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UTI/Pyelonephritis/Incontinence > UTI > Flashcards

UTI Flashcards

1
Q

UTI risk factors

A

aging, females, males (prostatic hypertrophy, bacterial prostatitis, anal intercourse), urinary tract obstruction (tumor, calculi), impaired bladder innervation

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2
Q

Lower tract infection

A

urethritis, prostatitis, cystitis

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3
Q

Upper tract infection

A

pyelonephritis, peri nephric abscess

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4
Q

Trigone

A
  • smooth triangular region of the internal urinary bladder formed by the two uretral orifices and the internal urethral orifice
  • sensitive to expansion and when stretched to certain degree signals the brain it needs to empty
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5
Q

Symptoms of UTI

A
  • dysuria
  • increased frequency
  • hematuria
  • fever (systemic)
  • N/V (pyelonephritis)
  • flank pain (pyelonephritis)
  • pain with defecation
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6
Q

CVA tenderness

A

pyelonephritis

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7
Q

Urethral discharge

A

urethritis

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8
Q

Tender prostate on DRE

A

prostatitis

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9
Q

Labs (urinalysis)

A

+ leukocytes
+ nitrites (gram neg rods)
+ WBC
+ RBC

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10
Q

Most valuable LAB diagnostic test for UTI

A

UA for pyuria

- presence of pyuria makes the dDx

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11
Q

Most common pathogens

A

E. coli (80%) ; Staphylococcus saprophyticus (15%)

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12
Q

Positive Urine Culture

A

Bacterial colony >10 (2) CFU/ml (symptomatic pt) or 10 (5) CFU/ml (Asymptomatic) + leukocytes

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13
Q

Uncomplicated (Simple) Cystits

A

+ Dysuria - non- pregnant
+ Lower abd cramping - Healthy (> 12 y.o)
+ frequency - No N/V, flank pain
+ urgency

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14
Q

How do you diagnose simple cystitis

A

Dipstick Urinalysis

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15
Q

What is present in almost all pts with complicated UTI?

A

Pyuria

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16
Q

What does white cell casts suggest?

A

Renal origin for pyuria

17
Q

Treatment for Uncomplicated (Simple) Cystitis

A
  • Trimethroprim/Sulfamethoxazole for 3 DAYS
  • TMP-SMX double strength 1 tab BID
  • Given for 7-14 days in men
  • May use fluoroquinolone (Ciprofloxacin/Levaquin) with sulfa allergies or areas of high bactrim resistance
18
Q

Risk fx for Uncomplicated Cystitis

A

Sexual Intercourse: may recommend post-coital voiding or prophylactic ABT use

19
Q

Definition of Complicated Cystitis

A
  • female with comorbid medical conditions
  • ALL MALE PATIENTS
  • Indwelling foley cath
  • Urosepsis/hospitalization
20
Q

How do you diagnose Complicated Cystitis?

A

UA/C&S

21
Q

Tx for Complicated Cystitis

A
  • Fluoroquinolone (or another broad spectrum)
  • 7-14 days tx
  • May treat longer (2-4 weeks) in males with UTI
22
Q

Pyelonephritis (S/S)

A

fever, N/V, headache

23
Q

Pyelonephritis (Diagnosis)

A

UA, C&S, CBC, Chemistry

24
Q

Pyelonephritis (Treatment)

A
  • 2 weeks of Bactrim or Fluoroquinolone

- Hospitalization and IV ABT if pt unable to take PO

25
Q

Perinephric / Renal Abscess

A
  • suspect in pt who is not improving on ABT therapy

- Dx: CT with contrast, renal ultrasound, may need surgical drain

26
Q

Treatment of Pyelonephritis (Mild to Moderate)

A
  • Ceftriaxone 1 g q 24 h
  • Cipro 400mg q 12 h
  • Levofloxacin 750mg q 24 h
  • Aztreonam 1 g q 8 to 12 h
27
Q

Treatment of Pyelonephritis (Severe)

A
  • Cefepime 2 g q 12 h
  • Piperacillin-tazobactam 3.375g q 6 h
  • Ceftolozpne-tazobactam 1.5g q 8 h
  • Ceftazidime-avibactam 2.5g q 8 h
  • Meropenem 500mg q 8 h
  • Imipenem 500mg q 6 h
  • Doripenem 500mg q 8 h
28
Q

Prostatitis (S/S)

A

pain in perimeum, lower abd, testicles, penis, and with ejaculation, bladder irritation, bladder outlet obstruction, sometimes blood in semen

29
Q

Prostatitis (Diagnosis)

A
  • Clinical Hx: fever, chills, dysuria, malaise, myalgia, pelvic/perineal pain, cloudy urine
  • edematous and tender prostate on exam
  • Increased PSA
  • UA/C&S
30
Q

Prostatitis (Treatment)

A

Bactrim, fluoroquinolone, or other broad spectrum ABT for 4-6 WEEKS

31
Q

Urethritis (Chlamydia trachomatis)

A
  • frequently asymptomatic in females
  • dysuria, discharge or PID
  • pyuria, (-) bacteria = suspect chlamydia
  • Chlamydia screening for females less than or equal to 25 yr
  • Tx: Azithromycin 1 g po x 1; Doxycycline 100mg po BID x 7 days
32
Q

Urethritis (Neisseria Gonorrhoeae)

A
  • may present with dysuria, discharge, PID
  • Tx: Ceftriaxone 125mg IM x 1; Cipro 500mg x 1; Levofloxacin 250mg po x1; Ofloxacin 400mg po x 1, Spectinomycin 2g IM x 1

UTI/Pyelonephritis/Incontinence (3 decks)

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