UTI In Pregnancy

Question 1

Differentiate between prevalance of asymptomatic bacteruria in pregnant vs general population:

Answer 1

Same prevalence

Question 2

Differentiate between prevalance of pyelonephritis and recurrent cystitis in pregnant vs general population:

Answer 2

More common in pregnant women

Question 3

What are the anatomical and physiological changes in renal system?

Answer 3

1- increased kidney size 
2- increase GFR\renal plasma
3- smooth muscle relaxation 
4- stasis of urine
5- relative immunosuppression

Question 4

What are the causes of enlarged kidney size on US?

Answer 4

Enlarged calcyceal size.

Question 5

Why does the GFR and renal plasma increase during pregnancy

Answer 5

D\t increase CO; increase in blood flow & decrease in creatinine clearance.

Question 6

What causes dilation of ureter during pregnancy?

Answer 6

Progestrone

Question 7

What causes dialtion of renal pelvis and calcyceal system

Answer 7

The effect of gravid uterus pressing on the ureter and kidney

Question 8

Where is the resemblance of hydronephrosis more likely to show on US? (Right or left)

Answer 8

Right

Question 9

Why do pregnant women have the appeance of hydronephrosis and hydroureter on US?

Answer 9

Due to the smooth muscle relaxation by progestrone and the effect of gravid uterus

Question 10

What are the predisposing factors of UTI in pregnancy?

Answer 10

1- UT obstruction (tumor\calculi)
2- conginital anomalies 
3- neurogenic bladder (DM\Spinal injury) 
4- steroid & immunocompromised
5- SCD\trait 
6- personal hygiene
7- dehydration 
8- multiple partners

Question 11

To diagnose asymptomatic UTI, one needs a lab finding of:

Answer 11

Same bacterial strain in quantitative counts of 10x5 CFU

Question 12

How to diagnose asymptomatic bacteruria?

Answer 12

1- 10x5 CFU
2- midstream clean catch
3- no S&S of UTI

Question 13

Why do we treat asymptomatic UTI?

Answer 13

To avoid complications (pyelonephritis)

Question 14

How to preform midstream clean catch?

Answer 14

Tell patient to clean area and seperate labia, void and take midstream.

Question 15

Why are women more likely to have UTI than men

Answer 15

1- short urethera
2- lower urethera easily contaminated
3- urogenital system exposed during intercourse

Question 16

What is the most common pathogen in asymptomatic UTI

Answer 16

E-coli

Question 17

Othe organisms likely to caause asymptomatic uti?

Answer 17

Klebseilla, enterobacter, proteus, GBS

Question 18

How to treat asymptomatic UTI

Answer 18

1- wait on the culture
2- tailor antibiotic for the culture (B-lactam, nitrofurtonin, Bacterim, cephalosporin)
3- give medication for 5-7d
4- no need to admit the patient

Question 19

What are symptoms of acute cystitis

Answer 19

1- dysurea 
2- frequency 
3- lower abdominal pain 
4- urgency
5- strong odor and cloudy\bloody urine

Question 20

Do we need a cutoff point for bacerial growth in urine sample if patient was symptomatic (presented with dysuria)?

Answer 20

No need, any bacterial growth is enough for diagnosis

Question 21

Do we wait on culture results to treat UTI in
1- asymptomatic bacteruria
2- acute cystitis

Answer 21

1- yes

2- no (provide emperic then change base on culture sensitivity)

Question 22

What if you left cystitis untreated?

Answer 22

May lead to pyelonephritis

Question 23

How to manage acute cystitis?

Answer 23

1- fluid hydration
2- analgesia
3- emperic AB then specific for culture
4- follow up culture after 1w to confirm sterilization

Question 24

What are the signs and symptoms of acute pyelonephritis

Answer 24

Fever, nausea, vomitting, chills, flank pain, costovertebral angle tenderness, shock

Question 25

What are the investigations to order for pyelonephritis?

Answer 25

1- urine analysis and culture
2- CBC, electrolyte, inflammatory markers and RFT
3- Blood culture IF ..
4- Renal US IF ..

Question 26

When to order blood culture in pyelo?

Answer 26

• suspecting sepsis

- no response to AB

Question 27

When to order renal US in pyelo?

Answer 27

• Recurrent pyelo

- complicated by abscess, sepsis, calculi