?
- high specific gravity (dehydrated)
- > 5 RBC per HPF (hematuria)
- nitrates
- leukocyte esterase
- > 100,000 bacteria/mL (diagnostic)
- > 10 WBC/mm3 (pyuria)
When should a urine culture be done in cases of complicated cystitis?
-before antibiotics +/- 1-2 wks after tx is finished
When should a urine culture be done in cases of cystitis in pregnant women?
-before antibiotics and 1-2 wks after tx is finished
When should a urine culture be done in cases of cystitis with clinical failure?
-after clinical failure and 2 wks after tx is finished
Non-pharm Tx for Lower UTI
- cranberry juice and hydration
- wipe front to back
- post intercourse voiding
- estrogen replacement
- yogurt
Pharm Tx for Uncomplicated UTI
-TMP/SMX 1 DS po bid x3 days
Pharm Tx for Complicated UTI:
- Pregnancy
- At risk for STD
- ampicillin 7 days
2. doxycycline 7 days
Pharm Tx for Male UTI
TMP/SMX 10-14 days
Lower UTI Prophylaxis for Recurrence in Young Women
- > 3 UTI per year
- 1 DS TMP/SMX po qday or po x1 post intercourse
What is another word for pyelonephritis?
- upper UTI
- kidney infection
What is pyelonephritis?
-infection of renal parenchyma and renal pelvis
Complicating Factors of Pyelonephritis
- pregnancy
- immunosuppression
- fever > 40C
- age > 65
- DM
- persistent N/V
- possible urosepsis
Signs and Sxs of Pyelonephritis
- dysuria, frequency, urgency
- flank pain, CVA tenderness
- fever, rigors
- HA
- N/V, abdominal pain
What are common UA findings in pyelonephritis?
-same as for lower UTI plus white cell casts
[-high specific gravity (dehydrated)
- > 5 RBC per HPF (hematuria)
- nitrates
- leukocyte esterase
- > 100,000 bacteria/mL (diagnostic)
- > 10 WBC/mm3 (pyuria)]
Risk Factors for Pyelonephritis
- same as UTI: pregnancy, DM, immunosuppressed, instrumentation, catheter, tract abnormalities
- renal calculi
- neurologic deficit
- prostatic enlargement
- stress incontinence
- hospital-acquired
Tx of Pyelonephritis
- supportive care
- uncomplicated: cipro or TMP/SMX x14 days
- complicated: hospitalize, IV quinolone, amp and gent
What is another name for renal calculi?
- kidney stones
- nephrolithiasis
What are kidney stones typically made of?
- 75% calcium oxalate
- some uric acid, some struvite
How can kidney stones be differentiated from appendicitis and pancreatitis?
- lay still in appy
- hands and knees in pancreatitis
- walking around with kidney stones
What are the most likely areas of obstruction with kidney stones?
- ureter-pelvic junction
- pelvic brim
- ureter-vesical junction
How can kidney stones be avoided?
- increase water intake
- decrease salt and meat intake
- avoid oxalate-rich foods
Risk Factors for Kidney Stones
- male
- age 20-40
- genetic predisposition
- dehydration, warm climate, summer
- diet rich in protein, obesity
- diuretics
- white > AA
Signs and Sxs of Kidney Stones
- “renal colic”: acute severe pain at rest originating in flank
- hematuria
- fever, tachycardia
- pain may wax and wane
- anxious, pacing
- urgency, frequency
- CVAn tenderness possible
What is the test of choice for kidney stones and why?
-non-contrast CT: shows size of stone and can help predict probability of passage
What will be found on urine dipstick in kidney stones?
- blood
- microscopic RBCs
- crystals
Treatment Options for Kidney Stones
- none (pass on own)
- control pain, give fluids, antiemetic
- ESWL (lithotripsy)
- cystoscopy to remove stone
- stent placement
- nephrostomy
Who is more likely to have incontinence problems?
women 2x more likely than men
Reversible Causes of UI
- medication side effects
- recent prostatectomy
- excess fluid intake
- atrophic vaginitis
- fecal impaction
- UTI
- impaired mobility
- glycosuria
Urge Incontinence
- most common type in elderly
- bladder overactivity
- strong desire to void followed by moderate to large loss of urine
Sxs of Urge Incontinence
- frequency
- abrupt urgency
- nocturia
Tx of Urge Incontinence
- oxybutynin (anticholinergic)
- topical estrogen in women w/ urethritis
- TCA: imipramine
Stress Incontinence
- common in women >65
- urethral underactivity
Sxs of Stress Incontinence
loss of small amounts of urine from increased abdominal pressure (sneezing, coughing, laughing)
Tx of Stress Incontinence
- Kegel exercises
- SNRI Duloxetine
- TCA imipramine
- pseudoephedrine
Overflow Incontinence
- most common in men
- urethral overactivity +/- bladder underactivity
Sxs of Overflow Incontinence
- high post void residual volume
- dribbling
- weak urinary stream
- hesitancy
- frequency
- nocturia
Tx of Overflow Incontinence
cholinomimetics: Bethanechol
Functional Incontinence
-physical or cognitive disability prevents a person from reaching toilet
Tx of Functional Incontinence
-scheduled bathroom breaks
