UTI MR Flashcards
most common complication in pregnancy
UTI
Predisposing factors of UTI
Short urethra
High levels of progestrone
Cortisol increase
Uterine enlargement
Physiological Glycosuria
Sex
Delivery
Instrementation
How high levels of progestrone increase chance of UTI
cause hypertrophy of smooth muscles in ureter narrowing lumen causing urine stasis
How high cortisol is factor of UTI
Suppresses immunity
Uterine enlargement
compresses ureters= urine stasis
Causative Organism
Most commonly E.Coli
Klebsiella
Streptococcus
Staph.aureus and saprophyticus
Proteus
Psuedomonas
Routes of infection
Ascending route
Lymphatic Spread
Hematogenous Spread
Severe type, requires hospitalization
Upper urinary tract infection
Mild, home treated UTI
Lower UTI
Part of urinary system that can be affected in Upper UTI
Kidney (Pyelonephritis)
Ureter (Ureteritis)
Part of urinary system that can be affected in Lower UTI
Bladder (cystitis)
Urethra(Urethritis)
Symptoms of Lower UTI
Dysuria
Burning micturation
Frequency (+6day +1 night)
Urgency
Hematuria (if there is stone)
Suprapubic or lower abdominal pain
Symptoms of upper UTI
Loin pain
Fever
Palpitation
Vomiting
Chills
Signs on examination of Upper UTI
Renal angle tenderness
High temp
Tachycardia
Signs of dehydration
Why right kidney is more affected in UTI in pregnant women
Uterus is dextro-rotated (coz colon on left side) so more pressure on right ureter.
Ovarian vein passes over right ureter compresses it (left passes adjacent to left ureter)
Investigation done for UTI
Midstream urine analysis
Culture and sensitivity
Nitrites
Ketone bodies
CBC (for WBC)
Random blood sugar
Renal function test
Midstream urine analysis
Colour
Smell
+10^5 bacteria/ml
+10 pus cells (pyuria)
RBCs in urine
Renal function test test for
creatinine and urea
Presence of elevated white cells in urine (+10) but no bacteria
Sterile Pyuria
Causes of Sterile Pyuria
Chlamydia
Gonorheaa
TB
Trichomonas Vaginalis
Herpes Virus
Renal stones
took antibiotic before sample
drank alot of water before sample
SLE
Kawasaki
Cancer
Asymptomatic bacteruria
Presence of +10^5/ml of bacteria in 2 mid stream samples w/no symtoms
Untreated Asymptomatic Bacteruria can cause
Progress to pyelonephritis
Preterm labour
ass. with Preclampsia and DM
Diagnosis of Asymptomatic Bacteruria
Routine Analysis in 1st visit
Treatment of Asymptomatic Bacteruria
Antibiotic
Ampicillin 500mg/6hrs
Cephalosporine, Nitofurantoin tablets
Prophylaxis of UTI
fluid intake increase
empty bladder frequently t/out day and after sex
Treatment of Upper UTI
Hospital admission
IV antibiotic
Paracetamol
Antiemetic
IV fluids
IV antibiotic given to Upper UTI
Penicillin (Amoxicillin, Ampicillin, Augmentin)
Cephalosporin (Cefalexin, Cefazolin)
If IV antibiotic for Upper UTI shows improvement after 48 hrs
Change to oral antibiotic
If no improvement after 48 hours of IV antibiotic in Upper UTI
give Gentamicin
No improvement on antibiotics for Upper UTI infections suggests
Renal Stone
Perinephric Abcess
Malformation (polycystic kidney)
Diagnose via U/S
Antiemetic given in Upper UTI
Metochlopramide
Prochloroperazin
Lower UTI treatment
Home treated
Broad spectrum antibiotic for 3 days (changed if no improvement according to culture result)
Fetal complications of UTI
Miscarriage
IUFD
IUGR
Preterm Labour
Childhood asthma
Maternal Complications
Septicemia
Perinephric abcess
Anemia
Renal failure
Pulmonary oedema
Safe antibiotic in pregnancy
Penecillins
Cephalosporins
Caution antibiotics
Gentamicin= ototoxicity
Avoid in 1st trimester antibiotic
Trimetoprim = folate antagonist
Avoid in 3rd trimester
Nitrofurantoin= Hemoplytic anemia
Sulphonamides = kernicterus
Contraindicated in Pregnancy Antibiotics
Tetracycline
Ciprofloxacine
Chloroamphenicol
