W3L1 UTI Flashcards
Host defense mechanisms?
A- Preventing bacteria from colonizing vagina
B- Eliminating bacteria that enter the bladder
C- Urine
Definition UTI?
- Presence >105 CFU/ml urine with/out symptoms
- Inflammatory response of urothelium to organism invasion leading to symptoms
Classification Bacteriuria & Pyuria?
- Bacteriuria
- Symptomatic
- Asymp - Pyuria
- Sterile
- Infection
Etiology?
- Causative organism
- Bacterial: E coli (80%)
- fungal: candida alb
- Protozoal: T vaginalis
- parasitic: Bilharziasis Oxyuris - Route of inf
- Asc-bl-lymph-others
3. Predis Factor A.General: - DM - Immune compromized patients - Chronic debilitating diseases B. Local: - Stones - Indwelling catheters - VUR - Obstruction
Classification UTI
- Uncomplicated UTI:
- Episode UTI in otherwise healthy individual
- No predisposing factors
- No functional/structural abnormalities
- Occasional lower UTI in women - Complicated UTI:
- All other UTIs.
- Factors predicting :- RF, DM, Tx
- Obstructive uropathy
- Perioperative
- Radiation/chemical injury
Nonspecific UTI?
- Urethritis
- Cystitis
- Pyelonephritis
- Epididymitis
- Epididymoorchitis
- Prostatitis
ACUTE PYELONEPHRITIS Incidence?
- > females
- Childhood
- Puberty
- Soon after marriage
- pregnancy
- menopausal
Clinical Features AP?
- Prodromal symptoms: Anorexia, headache, malaise
- Pain
- Fever
- Cystitis
- Tender loin
Investigations AP?
- Pyuria
- Leukocytosis
Management AP?
- Broad spectrum ab until
- Not very unwell:
- No need for hospitalization
- Ab: fluoroquinolone oral(10-14d)
- Symptomatic - Very ill patient
- Hospitalization.
- IV antibiotic:3rd gen cephalosporin IV/IM(10-14d)
Causes CHRONIC PYELONEPHRITIS?
- Recurrent attacks of acute pyelonephritis
- VUR
- Stone disease
- Previous surger
Pathology CP?
- Interstial inflammation & scarring renal parenchyma.
- Tubules atrophy
- THEN glomeruli (fibrosis & hyaline change)
Clinical Features CP?
- Constitutional symptoms: Anorexia, headache, malaise - Pain: Dull aching - Fever: Low grade in attacks - Cystitis - HTN - Anemia
Management CP?
- Ttt causes (stones)
- Chronic suppresive therapy
- Nephrectomy
CP/Inv PERINEPHRIC ABSCESS?
- Loin pain & tenderness
- Attacks high grade fever
- Oblitrated posas shadow(KUB)
- US & CT(diagnostic)
Management PA?
- Unilocular: PCTD
- Multilocular: open drainage
Incidence/ PF/ Organism CYSTITIS?
- >females (25%) PF: - Incomplete empty bladder(BPH, stricture) - Foregin body(stone, tumor) - Colonization perineal skin(E.coli) - Estrogen deficiency
CP/Inv Cyst?
- Urinary frequency (earliest symptom) - Painful micturition
- Pyuria
- Hematuria
- Suprapubic tenderness
- Urine analysis / C&S
DD Cy
- Acute urethritis
- Acute vaginitis
Management Cy
- General & symptomatic: Increase fluid intake
- Simple urinary antiseptics/Antimicrob
- If persistent symptoms: investigate for predisposing factors
Classification PROSTATITIS?
- Acute bacterial prostatitis (ABP)
- Chronic bacterial prostatitis (CBP)
- Chronic pelvic pain syndrome (CPPS)
A: inflammatory B: non inflammatory - Asymptomatic inflammatory prostatitis (histological prostatitis)
CP/Inv ABP?
- Fever & rigors
- LUTS
- Pain (SP, perineal, genital)
- DRE: Tender prostate boggy swelling if abcess is present
- Culture organism(diagnostic)
Management ABP?
- General & symptomatic: Increase fluid intake/ Antipyretic/ Bed rest
- Specific: Ab >=1m(IV till acute phase subside)
- Drainage of the abscess if present
CP/Inv CBP?
- Recurrent UTI.
- Asymptomatic between episode
- Intermittent low grade fever
- DRE: normal/slightly enlarged
tender prostate/not indurate, nodular - Prostatic massage: pus cells & bacteria in prostatic fluid
Management CBP?
- Specific: Ab >= 3m according to C&S
- Fluoroquinolones(choice)
- Consider prophylaxis
CHRONIC NON BACTERIAL PROSTATITIS
▪AE unknown. ▪Symptoms (pain and LUTS) ▪>3 months ▪Wax and wane with time ▪No bacterial infection.
ASYMPTOMATIC INFLAMMATORY PROSTATITIS
▪Asymptomatic
▪Detected only in histology
▪No treatment except surgical procedure is needed
Etiology, Route of infection and predisposing factors Acute Epidiymo-
orchitis?
▪Ascending infection( most common) ▪Hematogenous ( mumps) ▪UTI ▪Instrumentation. ▪Prostate or bladder surgery. ▪ST
CP/Inv AEO
▪General: FHMA ▪Pain ▪LUTS ▪Tender scrotal swelling ▪Urine analysis/ C&S ▪Scrotal US & doppler
Management AEO?
- General:
- Bed rest
- Local: lead subacetate fomentations testicular elevation
- Systemic: analgesic & antipyretic - Specific:
- STD: ( Gono&Non Gono-Coccal)- Ceftriaxone IM
- Doxycycline(100mgx2 daily)
- Azathioprine(14d)
- Non STD: - well: oral quinolone
- un well: IV ab(1m)
