UTI In Pregnancy Flashcards
Differentiate between prevalance of asymptomatic bacteruria in pregnant vs general population:
Same prevalence
Differentiate between prevalance of pyelonephritis and recurrent cystitis in pregnant vs general population:
More common in pregnant women
What are the anatomical and physiological changes in renal system?
1- increased kidney size 2- increase GFR\renal plasma 3- smooth muscle relaxation 4- stasis of urine 5- relative immunosuppression
What are the causes of enlarged kidney size on US?
Enlarged calcyceal size.
Why does the GFR and renal plasma increase during pregnancy
D\t increase CO; increase in blood flow & decrease in creatinine clearance.
What causes dilation of ureter during pregnancy?
Progestrone
What causes dialtion of renal pelvis and calcyceal system
The effect of gravid uterus pressing on the ureter and kidney
Where is the resemblance of hydronephrosis more likely to show on US? (Right or left)
Right
Why do pregnant women have the appeance of hydronephrosis and hydroureter on US?
Due to the smooth muscle relaxation by progestrone and the effect of gravid uterus
What are the predisposing factors of UTI in pregnancy?
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
To diagnose asymptomatic UTI, one needs a lab finding of:
Same bacterial strain in quantitative counts of 10x5 CFU
How to diagnose asymptomatic bacteruria?
1- 10x5 CFU
2- midstream clean catch
3- no S&S of UTI
Why do we treat asymptomatic UTI?
To avoid complications (pyelonephritis)
How to preform midstream clean catch?
Tell patient to clean area and seperate labia, void and take midstream.
Why are women more likely to have UTI than men
1- short urethera
2- lower urethera easily contaminated
3- urogenital system exposed during intercourse
What is the most common pathogen in asymptomatic UTI
E-coli
Othe organisms likely to caause asymptomatic uti?
Klebseilla, enterobacter, proteus, GBS
How to treat asymptomatic UTI
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
What are symptoms of acute cystitis
1- dysurea 2- frequency 3- lower abdominal pain 4- urgency 5- strong odor and cloudy\bloody urine
Do we need a cutoff point for bacerial growth in urine sample if patient was symptomatic (presented with dysuria)?
No need, any bacterial growth is enough for diagnosis
Do we wait on culture results to treat UTI in
1- asymptomatic bacteruria
2- acute cystitis
1- yes
2- no (provide emperic then change base on culture sensitivity)
What if you left cystitis untreated?
May lead to pyelonephritis
How to manage acute cystitis?
1- fluid hydration
2- analgesia
3- emperic AB then specific for culture
4- follow up culture after 1w to confirm sterilization
What are the signs and symptoms of acute pyelonephritis
Fever, nausea, vomitting, chills, flank pain, costovertebral angle tenderness, shock
What are the investigations to order for pyelonephritis?
1- urine analysis and culture
2- CBC, electrolyte, inflammatory markers and RFT
3- Blood culture IF ..
4- Renal US IF ..
When to order blood culture in pyelo?
- suspecting sepsis
- no response to AB
When to order renal US in pyelo?
- Recurrent pyelo
- complicated by abscess, sepsis, calculi
