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UTI + Pyelonephritis Flashcards

1
Q

Infection of urethra, prostate, bladder, ureter, kidney, testes

A 
Urethritis
Prostatitis
Cystitis
Ureteritis = very rare
Pyelonephritis
Orchitis
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2
Q

What is an uncomplicated UTI

A

Sexually active female with normal renal structure

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3
Q

What is a complicated UTI

A

Abnormal tract e.g. catheter / obstruction / transplant
Co-morbid
Foreign body
Type of organism

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4
Q

What is the most common cause of UTI

A

E.coli

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5
Q

What are other causes

A

Usually gram -ve from vaginal / bowel
Pseudomonas
Klebsiella (enterococcus)
Proteus mirabilis

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6
Q

What is shown on USS with proteus

A

Staghorn calculi

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7
Q

What are gram +Ve causes

A

S. saphropgtticus
S.aureus
Usually due to haematogenous spread

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8
Q

What are common causes in hospital

A

Klebsiella
S.aureus
Pseudomonas

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9
Q

How is UTI transferred

A

Transurethral
Blood - schistosomiasis
Lymphatics

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10
Q

What are the symptoms of cystitis

A 
Dysuria
Frequency 
Urgency
Polyuria
Incontinence 
Smelly cloudy urine 
Loin / flank pain
Haematuria
Fever
Confusion - common in elderly 
Vomiting - common in children 
Stranguary
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11
Q

What are symptoms of prostatitis

A

Pain - rectum / sctrotum / penis / bladder
Fever
Malaise
Tender prostate PR
Prostate Sx - terminal dribbling / hesitation etc
Cystits Sx

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12
Q

How do children present

A 
Unexplained fever
Diarrhoea
N+V
Crying 
Off food
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13
Q

What should you always do in children

A

Follow up for VUJ reflux as risk of chronic pyelonephritis

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14
Q

What are RF for UTI

A 
Urine stasis
Obstruction 
Pushing bacteria up urethra
Predisposition to infection
Female
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15
Q

What are RF for prostatitis

A

Biopsy
Catheter
Recent UTI
Bladder instruments

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16
Q

What causes urine stasis

A

Obstruction
Dehydration
Spinal injury = loss of sensation
Pregnancy as increased relaxation

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17
Q

What causes obstruction + hydronephrosis

A 
Tumour
Calculi
Cyst
Trauma
BPH
Uterine prolapse
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18
Q

What are causes in children

A

Congenital VUJ
Duplex kidney
CAKUT

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19
Q

What causes bacteria to be pushed up

A 
Sex
Catheter = very common cause 
Fistula
Incontinence
Constipation
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20
Q

What predispose you to an infection

A 
DM
Steroids
Immunouppression
CKD - immune
Oestrogen insufficeicny
Repeated cystitis
Malnutrition
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21
Q

Why is female a RF

A 
Short urethra
Urethra close to rectum
Lack of prostatic secetion
Pregnancy
Post menopause
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22
Q

What causes recurrent UTI in old and young male

A 
Young= C+G
Old = coliform
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23
Q

What should you check in recurrent UTI in elderly male

A

Check emptying bladder properly - post void USS
Check kidney - USS
Check bladder malignancy - cystourehtroscopy

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24
Q

What should you always check for in UTI

A

Distended bladder / enlarged prostate

Do not rely on classic Sx in cancer

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25
How do you investigate UTI
Dipstick if <3 Sx MSSU Blood if systemically unwell patient - FBC, U+E, CRP
26
What level of MSSU suggests infection
10^5 but some bacteria pathological in low numbers
27
What does dipstick show
Nitrite = most specific Protein Leucocyte - if only leucocyte present, do not treat for UTI unless clinical evidence Haematuria
28
What are further investigations
``` Refer urology Bladder USS Bladder flow study Isotope study Cystoscopy IVU / CT KUB ```
29
What Ax are used to treat UTI
Trimethoprim Nitrofurantoin Always increase fluid
30
If women with 3+ Sx, not pregnancy and no discharge
Treat
31
If mild or 2+ symptoms
Do dipstick first
32
What is advice if recurrent UTI
Fluid >2l Void 2-3 hours Void before bed and sex Single dose Ax prophylaxis
33
When would you do MSSU or further investigations
``` Mild Sx ALL MEN ALL CHILDREN Recurrent >3 Failed Ax to find sensitivity Pregnant Suspected pyelonephritis Unusual bacteria ```
34
Why do you do MSSU in pregnancy
Dipstick not accurate | Want to screen for asymptomatic as risk of pyelonephritis and pre-term
35
Do you treat +ve dip in elderly
No | Need Sx or culture result
36
What are complications of UTI
``` Acute retention Recurrent UTI -> hydronephrosis Renal failure Chronic pyelonephritis Severe urosepsis Calculi formation = obstruction = more infection ```
37
Do you treat catheter infection
Only if symptoms
38
What is differential
PID | STI
39
What are the risks of nitrofurantoin
Fibrosis long term | Haemolytic anaemia if in pregnancy 3rd trimester
40
What causes sterile pyuria
``` Ax use = most common Renal TB C+G Calculi Malignancy Autoimmune - SLE Catheter Pregnancy Appendicitis Prostatitis PCKD ```
41
What should you ask if suspect renal TB
Fever Malaise Weight loss Night sweats
42
What can renal TB lead to
Intersitital nephritis | Renal amyloidosis
43
What is sterile pyuria
Pus cells on microscopy | No organism cultured
44
How do you Dx renal TB present
-ve culture Mycobacteria clture AAFB
45
What causes acute pyelonephritis
Infection spreading up to kidney - E.coli = most common - Klebsiella - Enterococcus - Pseudomonas
46
What are the symptoms of pyelonephritis
``` Loin pain / tender + renal angle tenderness O/E Fever Rigors Vomiting Anorexia Haematuria Dehydration Cystits - frequency, dysuria, Systemically unwel ```
47
How do you Dx
Urine dip MSSU Blood culture Renal USS
48
How do you treat
Broad spec - co-amox 7-10 days Refer to hospital if signs of sepsis IV gent
49
What are the risks of pyelonephritis
Sepsis Renal abscess Hameaturia if due to stone
50
What causes chronic pyelonephritis
Reflux in children Duplex DM Repeated UTI
51
What happens in chronic
Scarring Hypertension Chronic infections CKD
52
How do you Dx
``` Blood USS - scar Micturating cystogram - show reflux CT - show scar DMSA - scar ```
53
What can scarring lead too
Proteinuria
54
What do you do for urosepsis
SEPSIS 6 USS if not improving to look for abscess / stone CT
55
How do you treat
Gentamicin - covers gram -ve E.coli
56
How do you treat pregnant women with UTI
7 days Ax Send urine for culture and sensitive Treat asymptomatic Avoid nitrofurantoin near term as risk of haemolytic anaemia Avoid trimethoprim in 1st trimester if taking other anti-folate drugs
57
How long do you treat simple UTI
3 days
58
How long if immunocompromised / abnormal kidney structure or function
5 days
59
How long if catheter / pregnant / men
7 days
60
What does UTI in pregnancy cause
Pyelonephritis PPROM Pre-term
61
What puts you at higher risk of pyelonephritis
Female Pregnant Structural abnormality DM

Renal / Urology (16 decks)

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