UTI, Pyelonephritis and Sepsis Flashcards
any discomfort associated with urination
dysuria
abnormally frequent urination (once every hour or two)
urinary frequency
abrupt, strong, often overwhelming need to urinate
urgency
uncomplicated UTI parameters include
non-pregnant female
no anatomi abnormalities
no instrumentation of the urinary tract
factors that predispose women to UTIs include
use of spermicide with diaphragm for contraception
frequent sexual intercourse
increased risk with previous UTIs
diabetes
factors predisposing post-menopausal females to UTIs
pre-menopausal UTIs
anatomic factors that affect emptying such as cystoceles, urinary intcontinence, residual urine
tissue effect of estrogen depletion
woman presents with dysuria, whats on your differential
cystitis cervicitis (chlamydia and neisseria) vaginitis (candida and trichomonas) urethritis - herpetic interstitial cystitis non-infectious vaginal or vulvar irritation
pt characteristics that make UTIs complicated
pregnancy (2 patients, more likely to develop sepsis, can lead to premature, low birth weight)
anatomic variant such as polycystic kidneys
foreign bodies in the urinary tract (stones, caths, nephrostomy tubes)
extrinsic compression (tumors, profound constipation, other anomalies)
immune suppressed conditions (diabetes, drug induced, HIV/AIDS)
how long should antibiotics be given for prostatitis
4-6 weeks
prostatitis can be chronic in prostatic hypertrophy
hematogenous infection of the kidneys leading to pyelonephritis is rare, but may occur in systemic infections of
candida
salmonella
staph aureus
three major complications of pyelonephritis
papillary necrosis
emphysematous pyelonephritis
xanthogranulomatous pyelonephritis
inciting events of papillary necrosis (4)
sickle cell
obstruction
diabetes
analgesic nephropathy
production of gas in nephritic and perinephric area as a complication of pyelonephritis that almost exclusively occurs in diabetic patients
emphysematous pyelonephritis
chronic obstruction, infection leading to suppurative destruction of renal tissue can lead to abscess formation in this complication of pyelonephrtisi
xanthogranulomatous pyelonephritis
positive blood culture of bacteria
bacteremia
definition of sepsis
suspected or documented infection and an acute increase in organ failure
dysregulated host response to infection
definition of septic shock
progressive organ dysfunction leading to marked increase in mortality
a subset of sepsis with a serum lactate greater than 2mmol/L
septic shock may require vasopressor therapy if MAP falls below
65 mmHg
MoA of damage in acute ischemia d/t reduced ECV
decreased O2 delivery, impaired removal of cellular waste
**direct tubular damage by endotoxins and inflammatory cytokines ***
hypotension that cannot be reversed with infusion of fluids
septic shock
signs of shock
tachycardia
hypotension
tachypnea
hypothermia/fever - low O2 –> cellular injury –> worsening microvascular circulation
tubular pathophysiology of ischemic acute renal failure
cytoskeletal breakdown loss of polarity apoptosis and necrosis desquamation of viable and necrotic cells tubular obstruction backleak
microvascular pathophysiology of ischemic acute renal failure
vasoconstriction in response to endothelin, adenosine, angiotensin II, thromboxane A2, leukotrienes, sympathetic nerve activity
vasodilation in response to NO, PGE2, acetylcholine, bradykinin
increased endothelial nd vascular muscle clels tructural damage
increased leukocyte-endothelial adhesion, vascular obstruction, leukotye activation and inflammation
signs of septic shock and their contributing mechanisms
signs of infection - fever/hypothermia
tachycardia - cardiac response to hypoperfusion and fever
tachypnea - compensatory respiratory respnose
hypotension - sign of critical illness; responsive to fluid resucitation
circulating cytokines endothelial injury --> decreased tone and increased permeability edema decreased oxygenation of tissues buildup of lactic acid
how can you identify the source of infection?
culture that bitch
initial tx for sepsis/septic shock
volume resuscitation culture blood/urine/csf initiate abx empirically initiate pressor therapy if severe correct acid/base imbalances - fluids, xoygenation monitor electrolytes
lab findings in sepsis and ischemia
increase BUN/Cr ratio indicates pre-renal azotemia
FeNa <1%
decreased urine concentration
proteinuria - minor
hematuria +-1
muddy brown casts on microscopy - sloughing of renal tubular epithelial cells
prevention strategies for recurrent UTIs
abx therapy - continuous/post-coital/;patient-initiated
non-medication prevention strategies for women
empty bladder as soon as possible after intercourse wipe front to back shower instead of bath lactobacillus probiotics cranberry products vitamin c increased fluid intake
