uti

Question 1

symptoms of uti?

Answer 1

Acute Pyelonephritis Symptoms of Infection Pyonephrosis Perinephric Abscess •fever •malaise •nausea •vomiting •abdominal pain Pyonephrosis Perinephric Abscess•rigors •loin pain •scoliosis •loin swelling •weight loss •night sweats Lower Tract Infection •dysuria •frequency •haematuria •nocturia •suprapubic pain •urgency •foul urine

Question 2

abnormalities of the tract?

Answer 2

•Congenital abnormalities of the tract –Vesicoureteric reflux –Anatomical abnormalities –Dilatation +/- obstruction •Acquired abnormalities –Prostatic enlargement •Calculi •Haematuria –Fe •Host urine status –Secretor status (non-secretor > secretor) –Blood group (AB, B & P1)

Question 3

symptoms of cystitis?

Answer 3

Dysuria •Frequency •Haematuria •Cloudy urine •Nocturia •Urgency

Question 4

treat people with uti?

Answer 4

High fluid intake –Symptomatic relief •Alkalinization of urine –Antibiotics - best guess •Trimethoprim •Nitrofurantoin •Fluoroquinolone

Question 5

acute ptelonephritis?

Answer 5

An inflammatory process occurring within the renal parenchyma caused by bacterial infection. •Most commonly results from ascending infection within the urinary tract. •Can be Complicated or Uncomplicated cf Cystitis •250 000 hospitalisations in USA/yr

Question 6

diagnose pyelonephritis?

Answer 6

Imaging generally not indicated in uncomplicated cases1 –Mostly in patients with persistent or recurrent infection •Image with Uncontrasted CT in –Renal colic - infection and obstruction = emergency –Slow response of fever >72hours –Unusual organism eg pseudomonas –Rapid relapse –Men

Question 7

treat pyelonephrities?

Answer 7

Hospitalisation-probably1 •Hydration •IV antibiotics –Up to 5 days IV then oral –10-14 days conventional Third Generation Cephalosporin Fluoroquinolone

Question 8

causes of pyelonephritis?

Answer 8

•None •Diabetes •VUR •Congenital obstruction •Calculi •Papillary necrosis

Question 9

prevent infection?

Answer 9

High fluid intake •Frequent and complete voiding •Temporal relation to intercourse Post coital voiding Method of contraception •Cranberry Juice Trials suggest efficacy but not proven Problems with trial data

Question 10

who whould be investifated?

Answer 10

Frequently recurring or relapsing infection •Persistent proteinuria and/or haematuria •Unusual bugs - Pseudomonas, Proteus •Hypertension •Men

Question 11

further investigations?

Answer 11

Intravenous urography •Isotope renogram •Cystoscopy •Computed Tomography

Question 12

sterile pyuria?

Answer 12

Renal tuberculosis Urethritis Viral cystitis Fistula Glomerulonephritis Pelvic abscess Prostatitis Stones

Question 13

urinary physiology?

Answer 13

Urinary frequency –Increased fluid intake –Plasma Volume Expansion –Increased GFR and ERPF •Ureteral dilatation –Hormonal effects - Progesterone reduced ureteral tone –External compression - Hydronephrosis R > L –Hypertrophy of Waldeyer’s sheath - muscle bundles in ureter leading to mild juxtavesical stenosis