UTI- unrein Flashcards
level of bifurcation of upper and lower UTI
urethral orifices of bladder
risk facotrs UTI
female
spermicides
pregnancy
vaginal atrophy
Sx UTI
dysuria, frequency, urgency, strong urine odor, cloudy urine, suprapubic tenderness on PE
absence of vaginal discharge or vaginal pain
underlying risk factors for UTI
neurogenic bladder
DM
urinary instrumentation
structural abnormalities like cystocele
when is culture indicated even if suspect simple cystitis
pregnancy
antibiotic resistant organisms
multiple drug sensitivities
underlying complicating medical condition
complicated cystitis
recurrent in female ANY male urethral malformations strictures or obstructions neurogenic bladder immunocompromised renal disease pregnancy DM catheterization upper tract disease
presentation pyelonephritis
fever and toxic appearance
lloyds sign
elevated WBC with lef tshift
what causes pyelonephritis
most common- ascending bacteria from residual urine and reflux
hematogenous or lymphatic spread- endocarditis, osteomyelitis, injeciton drug users
where do you palpate kidney
anterior hand, should not be able to palpate kidney in normal individual
do you Tx asymptomatic bacteriuria
not usually
indications for Tx asymptomatic bacteriuria
pregnancy
urinary outflow obstruction
anticipated urinary instrumentation
when the goal is to prevent upper tract disease
what is urosepsis
septic
tachy, fever or low temp
elevated WBC left shfit
rigors
what to order for urosepsis
blood and urine cultures and imaging
pathogens in urine normally
gram - bacteria
gram + bacteria
what bacteria found in young women
staphylococcus saprophyticus
what grows on prosthetic devices
staph epidermidis
what staph occurs in injection drug users
aureus
what is sterile pyuria
doesn’t grow on regular agar
what pathogens are “culture negative”
mycobacterium TB adenovirus polyomavirus cytomegalovirus anaerobes fungal interstitial cystitis
what will a urine dipstick tell you
+ nitrites and leukocyte esterase in for UTI
negative nitrites and leukocyt high negative predictive value!!
use of urine cultures in lab eval
colony counts
antibiotic sensitivity patterns
what imaging is used for lab evals
US and CT scan
what cells make nitrites? nitrates?
nitrites prokaryotic cells
nitrates eukaryotic cells
Tx UTI that is bacteriostatic
nitrofurantoin
