UTI + others Flashcards
key points of UTI + S+S
UTI are very common
female more likely, in men should prompt further investigation.
classified into lower and upper.
most commmonly cused by E Coli (other aer likely to be gram negative bact)
S+S:
dysuria, inc frequency, smelly urine, if upper UTI- fever, loin pain, back pain
Ix for UTI
if 3 or more symptoms of cyctitis and non pregnant woman - treat without any further Ix
Urine dip
MSU culture
Blood tests
USS to look for other causes (e.t Men, faliure of rx, recurrent / more than 2 per year, pyelonephritis, unusual organism, persistant haematurea)
management of UTI + prostatitis
non pregnant woman- 3/7 trimethoprim 200mg BD OR nitrofuratoin 59mg QDS
if this fails culture and treat empirically
if pregnant- 7/7 nitro in 1/2 tri
in 3rd trimethoprim or ciprofloxacin
MEN:
7/7 tri or nitro
if prostatistis then 4/52 cipro
if catheterised only Rx if symptomatic as they will likely be bacteraemic anyway. change catheter before starting Rx.
what is cystitis
lower UTI
most common
E COli
classic symptoms- freq, urgency, suprapubic pain, polyura, haematurea
NO VAGINAL DISCHARGE
if one severe or 3 or more normal then treat without further tests
what is acute pyelonephritis, risk factors for and investigations
acute infection into the renal pelvis and parenchyma
dev over 24-48hrs
consequence of ascending UTI.
E Coli, proteus, klebsiellas
woman and elderly affected. most commonly
RF: structural and functional urinary tract abnormalities, diabetes, vesicouteric reflux.
ultrasound- gold standard
urinanalysis (haem, prot, nitrates)
preg test
FBC–> CRP
CT for complications
management of pyelonephritis
ABCDE- can be septic
analgesia
IV fluids
anti-emetics
broad spectrum abx- cephalosporin or quinolone
catheter + monitor output.
complications are perinephric abscess
overview of prostatitis, including causes, risk factors
inflammation of the prostate gland, UTI or STI usual cause.
assoc with inc rates of BPH, Ca prostate + LUTS
bacterial causes- gran neg organisms- e coli Enterobacter, serrate
STI- Gonorrhoea, chlamydia
RF:
Hx of s/uti
indwelling catheter
prostate biopsy
DM
immunosuppression
signs and symptoms of prostatitis
LUTS symptoms
perineal, penile, or rectal pain; acute urinary retention, obstructive voiding symptoms; low back pain, pain on ejaculation; tender, swollen, warm prostate (on gentle rectal examination).
Bacteraemia — rigors, arthralgia, or myalgia; fever, tachycardia.
acute bacterial prostatitis synopsis
Acute bacterial prostatitis
rare- life threatening (young men <35)
gram -ve bacteria
septic symptoms
hot to touch prostate on DRE
inguinal lymph swelling, urethral discharge, retention, LUTS
Ix: MSU, Bloods, screen STI
Mx: if septic Gent + ceftriaxone
if well, 14/7: ciprofloxacin 500 mg twice daily or ofloxacin 200 mg twice daily
if in retention need supra pubic as catheterisation is contraindicated.
USS/ CT if no improvement after 1 week for ? abscess
discuss the chronic prostatitises
either bacterial or abacterial
bacterial- non specific symptoms- presents as recurrent UTI, E coli driven, oral abx
abacterial- chronic pelvic pain syndrome- longer than 3/12. pain on ejaculation.
negative urine + prostatic fluid culture
Mx: analgesia, abx, alpha blockers.
