Pathophysiology 1 Flashcards Preview

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Flashcards in Pathophysiology 1 Deck (29):
1

Bacteriuria

-bacteria in urine (UTI or colonization)

2

Pyuria

-pus in urine (WBC)

3

"significant" bacteriuria

-10^5 colonie forming units per mL

4

Dysuria

-pain/burning on urination

5

Lower Urinary Tract Infection

-bladder infection (cystitis)

6

Urethritis

-inflammation of urethra, trauma, chemical hurt (dysuria)

7

Pyelonephritis

-infection of renal pelvis, kidney collecting system

8

Acute Urethra Syndrome

-frequent urination, urgency, burning, dysuria
-can happen if no infection

9

Causes of Dysuria

-50% clasic cystitis >10^5
-10% herpes urethritis
-14% unknown
-8% chlamydia
-bacterial lower UTI 10^2-4/mL

10

UTI Epidemiology

-most common bacterial infection
-infants: males>females
-years 3-50: females>>>males
-elderly >65 increased bacteriuria, multiple factors
-greater with intercourse
-greater with pregnancy (4-10% all women), 25% progression

11

Bacteria that cause UTIs

-95% from GI tract
-E. coli is most common
-staph. saprophyticus
-other "niche" organisms

12

Does the type of birth control matter with UTIs?

-yes
-diaphragm changes angle of urethra
-spermicidal changes flora of vagina
-oral pill is best for lowest bacteria

13

Route of Infection of UTIs

-ascending 95%
urethral trauma, intercourse, instrumentation, diaphragm
-hematogenous <5% (endocarditis, etc.)

14

Mechanisms of UTIs

-adhesion: fimbrie to stick to uroendothelial cells
-colonization: replicate in urinary tract
-invasion: evade host defense, go to soft tissue
-phase variation: shift antigens/virulence factors

15

Type 1 Fimbriae

-mano sensitive (blocked by adding manose, b/c it will bind to the manose)

16

P-fimbriae

-named for P antigen of blood group
-causes pyelonephritis

17

Do bacteria need Fe?

-yes, rate limiting step of growth
-will lyse RBC if needed

18

Host Defense Mechanisms for UTIs

-bacterial growth inhibition
-urine flow
-epithelial cell turnover (sloughed off)
-antibodies (target bacteria)

19

Factors that predispose to UTIs

-urine flow obstruction
-female factors
-abnormal urine flow
-urethral trauma
-vesiculo-ureteral reflux
-instrumentation
-general health (bad hygiene)

20

Hydroureter

-ureter dilates because urine flow is blocked

21

Symptoms of Lower UTI

-frequency of urination
-dysuria
-turbid urine
-suprapubic discomfort
-hematuria
-asymptomatic cystitis

22

Symptoms of Upper UTI

-fever
-chills
-flank pain & "CVAT" costovertebral angle tenderness
-asymptomatic pyelonephritis

23

Diagnosis of UTI

-microscopic urinalysis (screening)
-gram stain of urine
-urine culture
-blood cultures for pyelonephritis
-screening tests

24

Complications of UTI

-gram - sepsis
-intrarenal or extrarenal abscess
-chronic renal insufficiency
-struvite renal calculi (infections not Ca)
-recurrent infection

25

Prevention of UTI

-proper use of urinary catheterization
-correction of anatomic abnormalities
-prophylactic antibiotics (rare)

26

Treatment of UTI

Lower: men - 1 week (prostitis)
women - 1-3 days (longer if complicated)
Upper: 1-6 weeks, IV & oral combo
***don't treat asymptomatic bacteriuria unless pregnant***

27

Treat Upper UTI

-ceftriaxones

28

What gets UTI drug in prostate?

-ciprofloxacin

29

Treat Pyelonephritis?

-fluoroquinalones