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60 Cards in this Set

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what is...

1. when you cant hold your bladder
2. peeing
3. peeing excessively at night
4. lots of volume
5. peeing often
6. painful urination
7. difficult urination
8. bacteria in urine
9. pus in urine
10. infection anywhere in the UT
1. ENURESIS: when you cant hold your bladder
2. MICTURATION: peeing
3. NOCTURIA peeing excessively at night
4. : POLYURIA: : lots of volume
5. FREQUENCY: peeing often
6. DYSURIA: painful urination
7. DYSURIA: difficult urination
8. BACTURIA: bacteria in urine, cal also have asymptomatic bacturia
9. PYURIA: pus in urine, WBC means infection usually
10. UTI: infection anywhere in the UT
what is
acute cystitis?
Acute Pyelonephritis?
Chronic Pylonephritis?
Acute bacterial prostatitis?
Chronic bacterial prostatitis?
acute cystititis- infected bladder epithelium

Acute Pyelonephritis- infection of renal parynchema

Chronic Pylonephritis- inflammation/scarring of renal parynchema. seen in kids with chronic UTI/vesicurectal reflux

Acute bacterial prostatitis- uropathogens cause infection, prostate is tender, sx of cystitis

Chronic bacterial prostatitis- recurrent prostatic infection
what is a complicated UTI
anyone who is not a healthy young non pregnant woman

**complications: may have fever, nausea, flank pain,
DM
Old
Pregnant
men
vesicourethral reflux
catheter
obstruction
what is a relapse of UTI?


what is reinfection of UTI?
recurrence of bug in original isolate within 2 weeks after tx ends


new bacteria
what are some natural ways we prevent UTI
1. peeing at regular frequency
2. emptying bladder completely
3. mucopolysaccharide layer of bladder that is anti adherant/antibacterial
4. angled uretocystic junction- prevents reflux from bladder into ureter
5. Urethra- keeps the buggy outside away from the sterile bladder
what are some thigns that increase UTI in male and female
MALE:
old, DM, anal, uncircumsized, catheter, neuro issues, anatomical/obstruction

FEMALE:
same but diaphragm, spermicide, pregnant
why the increase risk of UTI with diaphragm adn spermicide
alter normal flora so that bugs can attach easier
what are most uncomplicated UTI's caused by
E coli

**it migrates from the rectum to urethro
Recurrent or complicated UTI's are associated with what?

what bug/
long term catheterization, recent AB use

*Proteus- urea splitter, urine pH >8
pseudomonas
Klebsiella
Serratia
Providencia
Enterobacter
Enterococcus
what can cause pyelonephritis
organsims ascend from outside to kidney

**infection of renal parynchema
why ask UTI pt about location and character of pain/discomfort
flank pain indicates pyelonephritis

itching when pee- vaginitis

burning when you pee- cystitis, urethritis

pain that comes and goes (colicky) and radiates to groin- stone
why ask how long a pt has been in pain when you think its UTI
sx >7 days pyelonephritis, non bacterial urethtitis, vagninis
what 3 things might present a little like UTI but last way longer (7 days or more)
1. Vaginitis
2. pyelonephritis
3. non bacterial urethritis
if a pt presents with UTI like things and has... does your ddx change

1. fever, vomit,

2. vaginal/penile dischagre
1. pyelonephritis

2. vaginitis/STD
why do you ask a pt if they have taken AB
it will make a test (-)
it increases likelihood of resistance

**sometimes pts take their left over AB they have around the house
why ask a pt with UTI sx if they have had it before
find out when and determine if you have relapse (same bug 2 weeks after tx) or reinfection (new infection)
you always need to get the whole story, including PMH. whats the dignificance of tehse assoiated with UTI

1. DM

2. Sickle Cell/NSAIDS
1. DM increases risk of asocaited kidney issues (abcess, papillary necrosis)

2. papillary necrosis, ureter onstruciton
on physical exam for a pt presenting with UTI what does it mean if they have

1. Fever
2. Tachycardia, hypotension, altered mental status
1. pyelonephritis (also have CVA tenderness)
2. sepsis, volume depletion
what might you think if a pt has CVA tenderness with UTI sx
pyelonephritis (also fever)
what are the 2 things you are looking for on abdominal exam for person with UTI sx
1. Kidney: enlargement may indicate polycystic kidney

2. Bladder, shouldnt be percussable or palpable. if its full of pee you can
why do a pelvic for pts with sx of UTI
if they have vaginal discharge/odor, painful sex, itching or pain do a pelvic

1. can be VD: gonorrhea, chlamydia, PID, cystocele, urethrocele
what is the presentation for acute cystitis
1. dysuria
2. frequency
3. urgency
4. suprapubic pain
5. hematuria
**common in pregnant ppl
so if we have dysuria, frequency, ugency, we may think acute cyctitis, what if there is also: fever, flank pain, nausea, vomit, malaise
acute pyelonephritis

if they dont have flank pain its prbly something else!

dangerous for kids nad oldies
whats the big word for stones. whats hte presentation for stones?
Nephrolithiasis, Ureterolithiasis

Colicky flank pain that radiates to groin

dysuria, hematuria,
Acute Pyelonephritis:

Clinical Findings
Dx Test Results
Clinical: fever, flank pain, CVA tenderness

Dx: UA shows pyuria, bacteriuria, white cell clasts

**infection of renal parynchema
when do you see white cell clasts
in the urine of ppl with acute pyelonephritis, infection of renal parynchema

