Flashcards in Genitourinary Deck (378)
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331
What is severe sepsis?
sepsis and end organ damage, hypotension with SBP2mmol
332
What is septic shock?
severe sepsis with perisitant hypotension
333
Management of urosepsis?
diagnose with screening sepsis tool, treat with sepsis 6, manage systemic factors, relieve pressure with catheter and nephrostomy
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What is the sepsis 6 treatment?
high flow o2, blood cultures, iv antibiotics, iv fluid resuscitation, check lactate, monitor hourly urine output
must do this within one hour then critical care support to complete early goal directed therapy
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What is asymptomatic bacteriuria?
normal urine is sterile but is coming increasing common and may need treatment in pregnancy and children, bacteria ispresent in all catheterised patients
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Why should you not treat asymptomatic bacteriuria?
increases antibiotic resistant organisms and does no sterilise the system or reduce the number of bacterial species, should only be done if symptoms occur
337
Why are intermittent self catheters preferred?
lowest risk of catheter related complications, and provides max protection for kidneys and better QoL
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What is a UTI?
inflammatory response of urothelium to bacterial invasion associated with bacteruria and pyuria
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What is the main organism to cause UTIs?
E.coli
coagulated proteus sp., enterococci, Kiebsiella sp.
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What is bacteriuria?
prescence or bacteria in the urine that can be asmyptomatic or symptomatic
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When does bacteriuria need treating?
in pregnancy due to the risk of pyelonephritis and preterm labour risk
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What is the difference between pathogenic and contaminant bacteriuria?
pathogenic is single isolate and contaminant is mixed growth
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In who is bacteriuria most common?
over 70s, females, catheters, less common in those who have been circumcised
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What is pyruria?
prescence of leukocytes in urine, appearing as pus in the urine, associated with infection as it is the hosts tissue response
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Causes of pyruria?
treated UTI, appendicitis, calculi, bladder tumour, papillary necrosis, PKD, chemical cystisis, tubulointerstitial nephritis
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Symptoms of cystisis?
dysuria, frequency, urgency, pain, haematuria, cloudy, smell
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Treatment of cystisis?
hydration, cranberry, ibuprofen, antibiotics
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Diagnosis of cystisis?
urine multistix dipstick
nitrates and leucocytes means UTI in 98.5% of cases as nitrates are a product of bacteria
haematuria
pH >8 in urea splitting infections
S9 raised in concentrated/protein rich urine
proteinuria
glucose - DM increases UTI risk
ketones - raised in catabolic states
MC+S, clean catch
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What is classed as a complicated UTI?
males, pregnant, children, reucrrent infection, immunocompromised, nasocomial infection, structural/functional abnormality, SIRS, urosepsis, associated disease
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Treatment of uncomplicated UTI?
antibiotics e.g. trimethoprim, nitrofuratoin
increased fluids, void pre and post sex
hygiene
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Causes of antibiotic resistance?
extended spectrum B lactamase production reduces effectiveness of penicillins and cephalosporins
DNA changes e.g. plasma mediated, altered binding sires, altered permeability
repeated antibiotic course or not finished antibiotics
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What is classed as a recurrent UTI?
>2 episodes in 6 months or >3 in 12 months
caused by reinfection, bacterial persistance or unresolved infection
can be same or different organism >2 weeks after stopping antibiotics
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What is a UTI relapse?
recurrance of bacteriuria with the same organism within 7 days of completing treatment
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Treatment of complicated UTI?
MSU needed, longer antibiotics course, USS scan, avoid spemicides and perfumed soaps, vaginal oestrogen replacement, prosnthrocyadins (cranberry), prophylaxis, GAG replacement, urovaxom for Ecoli infection
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How many pregnant women will develop pyelonephritis?
20%
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What complications can complicated UTIs lead to?
renal papillary necrosis, renal or perinephric abscess with gram negative septicaemia
357
Who is most likely to get prostatitis?
men of all ages, most common one in men
358
What is the NIDDK/NIH classification for prostatitis?
1 - acute bacterial with s.faecalis and ecoli and chlamydia, presents with systemically unwell, fevers, rigors, significant voiding, pelvic pain, swollen prostate, treat with analgesia and levofloxacin
2 - chronic bacterial or non bacterial, symptoms >3 months, recurrent, pelvic pain, voiding LUTS, uropathogens and blood in urine, treat with anti inflammatorys and a blockers
3 - chronic pelvic pain syndrome and can be inflammatory or non inflammatory
4 - asymptomatic inflammatory prostatitis
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Treatment of prostatitis?
1 - antibiotics e.g. gentamicin and co-amoxycillin
once well, 2-4 weeks quinolone
IRUSS guided abscess drainage if >1cm
2 - 4-6 weeks quinolone and a blocker and NSAIDs
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