UTI, Pyelonephritis and Sepsis

Question 1

any discomfort associated with urination

Answer 1

dysuria

Question 2

abnormally frequent urination (once every hour or two)

Answer 2

urinary frequency

Question 3

abrupt, strong, often overwhelming need to urinate

Answer 3

urgency

Question 4

uncomplicated UTI parameters include

Answer 4

non-pregnant female
no anatomi abnormalities
no instrumentation of the urinary tract

Question 5

factors that predispose women to UTIs include

Answer 5

use of spermicide with diaphragm for contraception
frequent sexual intercourse
increased risk with previous UTIs
diabetes

Question 6

factors predisposing post-menopausal females to UTIs

Answer 6

pre-menopausal UTIs
anatomic factors that affect emptying such as cystoceles, urinary intcontinence, residual urine
tissue effect of estrogen depletion

Question 7

woman presents with dysuria, whats on your differential

Answer 7

cystitis
cervicitis (chlamydia and neisseria)
vaginitis (candida and trichomonas) 
urethritis - herpetic
interstitial cystitis 
non-infectious vaginal or vulvar irritation

Question 8

pt characteristics that make UTIs complicated

Answer 8

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)

Question 9

how long should antibiotics be given for prostatitis

Answer 9

4-6 weeks

prostatitis can be chronic in prostatic hypertrophy

Question 10

hematogenous infection of the kidneys leading to pyelonephritis is rare, but may occur in systemic infections of

Answer 10

candida
salmonella
staph aureus

Question 11

three major complications of pyelonephritis

Answer 11

papillary necrosis
emphysematous pyelonephritis
xanthogranulomatous pyelonephritis

Question 12

inciting events of papillary necrosis (4)

Answer 12

sickle cell
obstruction
diabetes
analgesic nephropathy

Question 13

production of gas in nephritic and perinephric area as a complication of pyelonephritis that almost exclusively occurs in diabetic patients

Answer 13

emphysematous pyelonephritis

Question 14

chronic obstruction, infection leading to suppurative destruction of renal tissue can lead to abscess formation in this complication of pyelonephrtisi

Answer 14

xanthogranulomatous pyelonephritis

Question 15

positive blood culture of bacteria

Answer 15

bacteremia

Question 16

definition of sepsis

Answer 16

suspected or documented infection and an acute increase in organ failure
dysregulated host response to infection

Question 17

definition of septic shock

Answer 17

progressive organ dysfunction leading to marked increase in mortality
a subset of sepsis with a serum lactate greater than 2mmol/L

Question 18

septic shock may require vasopressor therapy if MAP falls below

Answer 18

65 mmHg

Question 19

MoA of damage in acute ischemia d/t reduced ECV

Answer 19

decreased O2 delivery, impaired removal of cellular waste

**direct tubular damage by endotoxins and inflammatory cytokines ***

Question 20

hypotension that cannot be reversed with infusion of fluids

Answer 20

septic shock

Question 21

signs of shock

Answer 21

tachycardia
hypotension
tachypnea
hypothermia/fever - low O2 –> cellular injury –> worsening microvascular circulation

Question 22

tubular pathophysiology of ischemic acute renal failure

Answer 22

cytoskeletal breakdown
loss of polarity
apoptosis and necrosis
desquamation of viable and necrotic cells
tubular obstruction 
backleak

Question 23

microvascular pathophysiology of ischemic acute renal failure

Answer 23

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

Question 24

signs of septic shock and their contributing mechanisms

Answer 24

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

Question 25

how can you identify the source of infection?

Answer 25

culture that bitch

Question 26

initial tx for sepsis/septic shock

Answer 26

volume resuscitation 
culture blood/urine/csf 
initiate abx empirically 
initiate pressor therapy if severe 
correct acid/base imbalances - fluids, xoygenation 
monitor electrolytes

Question 27

lab findings in sepsis and ischemia

Answer 27

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

Question 28

prevention strategies for recurrent UTIs

Answer 28

abx therapy - continuous/post-coital/;patient-initiated

Question 29

non-medication prevention strategies for women

Answer 29

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