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35 Cards in this Set
- Front
- Back
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What is the most common route for UTI infection?
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urethra
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What are different mechanisms that a UTI can spread?
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• ascending infection
• hematogenous spread • lymphogenous spread • direct extension (from another organ) |
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What are factors that increases the susceptibility of UTIs?
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• female anatomy
• incomplete emptying of the bladder • lack of fucosyltransferase activity in mucosal secretions • more adhesin receptors |
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Besides E. coli, what is a common causative agent of UTIs in children?
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adenovirus
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What are risk factors for UTIs?
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• anatomic abnormalities of the GU tract
• diabetes • estrogen deficiency • instrumentation (ex. catherization) • pregnancy • urethral epithelial changes |
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What are signs and symptoms of acute cystitis?
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• dysuria
• gross hematuria • supra-pubic discomfort • urinary frequency • urinary urgency * symptoms can appear post intercourse |
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What will urinalysis show in patients with acute cystitis?
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• bacteriuria
• hematuria (varying degrees) • pyuria (positive nitrites) |
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When are imaging studies indicated in patients with UTIs?
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• anatomic abnormalities
• recurrent infections • suspepcted pyelonephritis |
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When would you treat acute cystitis with IV antibiotics (as opposed to PO)?
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• IV antibiotics when there is greater than 50,000 WBC in urine
• PO antibiotics when the patient appears generally healthy with UTI symptoms |
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What are treatment options for acute cystitis?
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• Cephalexin
• Ciprofloxacin • Nitrofurantoin • Norfloxacin • Ofloxacin • Trimethoprim-sulfamethoxazole |
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What can be used to provide symptomatic relief in patients with acute cysitis?
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• hot sitz bath
• phenazopyridine (Pyridium) |
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What is the DOC for UTI in pregnancy?
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Nitrofurantoin (Macrobid)
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What is asymptomatic bacteriuria?
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presence of actively multiplying organisms in the urinary tract without any obvious symptoms
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Which patients are more susceptible to asymptomatic bacteriuria?
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• women (2x more susceptible)
• diabetics (3x more susceptible) |
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What are the bacterial causes of asymptomatic bacteriuria?
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• E. coli (most common ~ 80%)
• Enterobacter • Klebsiella • Proteus • Serratia |
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Acute pyelonephritis during pregnancy puts the mother at risk for what?
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• ARDS
• bacterial endotoxemia • diminished RBCs • endotoxic shock • increased incidience of anemia • pulmonary dysfunction • renal dysfucntion • renal failure |
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Acute pyelonephritis during pregnancy puts the fetus at risk for what?
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• prematurity
• small-for-gestational age |
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What are treatment options of UTIs in pregnancy?
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• Cephalosporins, ampicillin, nitrofurantoin (10-14 days)
* follow-up culture 1-2 weeks after therapy is initiated and culture Q monthly for remainder of pregnancy |
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What are some drugs (that treat UTIs) that should be avoid during pregnancy?
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• sulfa drugs
• Bactrim/Septra |
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What are treatment options for pyelonephritis in pregnancy?
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• Ampicillin, Cephalosporin IV
* if no improvement in 48-72 hrs, gentamicin or tobramycin |
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What are causative agents for pyelonephritis?
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• Gram-negative bacteria (most common):
- E. coli - Enterobacter - Klebsiella - Proteus - Pseudomonas • Gram-positive bacteria - Enterococcus - S. aureus |
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What are signs and symptoms of pyelonephritis?
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• chills
• CVA tenderness • dysuria • fever • flank pain • nausea/vomiting/diarrhea • tachycardia • urinary frequency • urinary urgency |
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Nephrolithiasis can present similiarly to pyelonephritis. Generally, how can you differentiate between the two by the quality of pain?
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• Nephrolithiasis: sharp, stabbing pain in the flank that radiates down the ureter; crescendo-decresendo pattern
• Pyelonephritis: constant, dull, achy pain; does not radiate |
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Severe infections or complicating factors for pyelonephritis require hospital admission. What antibiotics should be used?
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IV ampicillin + aminoglycoside
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What antibiotics can be used to treat pyelonephritis in the outpatient setting?
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• quinolone
• nitrofurantoin |
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Besides infection, what are other causes of chronic pyelpnephritis?
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• analgesic nephropathy
• diabetes • hypokalemic nephropathy • ischemia • uric acid nephropathy |
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What is the definition of interstitial cystitis?
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• pain with bladder filling & relieved by emptying
• associated with urgency and frequency |
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What are signs and symptoms of interstitial cystitis?
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• pain with bladder filling relieved by urination
• urinary frequency & urgency • nocturia |
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Interstitial cystitis is a diagnosis of exclusion. What other processes must be rule-out first?
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• cancer
• exposure to pelvic radiation & cyclophosphamide • genital herpes • infectious causes • urethral diverticulum • vaginitis |
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What are treatment options for interstitial cystitis?
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• symptomatic relief
• Amitriptyline • DMSO • Heparin • transcutaneous electric nerve stimulation (TENS) & acupuncture • surgical cystoyrethrectomy (last resort) |
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What are the different classifications of unriary incontinence?
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• total incontinence
• stress incontinence (most common) • urge incontinence • overflow incontinence |
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What are characterisitics of total incontinence?
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• pts lose urine at all times & in all positions
• caused by loss of sphincteric efficiency or fistulas |
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What are characteristics of stress incontinence?
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• associated wiht activites that result in an increase in intra-abdominal pressure (ex. coughing, sneezing, laughing)
• small spurts of urine loss in a brief period • usually in upright or sitting position • structural causes (cystocele, urethrocele) |
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What are characteristics of urge incontinence?
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• uncontrolled loss of urine (large amounts over several seconds) that is preceded by a strong unexpected urge to void
• unrelated to poisition or activity • indicative of detrusor hyperrelfexia or sphincter dysfunction (loss of bladder inhibition) • associated with urgency & nocturia |
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What are characterisitcs of overflow incontinence?
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• due to chronic urinary retention
• incontinence results from the chronically distended bladder recveiving an additional increment of urine • intravesical pressure exceeds the outlet resistance • small amount of urine dribbling out • caused by obstruction or loss of neurologic control • associated with fullness, pressure, & frequency |
