UTIs Flashcards
who do UTIs affect
women commonly
what causes the symptoms of UTIs
the inflammatory response of the urothelium to bacterial infection, associated with pyuria and bacteruria
common risk factors for UTIs
sex
catheterisation
why women more susceptible to UTIs
short urethra & proximity to the anus facilitates transfer of bowel organisms to the bladder
most common bacterial causes of UTIs
e coli = most common
then: staph epidermidis, proteus mirabilis, klebsiella aerogenes
pathogenesis UTI
colonises flora colonisation of vagina colonisation of urethral meatus ascent of bacteria = bacteriuria UTI
abnormalities that encourage bladder infection (cystitis) ?
urinary obstruction damage to bladder epithelium bladder stones poor bladder emptying oestrogen depletion
clinical features of a lower UTI
freq of micturition dysuria suprapubic pain tenderness haematuria smelly urine
clinical features of acute pylonephritis
loin pain tenderness vomitting fever nausea
investigations UTI
hx physical examination dipstick urine microscopy and culture renal tract imagine in persistent cases
what looking for on dipstick
presence of nitrites - bacteria break down nitrates to nitrites
leucocyte elastase
pyuria
what looking for in microscopy
pathogens
unnecessary in women with symptoms suggestive of cystitis in whom rx is given based on symptoms and dipstick
management uti
pre treatment urine culture is desirable
Abx - 3-5d course amoxicillin, nitrofurantoin or trimethoprim
rx modified on culture and sensivity testing
UTI in pregnancy
more serious
if untreated bacteriuria can develop acute pyelonephritis and septic shock = low birth weight risk
prostatis
inflammation of the prostate gland
common
associated with lower urinary tract symptoms
if bacterial needs urgent rx
urethritis
rare
predominantly caused by STI
urethral pain / dysuria / discharge
epididymo-orchitis
inflamed epididymis & inflamed testicle
acute presentation
usually unilateral
must rule out torsion - any doubt = surgical scrotal exploration
features suggestive of torsion
short duration of pain, sudden onset
nausea and abdo pain
previous short-duration orchalgia
cause epididymo-orchitis
age UTI
age > 35 UTI > STI
take a sexual hx
elderly = predom catheter related
pyelonephritis what is it and cause
infection of renal parenchyma and soft tissues of renal pelvis / upper ureter
e coli main cause
triad symptoms pyelonephritis
loin pain
fever
pyuria
rx pylonephritis
IV ABx - gentamicin / cotmox
cant use trimethroprim or nitrofuratoin as secreted too efficiently
drain obstructed kidney
analgesia
sepsis 6
3 in 3 out high flow oxygen IV ABx IV fluid resuscitation Lactate UO hrly cultures
