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35 Cards in this Set

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What is the most common route for UTI infection?
urethra
What are different mechanisms that a UTI can spread?
• ascending infection
• hematogenous spread
• lymphogenous spread
• direct extension (from another organ)
What are factors that increases the susceptibility of UTIs?
• female anatomy
• incomplete emptying of the bladder
• lack of fucosyltransferase activity in mucosal secretions
• more adhesin receptors
Besides E. coli, what is a common causative agent of UTIs in children?
adenovirus
What are risk factors for UTIs?
• anatomic abnormalities of the GU tract
• diabetes
• estrogen deficiency
• instrumentation (ex. catherization)
• pregnancy
• urethral epithelial changes
What are signs and symptoms of acute cystitis?
• dysuria
• gross hematuria
• supra-pubic discomfort
• urinary frequency
• urinary urgency

* symptoms can appear post intercourse
What will urinalysis show in patients with acute cystitis?
• bacteriuria
• hematuria (varying degrees)
• pyuria (positive nitrites)
When are imaging studies indicated in patients with UTIs?
• anatomic abnormalities
• recurrent infections
• suspepcted pyelonephritis
When would you treat acute cystitis with IV antibiotics (as opposed to PO)?
• IV antibiotics when there is greater than 50,000 WBC in urine
• PO antibiotics when the patient appears generally healthy with UTI symptoms
What are treatment options for acute cystitis?
• Cephalexin
• Ciprofloxacin
• Nitrofurantoin
• Norfloxacin
• Ofloxacin
• Trimethoprim-sulfamethoxazole
What can be used to provide symptomatic relief in patients with acute cysitis?
• hot sitz bath
• phenazopyridine (Pyridium)
What is the DOC for UTI in pregnancy?
Nitrofurantoin (Macrobid)
What is asymptomatic bacteriuria?
presence of actively multiplying organisms in the urinary tract without any obvious symptoms
Which patients are more susceptible to asymptomatic bacteriuria?
• women (2x more susceptible)
• diabetics (3x more susceptible)
What are the bacterial causes of asymptomatic bacteriuria?
• E. coli (most common ~ 80%)
• Enterobacter
• Klebsiella
• Proteus
• Serratia
Acute pyelonephritis during pregnancy puts the mother at risk for what?
• ARDS
• bacterial endotoxemia
• diminished RBCs
• endotoxic shock
• increased incidience of anemia
• pulmonary dysfunction
• renal dysfucntion
• renal failure
Acute pyelonephritis during pregnancy puts the fetus at risk for what?
• prematurity
• small-for-gestational age
What are treatment options of UTIs in pregnancy?
• Cephalosporins, ampicillin, nitrofurantoin (10-14 days)

* follow-up culture 1-2 weeks after therapy is initiated and culture Q monthly for remainder of pregnancy
What are some drugs (that treat UTIs) that should be avoid during pregnancy?
• sulfa drugs
• Bactrim/Septra
What are treatment options for pyelonephritis in pregnancy?
• Ampicillin, Cephalosporin IV

* if no improvement in 48-72 hrs, gentamicin or tobramycin
What are causative agents for pyelonephritis?
• Gram-negative bacteria (most common):
- E. coli
- Enterobacter
- Klebsiella
- Proteus
- Pseudomonas

• Gram-positive bacteria
- Enterococcus
- S. aureus
What are signs and symptoms of pyelonephritis?
• chills
• CVA tenderness
• dysuria
• fever
• flank pain
• nausea/vomiting/diarrhea
• tachycardia
• urinary frequency
• urinary urgency
Nephrolithiasis can present similiarly to pyelonephritis. Generally, how can you differentiate between the two by the quality of pain?
• Nephrolithiasis: sharp, stabbing pain in the flank that radiates down the ureter; crescendo-decresendo pattern
• Pyelonephritis: constant, dull, achy pain; does not radiate
Severe infections or complicating factors for pyelonephritis require hospital admission. What antibiotics should be used?
IV ampicillin + aminoglycoside
What antibiotics can be used to treat pyelonephritis in the outpatient setting?
• quinolone
• nitrofurantoin
Besides infection, what are other causes of chronic pyelpnephritis?
• analgesic nephropathy
• diabetes
• hypokalemic nephropathy
• ischemia
• uric acid nephropathy
What is the definition of interstitial cystitis?
• pain with bladder filling & relieved by emptying
• associated with urgency and frequency
What are signs and symptoms of interstitial cystitis?
• pain with bladder filling relieved by urination
• urinary frequency & urgency
• nocturia
Interstitial cystitis is a diagnosis of exclusion. What other processes must be rule-out first?
• cancer
• exposure to pelvic radiation & cyclophosphamide
• genital herpes
• infectious causes
• urethral diverticulum
• vaginitis
What are treatment options for interstitial cystitis?
• symptomatic relief
• Amitriptyline
• DMSO
• Heparin
• transcutaneous electric nerve stimulation (TENS) & acupuncture
• surgical cystoyrethrectomy (last resort)
What are the different classifications of unriary incontinence?
• total incontinence
• stress incontinence (most common)
• urge incontinence
• overflow incontinence
What are characterisitics of total incontinence?
• pts lose urine at all times & in all positions
• caused by loss of sphincteric efficiency or fistulas
What are characteristics of stress incontinence?
• 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)
What are characteristics of urge incontinence?
• 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
What are characterisitcs of overflow incontinence?
• 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