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Urology > 1: Infections of the kidney (cystitis, acute pyelonephritis, urethral syndrome) > Flashcards

1: Infections of the kidney (cystitis, acute pyelonephritis, urethral syndrome) Flashcards

1
Q

How are UTIs classified

A
  1. Upper or lower UTI

2. Simple or complicated UTI

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2
Q

How are UTIs classified

A
  1. Upper or lower UTI

2. Simple or complicated UTI

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3
Q

What counts as upper urinary tract

A
  • Kidneys

- Ureters

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4
Q

What is infection of the upper urinary tract called

A

Pyelonephritis

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5
Q

What is classed as lower urinary tract

A
  • Bladder
  • Urethra
  • Prostate in males
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6
Q

What is infection of the bladder

A

Cystitis

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7
Q

What is infection of the urethra

A

Urethritis

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8
Q

What population is a simple UTI

A

Non-pregnant pre-menopausal Immunocompetent women

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9
Q

Who is classified as a complicated UTI

A
  • Males
  • Post-menopausal females
  • Immunocompromised
  • Diabetes
  • Pregnant
  • Anatomical abnormalities of the urinary tract
  • Recent history instrumentation
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10
Q

What counts as upper urinary tract

A
  • Kidneys

- Ureters

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11
Q

What is infection of the upper urinary tract called

A

Pyelonephritis

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12
Q

What is classed as lower urinary tract

A
  • Bladder
  • Urethra
  • Prostate in males
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13
Q

What is infection of the bladder

A

Cystitis

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14
Q

What is infection of the urethra

A

Urethritis

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15
Q

What population is a simple UTI

A

Non-pregnant pre-menopausal Immunocompetent women

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16
Q

Who is classified as a complicated UTI

A
  • Males
  • Post-menopausal females
  • Immunocompromised
  • Diabetes
  • Pregnant
  • Anatomical abnormalities of the urinary tract
  • Recent history instrumentation
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17
Q

What is acute pyelonephritis

A

Inflammation kidney

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18
Q

What causes 90% of pyelonephritis

A

E.coli

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19
Q

What are two rare causes of pyelonephritis

A
  • Pseudomonas

- Klebsiella

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20
Q

In which gender is pyelonephritis more common and why

A

Females - due to shorter urethra meaning a shorter distance to travel

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21
Q

What are 4 risk factor categories for pyelonephritis

A
  • Increase bacteria
  • Increase binding
  • Decrease urinary flow
  • Increase bacterial growth
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22
Q

What 4 factors increase bacterial inoculation

A
  • Sexual activity
  • Urinary incontinence
  • Faecal inconitnence
  • Constipation
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23
Q

What increases binding of uropathogenic bacteria

A

Spermicide

Low oestrogen: menopause

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24
Q

What decreases urinary flow

A

Urinary tract obstruction

Dehydration

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25
Q

What increase bacterial growth

A 
DM
Pregnancy
Immunocompromised
Obstruction 
Renal tract malformation
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26
Q

How does pyelonephritis present clinically

A
  • Flank pain
  • Haematuria
  • Rigors
  • Vomiting
  • Symptoms of cystitis
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27
Q

What is found on examination in pyelonephritis

A
  • Tenderness over costa-vertebral angle
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28
Q

How can pyelonephritis occur

A
  • Ascending infection

- Haematogenously

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29
Q

What investigations are ordered in suspected pyelonephritis

A

Urinalysis
MC+S
FBC, U+E, CRP, BC
USS

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30
Q

What will be seen on urinalysis

A

leucocytes
nitrites
haematuria

31
Q

What will be found on MSU culture

A

WCC >10(^5)

32
Q

How will FBC present in pyelonephritis

A

Leucocytosis

33
Q

How will CRP present in pyelonephritis

A

Raised

34
Q

What % of individuals with pyelonephritis have a positive blood culture

A

10-20

35
Q

What imaging is ordered in pyelonephritis

A

USS

36
Q

When are individuals with pyelonephritis admitted to hospital

A

Severe

Indicators of systemic illness (eg. sepsis)

