UTIs Flashcards
What are the key questions you want to ask in a UTI history
Frequency increases
Urgency increases
Nocturia
Dysuria => burning, stinging
Suprapubic tenderness
Cloudy, change in colour, blood, odour?
What conditions do you want to rule out during this consultation
Pyelonephritis
- fever, rigors
- flank pain
- N+V
Sepsis - hypotensive, tachycardia
Pregnancy - pregnancy testing
STDs -
What factors increase your risk of UTIs
Neurological conditions => overactive bladder, stress incontinence, issues with emptying
Diabetes
Immunosuppression, recent antibiotics
Urolithiasis
Bladder catheterisation
Sexual activity/pregnancy
Past history of UTI
What would you do on examination
Vital signs => check for sepsis/systemic illness
Palpate flank/superopubic => tenderness, pelvic/abdo mass
-consider pyelonephritis, obstruction, malignancy
Check catheter for blockages
Consider genital examination for vaginal atrophy/herpes simplex/STD
What investigations would you do in a GP setting
-how would you interpret the results
OFTEN NO TESTING NEEDED - increased urinary frequency, dysuria is almost always a UTI
Urine dipstick => nitrites, leukocytes, RBCs
-UTI likely if => N/L + RBCs
-UTI likely if => L only, send sample for culture to confirm diagnosis
-UTI less likely if => none found, consider another diagnosis
If previous ABx treatment failed/possibility of resistance => MCS
How would you manage a UTI
-conservative
-pharmacological
How would you safety net
Conservative
- paracetamol/ibuprofen for pain
- fluids
Pharmacological - often resolves with time, can delayed prescribe so patient can collect ABx if they feel they need them
- trimethoprim/nitrofurantoin (safe in pregnancy) for 3 days
- if catheter associated => remove/replace catheter if possible, nitrofurantoin/amoxicillin
Symptoms worsen/fail to improve within 2 days of Abx => consider pyelonephritis, sepsis
-send for culture/susceptibility testing
