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Mariya- PCM 3 Exam 2 > UTI, Pyelonephritis, and Antibiotics > Flashcards

UTI, Pyelonephritis, and Antibiotics Flashcards

1
Q

Common syx seen in cystitis?

A

suprapubic or abdominal pain

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2
Q

common symptoms of urethritis? predisposing factors?

A

no upper tract symptoms
risk of STI

predisposing factors: frequent intercourse, multiple partners, inconsistent condom use

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3
Q

common syx seen in pyelonephritis

A

fever, back pain, general malaise

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4
Q

Common syx seen in vaginitis?

A

reporting drainage or itching

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5
Q

What urine test is helpful/best in detecting urethritis?

A

Antigen for GC (gonorrhea) + chlamydia; these wont show on standard urine dip, micro or cultures

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6
Q

What are some predisposing factors to UTIs in women?

A

use of spermicids (ex. diaphragm for contraception), frequent sexual intercourse, diabetic women have 2-3 times higher incidences than non-diabetes

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7
Q

What is the recurrence rate of UTIs in women?

A

20-30%

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8
Q

Recurrence in post-menopausal females is related to what?

A
  • history of pre-menopausal UTIs
  • anatomic factors affecting bladder emptying (cystoceles, urinary incontinence, residual urine)
  • tissue effect of estrogen depletion (significant!)

why this occurs: tissues thin and this leaves them fragile and friable, increasing risk of infection

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9
Q

What are the predisposing factors to UTIs in men?

A

prostatic hypertrophy

non-circumscribed (bc ecoli more likely to colonize glans + prepuce)

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10
Q

A patient presents with a high fever and no urinary symptoms. A urine sample is obtained and shows bacteria on microscopic evluation. What is this and how would you treat them? Asymptomatic bacteriuria (ABU). What are your next steps to check and should you treat them?

A

Asymptomatic bacteriuria (ABU)

No treatment unless have other complications such as are diabetic or pregnant

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11
Q

Why is it important to treat Asymptomatic bacteriuria in a pregnant patient?

A

Can result in symptomatic pyelonephritis and more likely to develop sepsis

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12
Q

What is considered an uncomplicated UTI patient?

A

Non-pregnant female, no anatomic abnormalities, no instrumentation of the urinary tract

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13
Q

UTI is much more common in females until when?

A

mid-life

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14
Q

What is considered a complicated UTI patient?

A

ANY pregnant female since its 2 patients and can lead to premature labor or low birth weight babies

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15
Q

What is the single most important thing in a complicated UTI case?

A

HISTORY!!!

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16
Q

Causes of a complicated UTI (several things):

A
  • anatomic variant (eg. polycystic kidney dz, one kidney)
  • foreign body in urinary tract (stones, urinary catheters, nephrostomy tubes/ureteral stent)
  • extrinsic compression of ureter/bladder (tumors, profound constipation, other anomalies)
  • immune suppression conditions (diabetes, drug-induced, HIV/AIDS)
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17
Q

What are some differentials that may cause dysuria in females?

A
  • Urethritis (gonorrhea, chlamydia, herpes)
  • Cystitis (freqency, urgency nocturia, hesitancy, hematuria)
  • Interstitial Cystitis (“painful bladder syndrome”)
  • Vaginitis (candida, trichomonas)
  • Cervicitis (chlamydia, neisseria)
  • non-infectious vaginal or vulvar irritation
18
Q

What is Interstitial Cystitis? What are some possible contriubiting factors?

A

“Painful bladder syndrome”

  • chronic; unknown etiology
  • possible contributing factors: chronic bladder infection, inflammatory factors, unusual pain sensitivity, functional comorbidities
19
Q

What are some differentials that may cause dysuria in males?

A

Urethritis (gonorrhea, chlamydia), cystitis, prostatitis, pyelonephritis (DIFF compared to female**)

20
Q

Why is a urine culture not the best option in detecting UTIs?

A

Will not identify GC + chlamydia (need urine antigen for GC + chlamydia if STI suspected)

21
Q

What are some diagnostic tests you COULD use for UTIs?

