UTI, pyelonephritis, sepsis Flashcards
Urethritis
-no upper tract symptoms
predisposing factors
1) Frequent intercourse
2) Multiple partners
3) Inconsistent condom use
best test for urethritis due to STI
Antigen for GC & Chlamydia**- risk of STI;
will not show on standard urine dip, micro
or cultures
predisposing factors for UTI’s in women
Use of spermicide as with diaphragm for
contraception
Frequent sexual intercourse
20 – 30 % have recurrence
Diabetic women 2-3 times higher
incidence of UTI’s than non-diabetics
(There isn’t sufficient information
regarding diabetic men)
Recurrence in post-menopausal females thought related to: - History of pre-menopausal UTI’s - Anatomic factors affecting bladder emptying ○ Cystoceles ○ Urinary Incontinence ○ Residual urine - Tissue effect of estrogen depletion
predisposing factors of UTI in men
Prostatic hypertrophy
Non-circumcised – E coli more likely to
colonize glans & prepuce (foreskin)
Asymptomatic bacteriuria (ABU):
urine sample is obtained for another reason & shows bacteria on microscopic evaluation - Health screening - Diabetes follow-up
*dont treat unless symptomatic
uncomplicated UTI
Non-pregnant female
No anatomic abnormalities
No instrumentation of the urinary tract
UTI much more common in females until
mid-life
complicated UTI occurs in
ANY pregnant female since:
- 2 patients
- Can lead to premature labor
- Low birth-weight babies
Complicated UTI’s can occur in men or women - Anatomic variant eg polycystic kidneys - Foreign body in the urinary tract ○ Stones ○ Urinary catheters ○ Nephrostomy tubes/ureteral stents - Extrinsic compression of ureter/bladder ○ Tumors ○ Profound constipation ○ Other anomalies - Immune suppression conditions ○ Diabetes ○ Drug induced ○ HIV/AIDS
Untreated Asymptomatic Bacteriuria in pregnant pts
likely to
result in symptomatic pyelonephritis in a
pregnant patient
- More likely to develop sepsis
*TREAT
whats the most imp thing to do with complicated UTIS
-take HISTORY
urethral stent
– placed to help pass stones or
keep ureter open with extrinsic masses eg
colon or GYN
Differential Diagnosis – Dysuria
in female
Urethritis
- Gonorrhea
- Chlamydia
- Herpes
Cystitis – frequency, urgency, nocturia,
hesitancy, hematuria
Vaginitis
- Candida
- Trichomonas
Cervicitis
- Chlamydia
- Neisseria
Non-infectious vaginal or vulvar irritation
interstitial cystitis
Aka “Painful Bladder Syndrome” Chronic – in contrast to acute infectious process Etiology unknown Possible contributing factors - Chronic bladder infection - Inflammatory factors - Unusual pain sensitivity - Functional co-morbidities
Differential Diagnosis – Dysuria
in males
Urethritis
- Gonorrhea
- Chlamydia
Cystitis
Prostatitis
Pyelonephritis
diagnostics for dysuria
UA (Urinalysis)
- Urine dipstick (aka reagent strip)
- Urine microscopic
Urine culture and sensitivity – will not
identify GC and Chlamydia
Must order urinary antigen for GC and
Chlamydia if STI (Sexually Transmitted
Infection) is suspected**
when is a urine culture not indicated?
when dip and micro are negative
antibiotics for GC
ceftriaxone and Azithromycin
antibiotics for chlamydia
-azithromycin or doxycycline
antibiotics for cystitis
trimethoprim-sulfamethoxazole
antibiotics for pyelonephritis
fluoroquinolone eg levofloxacin
prostatitis
Infectious or non-infectious With or without hypertrophy Can be chronic in prostatic hypertrophy Pain in prostatic, pelvic or perineal area (“where I sit down"
Prolonged antibiotic course necessary
4-6 weeks
when should you use a nephrostomy tube?
- bad hydronephrosis
- bad metastatic cancer
pyelonephritis
Generally sicker Fevers/chills Body aches esp back (flank) pain Typically ascending from lower tract infection Positive CVA (Costovertebral Angle) tenderness
test for pyelonephritis
-lloyds punch
most common precursors of pyelonephritis
Same as UTI - Since most commonly ascending from lower tract - 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
Three Major Subtypes/
Complications of Pyelonephritis
- Papillary Necrosis (muddy brown casts)
- Emphysematous pyelonephritis (gas producing organism)
- Xanthogranulomatous pyelonephritis
papillary necrosis
Can occur in:
- Obstruction
- Diabetes
- Sickle Cell
- Analgesic nephropathy (NSAIDS)
Emphysematous pyelonephritis
Production of gas in nephric and
perinephric area
Occurs almost exclusively in diabetic
patients
Xanthogranulomatous pyelonephritis
Chronic obstruction Chronic infections Causes suppurative destruction of renal tissue Can lead to abscess formation
*white cells and white cell casts, muddy brown casts
what symptom indicates sepsis?
- hypotension
- indicates organ dysfunction and decreased oxygenation of organs and brain leading to confusion
bacteremia
simply means blood cultures are positive
sepsis (aka septicemia)
- Suspected or documented infection and an acute increase
in organ failure - Dysregulated host response to infection
septic shock
– progressive organ dysfunction
leading to marked increase in mortality
- Subset of sepsis
- Vasopressor therapy needed to maintain mean arterial
pressure at 65 mmHg or greater
-Serum lactate greater than 2 mmol/L (18mg/dL)
what do you give somebody in septic shock?
fluid bolus
what happens to organs during sepsis?
Decreased oxygen delivery
Impaired removal of cellular waste
Kidney receives 20- 25% of cardiac output
DOUBLE WHAMMY to kidney: Direct tubular damage by
endotoxins and inflammatory cytokines
signs and symptoms of septic shock
Signs of infection: fever or hypothermia
Tachycardia: cardiac response to hypoperfusion and
fever
Tachypnea: compensatory respiratory response
Hypotension*: may be unresponsive to fluid
resuscitation and need vasopressors
Circulating cytokines
Endothelial injury: decreased tone, increased permeability
Edema
Decreased oxygenation of tissues
Build up of lactic acid
prevention of recurrent UTIS
“Preventive strategy is indicated if
recurrent UTIs are interfering with a
patient’s lifestyle” (HPM)
Antibiotic therapy
- Continuous
- Post-coital
- Patient-initiated
non medication preventive strategies in women for UTIS
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*