**not always seen though bc the speciman is handled rough and they break all apart
Cystitis:

Clinical Findings:
Dx test results:
Clinical: suprapubic pain, dysuria, uegency, frequency, some hematuria

Dx: Pyuria, bacteriurea
Urethritis-Chlamydia

Clinical Presentation
Dx test
Clinical: new sexual partner, discharge, dyruria

Dx: pyuria WITHOUT bacteruria. positive chlamydia test
Urethritis- Gonococcal

Clinical Findings
Dx test
Clinical: cervical or penile discharge, hx of gono in pt or partner

Dx: gram - intracellular diplococci (pyuria WOTHOUT bacteruria)
prostatitis

Clinical Findings
Dx test results
Clinical: super tender prostate, perineal or suprapubic pain, dysuria, fever, urinary retention. deep ache with LBP

Dx: pyuria, bacteruiria, leukocytosis, L shift
Epididymitis

Clinical Findings
DX
Clinical: enlarged epididymis, dysuria, painful, discharge if STD

Dx: leukocytosis, L shift, pyuria, bacteruiria. if STD will have + std test
Stones

Clinical Presentation
Dx test
Clinical: Flank pain that may radiate to groin (if stone in ureter), colicky, hematuria, dysuria,

Dx: hematuria WITHOUT bacteriura/ + IVP or CT for stones
Vaginitis

Clinical Presetation
Dx test
Clinical: vaginal discharge, itch, irritation

Dx test: culture- yeast, trichomonadas
ok so you can tx UTI on histroy alone and can even do telephone treatment. what needs to be the sx
1. dysuria
2. frequency
3. NO VAGINAL DISCHARGE/Irritation

** good way to treat uncomplicated UTI
how shoudl you collect UA for cystitis and pyelonephritis
clean catch,

wipe, collect midstream for "sterile" urine
what is normal urine pH, what if its higher?
5-9

more basic indicates proteus, this is an ammonium splitter that makes the pee more basic
what does nitrites in the urine mean
bacteria

**they spilt nitrates into nitrites, nitrites not normally found
what does leukocyte esterase on dipstick indicate
WBC
how can you tell if there is bacteruiria?
what about pyuria
Bacteriura: nitrite (bugs convert nitrite to nitrate)

Pyuria; leukocyte esterase (indicates WBC)
what sthe best way to ID pyuria? what can be used as an alternative?
microscopic
can use leukocyte esterase in dipstick analysis as alternate
what do you tthink if leukocyte esterase is negatine
think non infectious cause
so its good to lookfor WBC on microscopy, what about bacteria
not really, they are too tiny!
what values give us good reason to suspect an infection?
pyuria nad bacteruira seen together!

when its just pyuria it may be STD
what does a comtaminated speciman look like
Epithelial cells on microscopic exam
is a urine culture necessary for UTI
not for an uncomplicated one (non pregnant female)

But shoudl take a culture for:
1. men
2. recurrent/relapse
3. complicated UTI
4. pyelonephritis
5
when take a CBC for pt presenting with dysuria
looking for systemic infection

*fever, flank pain, nausea/vomit,

Leukocytosis/left shift indicate systemic infectino
what additional tests might you order if you think a pt has sepsis
1. CBC
2. Blood Culture
3. Renal fx test
why might you order imaging for dysuria
1. recurrent pyelonephritis
2. relapsed cystitis
3. stone
4. fever >72 hrs after tx
5. male
6. in a child with UTI
when do you US a kid with UTI
always!!

when they have thier first bladder infection it can indicate a problem in the urinary tracy, do US on the whole thing
how do we manage fever and pain for UTI
1. Fever: should go away with tx, if its there for more than 72 hours maybe a resistant orgamism

2. Pain: phenazopyridine (pyridium), 2 days
what is the tx plan for out patient acute pyelophritis?

what about in patiend
1. Ciprofloxacin or Fluoroquinolone for 7-14 days. no systemic effects (can have low fever and slight WBC elevation)

2. In Patient: if vomiting, IV meds until the fever is gone for 24 hrs, continue on oral AB
how is an uncomplicated acute cystitis treated
3 days of oral AB:

TMP-SMX
nitrofurantoin monohydrate
flouroquinolones
how long do you treat?

uncomplicated UTI
Complicated UTI
3 days (TMX-SMX, flouroquinolens, nitrofurantoin)

7 days (broad spectrum AB)
Drugs to tx pyelonephritis?

Drugs to tx cystitis
fluoroquinolone- ciprofloxacin


flouroquinnolones (cipro andothers), TMP-SMX (bactrum)
e coli causes what?
proteus causes what
Uncomplicated UTI
Basic Urine
can you tx UTI prophylatically
yep, if they have more than 3 UTI/year and dont have other things goind on

can take a pill after sex or every night (TMX-SMX, Nitrofurantoin, Cephalaxin)
what is self initiated UTI therapy
woman can administer AB herself if she knows she has one
how is estrogen cream used for UTI
keeps the pH normal in post menopausal women
should we screen for asymptomatic bacteruria in,,,


1. Preggos
2. men
3. non preg woman
1. yes (canbe asymptomatic
2. no
3. no

**screen with a culture
**Tx asymptomatic bacteruria in preggos and ppl about to have urologic procedure
if a child presents with back pain, abd pain, and dysuria/frequency and you are thinking UTI what can abother sx be that adults dont ahve
incontinence