A

US (urinalysis) - urine dipstick, microscopic
urine culture (if + urine dip + micro)
urinary antigen for GC + Chlamydia
Ultrasound - if symptoms are progressing or are unusual

22
Q

A 34 y/o male presents with pain “where they sit down” and describes it specifically in the pelvic area. What might he have? What would you prescribe him?

A

Prostatitis

prolonged antibiotic course necessary for 4-6 weeks (hard to treat)

23
Q

What are the features of prostatitis?

A

Infectious or non-infectious, with or without hypertrophy, can be chronic in prostatic hypertrophy

-pain in prostatic, pelvic, or perineal area

24
Q

How would a patient with pyelonephritis present?

A

generally sicker, fever/chills, body aches (back/flank especially), typically ASCENDING from lower tract infection, positive CVA tenderness

25
Q

What kind of specialty test could you use for pyelonephritis

A

lloyds punch is preferred

26
Q

What are the most common precursors of pyelonephritis?

A
  • same as UTI (since most commonly ascending from lower tract) and most common organism is E. coli
  • bacteremia develops in 20-30% of cases
  • can be hematogenous spread to kidney instead of ascending, but very rare (candida, salmonella, staph aureus)
27
Q

Three major subtypes/complications of pyelonephritis:

A
  1. papillary necrosis
  2. emphysematous pyelonephritis
  3. xanthogranulomatous pyelonephritis
28
Q

What conditions can lead to papillary necrosis?

A

obstruction, diabetes, sickle cell, analgesic nephropathy

29
Q

What is emphysematous pyelonephritis? who mostly get its?

A

production of gas in nephric and perinephric area

occurs almost exclusively in diabetic patients

30
Q

What characteristics are seen in xanthogranulomatous pyelonephritis?

A

chronic obstruction, chronic infections, suppurative destruction of renal tissue, can lead abscess formation

31
Q

What does bacteremia mean?

A

blood cultures are positive for bacteria

32
Q

What is sepsis?

A

suspected or documented infection and an acute increase in organ failure

dysregulated host response to infection

33
Q

What is septic shock?

A

HYPOTENSION

subset of sepsis; progressive organ dysfunction leading to marked increase in mortality

serum lactate greater than 2 mmol/L (18 mg/dL)

34
Q

What therapy is needed for septic shock?

A

vasopressor therapy needed to maintain mean arterial pressure at 65 mmHg or greater

35
Q

Acute ischemia of major organs occurs when?

A

when there is a defect in effective circulating volume (decreased O2 delivery, impaired removal of cellular waste)

Double whammy on kidney: direct tubular damage by endotoxins and inflammatory cytokines

36
Q

What are signs/symptoms of septic shock?

A
  • signs of infection: fever/hypothermia
  • tachycardia (cardiac response to hypoperfusion + fever)
  • tachypnea (compensatory resp response)
  • hypotension (may be unresponsive to fluid resusc and need vasopressors)
  • circulating cytokines
  • endothelial injury (decreased tone, increased permeability)
  • edema (she emphasized)
  • decreased oxygenation of tissues
  • build up of lactic acid (emphasized)
37
Q

When would you treat recurrent UTIs with antibiotics?

A

if UTI is interfering with patients lifestyle; patient-initiated

38
Q

How would you prevent UTIs without antibiotics?

A
  • empty bladder as soon as reasonable after intercourse
  • wipe front to back after toileting
  • showers instead of tub baths
  • lactobacillus probiotics
  • cranberry products
  • vitamin c
  • increased fluid intake!!! (emphasized)
39
Q

A patient presents with the inability to lay still, pinkish urine, severe/excruciating back and abdominal pain, + CVA tendreness, and pain constant with frequent spasms. What is the most likely diagnosis?

A

Renal lithiasis

40
Q

What could you do to a patient to relieve really bad hydronephrosis?

A

nephrostomy tube

Mariya- PCM 3 Exam 2 (2 decks)

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