Upper Urinary Tract Infection Flashcards
What are the Sx/signs of pyelonephritis?
High fever
Loin pain w/ tenderness
Bacteriuria
Rigors, vomiting, oliguria
What are the Sx of cystitis?
Frequency & nocturia Dysuria Urgency Haematuria Odorous urine Suprapubic pain/tenderness Strangury
What are the predisposing factors for UTIs?
Female (short urethra) Pregnancy Menopause Obstruction/tract malformation Catheter (100%, if asymptomatic do not investigate) Diabetes (glycosuria, reduced defences)
What are the common bacteria associated w/ UTIs?
E.coli (75%) Proteus Staphylococcus Streptococcus Klebsiella Pseudomonas
What UTI Sx are more common in the elderly?
Confusion or delirium-like state Agitation Hallucinations Behavioral changes Poor motor skills or dizziness Falling
What investigations are appropriate for a suspected UTI?
Urine dipstick (double +ve nitrites/leukocytes) Midstream urine MCS (>10^5 organisms/ml)
What are the causes of a sterile pyuria?
Recently treated URTI Appendicitis TB Chylamydia Bladder cancer
What is strangury?
Painful, frequent urination of small volume, expelled only be straining despite a severe sense of urgency
When can UTI treatment be started empirically?
Symptomatic women if nitrates & leucoytes +ve
In what groups is further investigation indicated?
Males Children Treatment-resistant UTIs Recurrent UTIs Pyelonephritis Abnormal organism grown
What further investigations may be required in UTI?
USS (?renal scarring, obstruction, hydronephrosis)
CT/IV urography (?stones, tumours, diverticula)
How are UTIs managed conservatively?
Drink plenty of fluids & urinate often
What empirical treatment is available for women presenting w/ cystitis?
Nitrofurantoin 100mg BD for 3/7
-review when MCS comes back
What treatment options are available for pyelonephritis?
IV Tazocin 4.5g TDS for 7/7
-review when MCS comes back
How should UTIs/asymptomatic bacteriuria be treated in pregnant women?
Always treat, follow local guidelines
