Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Edinburgh GP UTIs > UTI > Flashcards

UTI Flashcards

1
Q

What is considered an upper UTI?

A

Kidney and Ureters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is considered a lower UTI

A

Prostate

Bladder

Urethra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is another name for a lower UTI and what are the symptoms?

A

Simple

Urinary frequency
Urinary urgency 
Dysuria
Suprapubic tenderness
Gross Haematuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is another name for upper UTI and what are the symptoms?

A

Complicated

Often cystitis Sx (not always) with addition of:
Systemic symptoms
Fever, rigors, lethargy
Loin pain/ paravertebral tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the common uropathogens causing UTIs

A 
Enterobacteriaceae
Escherichia coli  (75-95% cystitis)
P-fimbriated 
Klebsiella spp.
Proteus spp.
Staphylococci saprophyticus- young women

Recent antimicrobials, hospitalisation and urinary catheters
Pseudomonas spp, Enterococcus spp, and Staphylococci spp.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What tests are required for UTI diagnosis?

A

Urinalysis

urine culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does urinalysis work?

A

Detect
Leukocyte esterase released by leukocytes indicating pyuria
Nitrites- produced by some Enterobacteriaceae by breaking down nitrates

Can modestly improve diagnosis but cannot adequately rule out infection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When do you not use urinalysis?

A

Asymptomatic, elderly or catheterised patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Function of urine culture?

A

Confirm the presence of bacteriuria and to provide antibiotic susceptibility.
Mid stream urine routine
Out-with pregnant women only perform culture of urine on symptomatic patients.
≥ 100 000 cfu/ml of a single strain of bacteria confirms bacteriuria, however recent studies have suggested ≥1000 cfu/ml of E. coli can represent infection in symptomatic patients1.
Mixed cultures usually indicate contamination.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why are woman at more risk for cystitis than men?

A

Anatomy- shorter distance from anus to urethra compared to men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Risk factors for cystitis in adult woman

A 
Sexual activity 
Recent UTI
Diabetes mellitus 
Urinary tract abnormalities
Post-menopause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical symptoms in acute cystitis in women?

A 
Dysuria
Urinary frequency
Urinary urgency
 Suprapubic pain 
 Haematuria (sometimes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When should you look for an alternative diagnosis for acute cystitis in women?

A

Explore alternative diagnosis if vaginal discharge/itch present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What investigations for AC in women under 65 years?

A

In women with 3 or more symptoms of cystitis
Treat empirically. No further investigations required.

Urinalysis:
use to guide treatment decisions mild or 2 symptoms or less or atypical symptoms.
Be wary of using urinalysis in elderly patients

MSU:
Risk of multidrug resistant pathogens, to guide treatment in patients who do not respond to first line antibiotics.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Epidemiology of AC in men?

A

Much less common in men between 16-50 years due to anatomical differences.
Elderly males: risk increases = elderly women, in part due to outflow obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

AC in men?

A

Urinary frequency, dysuria, urgency, suprapubic pain, haematuria

17
Q

What should you always evaluate for in AC in men?

A

Systemic upset/costovertebral tenderness upper urinary tract infection.
Prostatitis- pelvic/perineal pain, obstructive symptoms (dribbling and hesitancy).
Chronic prostatitis-recurrent infections.
STIs and urethritis in all sexually active men.

18
Q

Diagnosis of AC in men?

A

Diagnosis of UTI: There is no evidence to suggest the best method for diagnosing UTI in men.

All men with suspected UTI should be regarded as complicated.

Send urine for culture in all suspected cases.

All men with recurrent UTIs should be referred for Urological investigation.

19
Q

Antibiotics treatment of acute cystitis?

A

Empirical treatment: Nitrofurantoin or Trimethoprim

Women: 3 days
Men: 7 days

Nitrofurantoin: Avoid in renal failure (eGFR <45 ml/min) due to concerns regarding toxicity.

Second line therapy: in treatment failure use antibiotic susceptibility from urine cultures to guide therapy.

20
Q

How to confirm asymptomatic bacteriuria?

A

Laboratory confirmed bacteriuria:
2 x specimens with at least 100 000 cfu/ml of a pure culture for women, only 1 required for men.
Common especially in elderly patients-
DO NOT TREAT
there is no benefit in terms of morbidity/mortality from treating UNLESS Pregnant or in Renal Transplant.

21
Q

Define recurrent UTI

A

3 or more laboratory confirmed UTIs within a year

22
Q

What should you assess for with recurrent UTI

A 
Constipation 
Uterine prolapse
Atrophic vaginitis 
Diabetes
Prostatitis 
Relating to sexual intercourse
Sexually transmitted diseases
23
Q

Investigations for recurrent UTI in women?

A

Investigations: Check renal function, urinary tract USS

24
Q

How to treat recurrent UTI in women?