37
Q

How are non-pregnant women, men or those with an indwelling catheter managed for pyelonephritis

A

7-10d Cefalexin

Co-amoxiclav, Trimethoprim and Ciprofloxacin are all alternatives

38
Q

How are pregnant women with pyelonephritis managed

A

Cefalexin 7-10d

39
Q

What are 4 complications of acute pyelonephritis

A
  • Chronic pyelonephritis
  • Perinephric abscess
  • ESRD
  • Renal abscess
40
Q

When does chronic pyelonephritis occur

A

Due to recurrent acute pyelonephritis

41
Q

What is cystitis

A

inflammation of the bladder

42
Q

how is cystitis divided

A
  • Complicated UTI

- Uncomplicated UTI

43
Q

what is a uncomplicated UTI

A

Normal urinary tract function and structure

44
Q

what is a complicated UTI

A
  • Male
  • Pregnant women
  • Structural abnormalities urinary tract: stones, congenital anomalies, renal transplant
45
Q

in which gender is cystitis more common and why

A

Females- due to a shorter urethra

46
Q

what causes 80% of cystitis

A

E. coli

47
Q

what indicates cystitis due to proteus mirabilis

A

Alkaline urine

As proteus mirabilis produces urease causing ammonia smell

48
Q

how does cystitis present clinically

A
  • Urinary frequency
  • Urgency
  • Dysuria
  • Haematuria
  • Supra-pubic pain
49
Q

when is investigation not required for UTI

A

Non-pregnant female under 65-years with more than 3-symptoms of UTI

50
Q

when is urinalysis indicated for UTI

A

Non-pregnant female under 65 years with less than 3 symptoms

51
Q

when should urinalysis not be used to diagnose UTI

A

Male
Pregnant
Children

52
Q

what is present in urinalysis in UTI

A

Haematuria
Leucocytes
Nitrites

53
Q

what finding on urinalysis indicates proteus mirabilis is causing infection

A

pH >7

Due to proteus mirabilis producing ammonia which increases urinary pH

54
Q

what is second-line (in some) and first line (in others investigation for UTI

A

MSU

55
Q

what MSU indicates UTI

A

> 10 (^5)

56
Q

when is USS indicated for cystitis

A
  • Recurrent (more than 2 a year)
  • Atypical organism
  • Persistent haematuria despite treatment
  • Failure to respond to treatment
57
Q

How is uncomplicated UTI managed

A

3-days nitrofurantoin

58
Q

What is a CI to nitrofurantoin use

A

eGFR <45

59
Q

If nitrofurantoin cannot be used what is used

A

trimethoprim

60
Q

what is used for complicated UTI

A

7days nitrofurantoin

61
Q

explain antibiotics for UTI in pregnant women

A
  • Trimethoprim is anti-folate so can’t be used in first trimester
  • Nitrofurantoin cannot be used in third trimester
  • Amoxicillin generally preferred
62
Q

what are two complications of cystitis

A
  • Acute pyelonephritis

- Prostatitis

63
Q

what are two complications of UTI in pre-term

A

IUGR

Pre-term delivery

64
Q

what is prostatitis

A

Ascending infection infiltrates the prostate gland

65
Q

what are four risk factors for prostatitis

A
  • UTI
  • Recent biopsy
  • Instrumentration
  • Recurrent catheterisation
66
Q

what are symptoms of prostatitis

A
  • Obstructive symptoms
  • Pain referred to perineum
  • Fevers
67
Q

how will DRE present in prostatitis

A

Tender, boggy prostate

68
Q

what should be screened for in prostatitis

A

STI

69
Q

how is prostatitis managed

A

14d Fluroquinolones

70
Q

define asymptomatic bacteria

A

presence >10(^5) bacteria in urine

71
Q

when is asymptomatic bacteruria screened for

A

screened for in pregnancy due to risk of pre-mature delivery

72
Q

what is urethral syndrome

A

symptomatic abacteruria

73
Q

what causes sterile pyuria

A
  • GU TB
  • Urethritis (Chalmydia)
  • Renal stones
  • Appendicitis
  • Cancer
  • ADPKD

Urology (14 decks)

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