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Clin Med GI > UTIs > Flashcards

UTIs Flashcards

1
Q

If you are not symptomatic for a UTI despite having a postive culture, do you treat?

A

No, typically not

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1
Q

What is suggestive of a UTI? Is this diagnostic?

A

100,000 cfu/mL (colony function units)
pyuria is also not diagnostic, but it is helpful

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2
Q

What is asymptomatic pyuria and when is it typically.

A

10^5 cfu
Less estrogen makes it easier to invade

This is why we only check if symtomatic

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3
Q

What is unsolved bateriuria and what can cause it?

A

Failure to sterilize urinary tract during UTI tx

Not taking meds correctly, resistance to AB

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4
Q

What can cause persistent bacteruria?

A

When the tract is sterilized, but there is a source of bacteria elsewehere:

Infected stone, prostatitis, foreign bodies, fistulas

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5
Q

What is the MC way UTIs spread and why does this make UTIs more common in women?

A

Ascending (90-95%)

Ascent up the urethra, bladder, ureters
Short urethra in women → much higher UTI incidence

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6
Q

Other than ascending, what are other ways UTIs spread?

A

Direct Extension - from local infected tissue (e.g., intraperitoneal abscess)

Hematogenous - rare - Staph aureus

Lymphatic - rare

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7
Q

What are some risk factors of UTIs?

A

Abnormal voiding (including vesicoureteral reflux)
Diminished renal blood flow (decreases immune response)
Intrinsic renal disease
Abnormal urine pH, osmolality (creates a more favorable environment)
Deficient mucosal coating

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8
Q

How does intercourse make it more common for women to get UTIs?

A

Honeymoon cystitis because intercourse pushes bacteria closer to bladder

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9
Q

What type of male is more likely to have a UTI?

A

Prostatitis
Foreskin (allows areas for bacteria to grow)

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10
Q

What is acute cystitis and what is the MC bacteria?

A

Typically what people have when they say “I had a bacterial infection)

Almost all bacteria
E coli is MC

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11
Q

If a male has recurrent UTIs, what should you investigate?

A

Underlying etiology like vesicouretal efflux

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12
Q

What is the classic triad of acute cystitis?

A

irritative voiding (dysuria, frequency, urgency),
suprapubic pain, +/- gross hematuria +/- malaise

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13
Q

What is the PE of acute cystits?

A

Exam - suprapubic tenderness possible
Minimal/no signs of systemic toxicity

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14
Q

When would you see CVA tenderness?

A

If pyleo - if just the bladder, you do not see it

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15
Q

What are the labs of acute cystitis?

A

Pyuria, hematuria, bacteriuria
Leukocyte esterase, urinary nitrate
Urine culture + for causative organism

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16
Q

When would you order a UA for acute cystits?

A

Don’t have to order (but can) unless

drug resistance, hospital stay, recent AB

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17
Q

What is the first-line AB therapy for acute cystits?

A

Macrobid, because it only concentrates in the urine (aka Nitrofurantoin)

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18
Q

What are other AB therapy for cystits that might not be first line (but still not second-line)

A

Bactrim (or trimethoprim if sulfa allergy)
Fosfomycin

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19
Q

What are the second-line and third line AB therapy of acute cystitis?

A

Amoxicillin/clavulanic acid, Cephalosporins

Third line
Fluroquinolones

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20
Q

What is the Phenazopyridine and SE?

A

Urinary analgesics
unknown MOA
CI: renal insuffiency or HTN
SE: discolored urine

rare: AKI, hemolytic anemia, methemoglobinemia

21
Q

What is methanine?

A

Urinary analgesics/antimicrobials
MOA becomes ammonia
SE: rash, nausea

can elevate LFTs

22
Q

What is a Sitz bath?

A

A bath for cystits, sit on the toilet (warm bath)

23
Q

What are some other supplemetal treatments of Acute cystits?

A

Sitz baths
Increased PO fluid intake
Cranberry juice or supplement
Probiotics
Vaginal estrogen

24
Q

What are non-pharmalogical therapy of cystits?

A

Voiding
Voiding after intercourse
Minimizing urinary retention
Other Patient Habits
Adequate PO fluid hydration
Avoiding causative meds
Wiping “front to back”
“Breathable” undergarments (cotton - not leather or spandix)
Supplements
Probiotics
Cranberry juice/supplement
D-mannose supplement (found in cranberries, sugar-based molecule that may coat the bladder)

25
Q

What DM med can cause recurrent UTIs?

A

-glifazon
SGLT2 inhibtors

26
Q

Itsy bittsy spider memory?

A

Itsy bitsy spiders climb up water spout and then you pee the spiders out

27
Q

What is consider frequent UTIs?

A

3+ UTIs in a 12-month period

28
Q

When should you do prevention of UTIs?

A

3+ UTIs in a 12-month period and tried other non-pharm therapy

TMP-SMZ 40/200 mg/d
Trimethoprim 100 mg/d
Nitrofurantoin 100 mg/d
Cephalexin 250 mg/d
Methenamine 500-1000 mg BID

29
Q

What is pyelonephritis? What is the MC cause

A

Kidney infection
MC d/t bacteria
sometimes progression of cystits

30
Q

What microbe can travel through hematologic route?

A

staph aureus

31
Q

What are the s/s of pyelonephritis?

A

fever, chills, N/V/D, flank pain
Exam - fever, tachycardia, CVA tenderness

fever can be masked by ibruprofen

32
Q

What do you order if you for imaging if you suspect pyelonephritis?

A

CT - preferred - can show renal inflammation, abscess
US - can show hydronephrosis, may show abscess

33
Q

What are the labs of pyelo?

A

Labs - pyuria, hematuria, bacteriuria, +/- WBC casts
Leukocyte esterase, urinary nitrite possible
Urine culture - + for heavy growth of causative organism
CBC - leukocytosis with left shift
Blood culture - may or may not be +

34
Q

What color is fluid on a CT?

A

Dark

35
Q

What is the outpatient therapy for pyelo?

A

Able to tolerate PO, have help, can do oral. Can start with IV before they go

levofloxacin, ciprofloxacin, trimethoprim-sulfamethoxazole
- amoxicillin/clavulanate

treatment is longer then cystits

36
Q

What is a CI of treatment for pyelo?

A

CI - nitrofurantoin, oral fosfomycin

Because these only make it to the urine and do not get to the kidneys

37
Q

When do you do inpatient therapy for pyelo?

A

Unable to tolerate PO fluids/meds, severe illness, complicated case (sepsis, obstruction), non-compliant

38
Q

What is the inpatient therapy?

A

No risk for MDR G- : IV ceftriaxone, IV piperacillin-tazobactam, IV ampicillin/gentamicin, or IV/oral fluoroquinolones
If MDR G+ suspected - add on vancomycin, linezolid or daptomycin
1+ risk factors for MDR G- : IV carbapenem (imipenem, meropenem, or doripenem)
If highly resistant - IV extended-spectrum cephalosporin + BL inhibitor
If MDR G+ suspected - add on vancomycin, linezolid or daptomycin
May switch to PO as pt improves clinically and can tolerate PO intake - 14 d total tx

39
Q

What are complication of pyelo?

A

Worried about damage to kidneys

Sepsis/Septic shock
Scarring and nephron loss
Chronic pyelonephritis
Requires antibiotic tx for 3-6 mo
Similar medications to acute pyelonephritis
Major renal abscess formation
May necessitate surgical drainage

40
Q

Why do abscess form quickly?

A

Kidney is delicate and the body wants to wall it off ASAP

41
Q

What is acute urethritis and the MC cause?

A

Only the urethra is the problem

typically an STD

1 cause Neisseria gonorrhoeae
#2 cause Chlamydia trachomatis
#3 cause - Mycoplasma genitalium
#4 Trichomonas vaginalis also emerging as etiology

ascends to the urethra

42
Q

MC demographic of acute urethritis

A

MC in sexually active young men
can occur in anyone

43
Q

What are the s/s of acute urethritis?

A

irritative voiding (dysuria, frequency, urgency), pain/pruritus at urethral meatus, urethral discharge

Discharge - from scanty/thin/watery to thick/purulent/copious

Asymptomatic - Up to 10% of gonococcal urethritis and 42% of NGU

44
Q

Which urethritis has the most discharge?

A

Gonorrohea

45
Q

What is a NAAT used for?

A

diagnosis of gonorrhea/chlamydia

can get back w/in 15-30 min

46
Q

How do you do a UA for urethritis?

A

FIRST discharge because this is where the bacteria bost likely is

47
Q

Treatment of gonorrhea

A

ceftriaxone

48
Q

Treatment of chlamydia

A

azithromycin

49
Q

Treatment of gonorrhea

A

doxycycline

Clin Med GI (10 decks)

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