Urinary Tract -- Krathwohl Flashcards
A complicated UTI is…
at risk of failing treatment or of severe disease for some reason
Common reasons for a complicated UTI
Diabetes, Pregnancy, Structural Abnormalities, Indwelling Catheters, UT Obstruction, Immunosuppression, Drug Resistant Organisms
Which men get UTIs?
Children
Elderly w/ anatomical abormalities
Uncircumcised, catheters
Pyelonephritis symptoms
Fever over 38, Chills, Flank Pain, CVA tenderness, Nausea
Dysuria, Frequency, Urgency, Hematuria
Most E Coli are still sensitive to…
Augmentin, Cephalexin, Fosfomycin
Important components of UTI
Classic symptoms in young woman is usually sufficient
Urinalysis – Pyuria (over 5 WBC), Pos Leukocyte Esterase, Nitrate Test
Role of urine culture in diagnosis of UTI
Helps determine causative organism, but doesn’t prove infection. Could be an asymptomatic bacteriuria
What do you need to see in Urine Culture to decide anything
24 hours
Usually requires 10^5 CFU
Any E Coli is significant
How does vaginitis present differently from UTI
Usually no change in frequency or urgency
Think Candida, trichamonas
How does urethritis present differently from UTI
No bacteria
Think GC, Chlamydia, and HSV
First line agents for Cystitis
Nitrofurantoin
Trimethoprim-sulfamethoxazole (Bactrim)
Treatment meds for Pyelonephritis
Mild – Oral Cipro, Levofloxacin
Severe – Cefriaxone, Piperacillin-tazobactam, meropenem
How long do you treat cystitis? pyelonephritis?
Cystitis – 3-5 days
Pyelonephritis – 10-14 days
In a complicated UTI patient that isn’t responding, you should…
CT for stones, obsruction, infarction, abscess
US as a backup
Important details on renal and perinephric abscess
Usually arises from extension or pyelonephritis, but can come from steph in bacteremia. Perinephric abscess occupies the space btw the renal capsule and Gerota’s fascia.
How to treat renal abscess
Usually needs percutaneous drainage
Call urology if any stone is present
Broad spectrum ABs until cultures
Calcium oxalate crystals look like…
Envelope or Dumbbell
Uric Acid crystals ususally look like..
Pleomorphic
Cystine stones usually look like…
Hexagonal Shape
Magnesium ammonium phosphate stones (struvite) usually look like…
Coffin Lids
Imaging best for kidney stones
Non-contrast CT is best
US is acceptable, but less sensitive
Therapy for kidney stones
Usually just pain meds and hydration
Consult if appears septic, anuria, ARF
Alpha blockers (tamsulosin)
Significant sizes of stone
Stones under 5 mm usually pass spontaneously
Stones over 1cm usually won’t pass
Biochemical risks for kidney stone occurance
Hypercalciuria
Hyperoxaluria
Hypocitraturia
High Urine pH