A

Non-antibiotic approaches:

Consider cranberry supplements in women- evidence is lacking but some may benefit from this.

Antibiotic approaches:

Post-intercourse antibiotic e.g. trimethoprim single dose
Standby antibiotics- 3 day course dependant on known susceptibilities
Prophylactic antibiotics- 3- 6 months course, stop and assess. Specialist input only. Trimethoprim preferred.
Promotes resistance. Evidence for benefit is not strong.

25
Q

Define acute pyelonephritis

A

Infection causing inflammation of the kidneys

26
Q

Most common cause of upper UTI

A

E. coli

27
Q

Clinical presentation of acute pyelonephritis

A

Cystitis symptoms of dysuria, urinary frequency, suprapubic pain and haematuria PLUS
Systemic illness – fever, rigors, marked fatigue.
Loin pain/costovertebral tenderness- often unilateral

Fever and flank pain think pyelonephritis.
Sepsis and no localizing symptoms think pyelonephritis in differential

Pelvic/perineal pain in men- ? prostatitis
Discharge/itch- ?pelvic inflammatory disease

27
Q

Clinical presentation of acute pyelonephritis

A

Cystitis symptoms of dysuria, urinary frequency, suprapubic pain and haematuria PLUS
Systemic illness – fever, rigors, marked fatigue.
Loin pain/costovertebral tenderness- often unilateral

Fever and flank pain think pyelonephritis.
Sepsis and no localizing symptoms think pyelonephritis in differential

Pelvic/perineal pain in men- ? prostatitis
Discharge/itch- ?pelvic inflammatory disease

28
Q

Examination of acute pyelonephritis

A

Fever
SIRS and SEPSIS 6
Costovertebral tenderness.
Suprapubic tenderness.

Caution if significant abdominal tenderness/guarding consider reasons for acute surgical abdomen.

29
Q

Investigations for pyelonephritis

A

All patients: Urine culture.

Urinalysis- absence of pyuria may indicate alternative diagnosis if atypical presentation.

Inpatients:
Blood cultures, FBC, UECs, LFTs, CRP, (lactate if sepsis).

30
Q

Indications of sever pyelonephritis

A

Severely unwell,
Persisting clinical symptoms (48-72 hours)
Urinary tract obstruction or Acute Kidney Injury
Recurrence of symptoms.

Renal tract ultrasound or
Computed tomography

31
Q

Who is at risk of a complicated urinary tract infection and how should they be managed?

A

Patients with urinary stones, history of urological surgery e.g. ureteric stents are at increased risk of both upper urinary tract infections and complications.

Perform imaging
Seek prompt urological input for obstructive related upper urinary tract infections.
Surgical management aimed at relieving the obstruction

32
Q

When should pyelonephritic patients be admited?

A

If septic, at higher risk of complications (e.g. diabetic), unable to take oral medication or concerns re urinary tract obstruction.

33
Q

Antibiotics therapy for pyelonephritis

A

IV amoxicillin 1g TDS and IV gentamicin (NHS Lothian calculator)

Oral options include:
cotrimoxazole, co-amoxiclav and ciprofloxacin.
Do not use nitrofurantoin.

Review with culture results
7 to 14 days in acute pyelonephritis.
Do not continue gentamicin >72 hours without specialist input.
All male patients with upper urinary tract infections should be referred for urological investigation.

34
Q

Signs and symptoms of catheterised UTIs

A 
New fever, rigors, delirium.
Flank pain
Pelvic discomfort
Acute haematuria 
In patients whom catheter has been removed- dysuria, urgency, suprapubic pain
35
Q

Investigations for UTI catheterized patients

A

Do not perform urine dipstick on catheterised patients.
Send urine for culture.
Send bloods and blood cultures.

Do not treat asymptomatic bacteriuria.
Catheters become colonised very rapidly after insertion, 80% of urinary catheters are colonized at 1 month.

36
Q

UTI antibiotic management in catheterised patients

A

IV gentamicin dose as per NHS Lothian calculator.
Change urinary catheter, consider the need for ongoing catheterisation.

Monitor daily decision for ongoing antibiotic therapy
7 day course of antibiotic therapy for males and females with symptomatic catheter associated UTI with prompt resolution of symptoms.

Do not continue gentamicin for longer than 72 hours without specialist input
Review with urine culture results and refine antibiotic choice.

37
Q

Why is diagnosing UTIs in elderly patients more difficult

A

Non-specific symptoms- delirium, abdominal pain, loss of diabetic control.
High rates of bacteriuria

38
Q

How to assess UTI for elderly patients

A

Urinary tract infection based upon full clinical assessment.
Urine dipstick is not routinely recommended in this age group due to difficulties with interpretation.
Extra care with antibiotic prescribing due to increased risk of adverse effects and Clostridiodes difficile infection.

Edinburgh GP UTIs (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions