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GU: UTIs & Prostatitis Flashcards

1
Q

most common cause(s) of UTIs

A
  1. E. coli - overall m/c
  2. s. saphrophyticus - in young, sexually active women
  3. klebsiella
  4. proteus
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2
Q

demographic most commonly affected by UTIs?

A

women

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3
Q

what are the most manifestations of UTIs?

A
  • urethritis
  • cystitis
  • hemorrhagic cystitis
  • asymptomatic bacteriuria (ABU)
  • pyelonephritis
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4
Q

urethritis presentation?

A

UTI manifestation: only urethra inflamed

  • dysuria
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5
Q

cystitis presentation?

A

UTI manifestation: urethra + bladder inflamed

  • dysuria AND
    • urgency / increased frequency / small urine volume
    • suprapubic tenderness - pre & post micturition
    • pyruria (WBCs in urine)
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6
Q

hemorrhagic cystitis

A

UTI manifestation: inflammation of urethra + bladder

  • sx of cystitis + blood in the urine
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7
Q

how to distinguish cystitis from glomerulonephritis?

A

cystitis will not present with

  • HTN
  • abnormal renal function
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8
Q

pyelonephritis - presentation

A

UTI manifestation: urethra + bladder + uteters + kidneys affected

  • sx of cystitis, AND
    • back pain
      • flank pain
      • costo-vertebral angle tenderness
    • systemic affects:
      • fever
      • nausea/vomiting
      • immune: PERIPHERAL LEUKOCYTES, WBC casts
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9
Q

untreated pyelonephritis can progress to?

A

sepsis

septic shock

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10
Q

UTI relapse vs UTI reinfection

A
  • relapse: recurrent UTI < 2 weeks after preceeding infection
  • reinfection: recurrent UTI > 2weeks after preceding infection
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11
Q

when do males start to experience a rapid increase UTIs?

A
  • their 5th decade
  • d/t inc incidence of BHP
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12
Q

major risk factors for UTIs

A
  • other GU problem: kidney stones, prostatitis
  • catheters
  • sexual intercourse
  • pregnancy
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13
Q

dx of a UTI

A

confirm pyuria and bacteriuria

  • pyruria: confirmed by
    • + dipstick test for leukocyte esterase
  • bacteriuria: confirmed by
    • + dipstick test for nitrite (note that s. saphrophyticus does NOT reduce create nitrites)
    • gram stain
    • semiquantitative test
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14
Q

dx of cystitis (acute uncomplicated)

A
  • reliable hx:
    • at least 1 cystitis symptom
    • pt has risk factors for UTI
  • if not reliable hx:
    • pyuria or bacteriuria dipstick tests
      • > 1,000 CFUs/ml
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15
Q

pyelonephritis (acute, uncompicated) dx

A
  • reliable hx
    • physical exam indicative (dysuria + inc frequency/small volume + suprapubic pain + flank pain/costo-verbral tenderness + fever/nausea/vomiting)
  • additional lab tests of hx not reliable:
    • CFUs > 10,000
    • WBC casts
    • Ab-coated bacteria
      • is bacteria makes it to the kidneys, it is more likely to contact the blood being filtered and trigger an immune response- will be attacked with & coated by Ab
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16
Q

Ab coated bacteria in a urine sample are indicative of what UTI manifestation?

why

A

pyelonephritis

if the microbe advances to the kidney, it will interface with blood & thus stimulate an immune response (Abs)

17
Q

dx of asymptomatic bacteriuria (ABU)

A

CFH > 100,000

  • in women: two specimens needed (same species)
  • in men: single specimen needed
18
Q

how to collect urine if trying to dx cystitis

A

patient will urinate for a few seconds to expel the urine at the distal end o the urethra, then urine will either be collected:

  • midstream
  • pt will stop and then start again, then that urine collected
19
Q

what demographics should and should not be treated for ABU?

A
  • do not treat - elderly
  • do treat -
    • pregnant women
    • GU tract procedure pre-ops
    • renal transplants
20
Q

proteus has what virulence factors?

describe clinical significance

A
  • factors
    • produces urease, which makes urine basic (>8)
    • has fimbrae
21
Q

m/c cause of prostatitis

A
  • acute bacterial prostatitis
    • E. coli
  • chronic bacterial prostatitis
    • E. coli (m/c)
    • enterococcus
22
Q

acute bacterial prostatitis - presentation

A

like cystitis + systemic sx + genital pain + abnormal prostate exam

  • cystitis sx
    • urinary sx
      • hesitancy
      • poor, interrupted stream
      • straining / incomplete emptying
    • suprapubic pain
  • external genital pain - testes/penis
  • systemic - fever / chills, nausea / vomiting
  • prostate - warm, tender, enlarged, boggy
23
Q

chronic bacterial prostatitis presentation

A

sx presence > 3 mos: urinary sx + systemic affects + back pain + genital pain +/- abormal prostate exam

  • urinary sx
    • hesitancy
    • poor, interrupted stream
    • straining / incomplete emptying
  • back pain (low back pain, not flank pain like pyelonephritis)
  • external genital pain - testes / penis
  • systemic sx - low grade fever, arthralgia/myalgia
  • prostate exam
    • normal or tender/boggy
24
Q

contrast the digital exam findings for acute vs chronic bacterial prostatitis

A
  • acute prostatitis
    • warm / enlarged / tender / boggy
  • chronic prostatitis
    • normal, or tender / boggy
25
what sx do acute and chronic bacterial prostatitis share?
* **urinary sx** - straining / poor, interrupted stream / incomplete emptying * **external genital pain** * **fever**
26
compare / contrast the systemic sx of acute vs bacterial chronic prostatitis
* acute * **high fever** * **chills** * emesis / vomiting * chronic * **low grade fever** * myalgia / arthralgia
27
chronic nonbacterial prostatitis-presentation
* like chronic bacterial prostatitis * **external genital pain** * **low back pain** * **prostate tender/boggy** - 50% * unlike chronic bacterial * **pain along inner aspect of thighs** * **_no_ recurrent UTIs** * can be either * inflammatory (+ leukocytes) * non-inflammatory (- leukocytes)
28
explain the PPMT test * clinical use? * steps?
* use: to differentiate between different types of _chronic prostatitis:_ * bacterial vs inflammatory nonbacterial vs non-inflammatory nonbacterial * process: * initial stream to clear distal urethra urine, then _two mid-stream collections_ * **VB2:** taken after 1st prostate massage * **VB3**: taken after 2nd prostate massage
29
chronic bacterial prostatitis would have what PPMT test result?
* VB2 - negative * VB3 - positive * + for bacterial counts * + for leukocytes
30
chronic nonbacterial inflammatory prostatitis would have what PPMT results?
* VB2 - negative * VB3 - mixed * - bacterial counts * + for leukocytes
31
chronic nonbacterial non-inflammatory prostatitis
* VB2 - negative * VB3 - negative * - for bacterial counts * - for leukocytes
32
how many CFUs are seen in a urine culture for * cystitis * pyelonephritis * ABU
* cystitis - 1,000 * pyelonephritis - 10,000 * ABU - 100,000
33
ABU can progress to what UTI manifestation? describe the clinical significance
* can cause **pyelonephritis in pregnant women.** this can then lead to * premature birth * low birth weight * pregnant women _must_ have urine sample screen during gestation * dx of ABU made by \> 100,000 CFUs. * if positive: these pts must be treated

IDIS (12 decks)

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