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Surgery AN > Urology- UTI > Flashcards

Urology- UTI Flashcards

(68 cards)

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1
Q

Define UTI

A

Symptoms + Bacteriuria (>10^5 CFU/ml)

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2
Q

What is the MOST COMMON Causative Organism for a UTI

A

Escherichia Coli

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3
Q

List the MOST COMMON Gram +VE Organisms which cause an UTI

A

Staphylococcus Saprophyticus, Staphylococcus Epidermis, Enterococcus Faecalis

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4
Q

What are the Risk Factors for a Post-Operative UTI

A

Female Gender, Co-Morbidities (DM, Renal Failure), Instrumentation, Pregnancy, Urinary Retention, Renal Stones

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5
Q

What are the SYMPTOMS for a UTI

A

Frequency, Urgency, Dysuria, Delirium

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6
Q

What are the SIGNS for a UTI

A

Supra-Pubic Pain, Pyrexia

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7
Q

What is the Management of Asymptomatic Bacteriuria in MOST CASES

A

Do NOT TREAT Asymptomatic Bacteriuria

Treating Asymptomatic Bacteriuria is ACTIVELY HARMFUL (Replace Low Virulence Organisms with something worse)

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8
Q

In what circumstances do you treat Asymptomatic Bacteriuria?

A

Pregnancy, Prior to Urological Surgery

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9
Q

What is the 1st line Management of a UTI in a Non-Pregnant Woman

A

3 day course of Nitrofurantoin (if eGFR >30) OR Trimethoprim

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10
Q

What is the Management of a UTI in a Non-Pregnant Woman if 1st Line Empirical Antibiotics FAIL

A

MSU Culture and Treat to Antibiotic Sensitivity

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11
Q

What is the Management of a UTI in a Pregnant Woman

A

GET EXPERT HELP

MSU Culture and Immediately Start Antibiotics

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12
Q

Why is it Important to get expert help when managing an UTI in a Pregnant Woman

A

UTI in Pregnancy is associated with Premature Birth and Intra-Uterine Growth Restrictions

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13
Q

What Antibiotics are started in the 1st Trimester of Pregnancy when Managing an UTI?

A

7 day course of Nitrofurantoin or Cefalexin

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14
Q

Which Antibiotic is AVOIDED when Managing an UTI in the 1st Trimester of Pregnancy

A

Trimethoprim (Acts as a Folate Antagonist)

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15
Q

What Antibiotics are started in the 2nd Trimester of Pregnancy when Managing an UTI?

A

7 day course of Nitrofurantoin OR Trimethoprim

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16
Q

What Antibiotics are started in the 3rd Trimester of Pregnancy when Managing an UTI?

A

7 day course of Trimethoprim or Cefalexin

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17
Q

Which Antibiotic is AVOIDED when Managing an UTI in the 3rd Trimester of Pregnancy

A

Nitrofurantoin

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18
Q

What is the Management of an UTI in a MALE

A

MSU Culture

7 day course of Nitrofurantoin (if eGFR >30) or Trimethoprim

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19
Q

What is the Management of Acute Pyelonephritis

A

MSU Culture

Broad-Spectrum Antibiotics (Co-Amoxiclav/Augmentin, Ciprofloxacin)

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20
Q

Under what Circumstances make Nitrofurantoin INEFFECTIVE against UTIs?

A

Pyelonephritis

Renal Failure

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21
Q

Define MGNO

A

Multi-Drug Resistant Gram Negative Organisms

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22
Q

What is the 1st Line Management of MGNO?

A 
Trimethoprim/Nitrofurantoin 
Oral Fosfomycin (If Sensitive)
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23
Q

What is the LAST Line Management of MGNO?

A

Meropenem

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24
Q

What is 1st Line Management of Recurrent UTIs in Women

A

USS (Exclude Structural Cause)

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25
What is the NON-Pharmacological Management of Recurrent UTIs in Women
Advise Fluid Intake, Avoid Synthetic Pants, Avoid Perfumed Soaps, Showers are BETTER than Baths, Correct Wiping Techniques
26
What is the Non-Antibiotic Management of Recurrent UTIs in Women
Topical Oestrogen if Post-Menopausal
27
What is the Antibiotic Management of Recurrent UTIs in Women
Start Single Dose of Antibiotic Post-Coital Self Start Antibiotic at 1st Sign of Symptoms Low Dose Continuous Prophylaxis
28
What are the Risk Factors for Pyelonephritis
Female, Vesicoureteric Reflex, Urinary Tract Obstruction, Diabetes Mellitus, Indwelling Catheter, Instrumentation
29
What is the MOST COMMON CAUSE for Pyelonephritis
Ascending Infection from Lower UTI
30
What are the Symptoms/Signs of Pyelonephritis
Fever, Loin Pain, LUTS, N/V | High WBC Count, Renal Angle Tenderness
31
What is the Management of Pyelonephritis if there is NO Response to 1st Line Treatment?
No Response within 24 hours -> Consider Hospital Admission (Exclusion of Obstruction with USS and IV Antibiotics) Failure of Response to Antibiotic Treatment suggests possible Pyonephrosis
32
Define Pyonephrosis
Infected Obstructed Kidney (Pus accumulates within Renal Pelvis and Calyces)
33
What are the Risk Factors for Pyonephrosis
Stone Disease, Previous UTI, Surgery
34
What is the Pathophysiology of Pyonephrosis
Hydronephrosis (secondary to Ureteric Obstruction) followed by an Infection
35
What are the Symptoms for Pyonephrosis
``` High Fever (Patient is VERY UNWELL) Loin Pain ```
36
What is the Management for Pyonephrosis
IV Fluids, Antibiotics, Urgent Percutaneous Nephrostomy
37
Define Acute Prostatitis
Infection of Prostate associated with Lower UTI and Generalised Sepsis
38
Define Pyelonephritis
Inflammation of Renal Pelvis secondary to Bacterial Infection
39
What is the MOST COMMON Causative Organism for Acute Prostatitis
Escherichia Coli
39
What is the MOST COMMON Causative Organism for Acute Prostatitis in a Young Male?
STI (Chlamydia Trachomatis, Neisseria Gonorrhoea)
39
What are the Symptoms of Acute Prostatitis
Pain (Genitalia, Buttocks, Lower Back) | Fever, Urinary Symptoms
39
What are the Signs for Acute Prostatitis
``` Systemic Toxicity (Fever, Tachycardia, Hypotension) Prostate is EXTREMELY TENDER on DRE ```
40
What is the Management of Acute Prostatitis if the Patient is Systematically WELL
MSU Culture | 4 week course of Ciprofloxacin or Trimethoprim
41
What is the Management of Acute Prostatitis if the Patient is Systematically UNWELL
IV Antibiotics + Pain Relief
42
What is another name for Chronic Prostatitis
Chronic Pelvic Pain Syndrome (CPPS)
43
Define Chronic Prostatitis
>3 month History of Pelvic/Perineal Pain +/- Urinary/Sexual Dysfunction
44
What is the Management of Chronic Prostatitis
6 week Course of Ciprofloxacin
45
Define Cremasteric Reflex
Stroking the Superior/Medial Thigh -> Contraction of the Cremaster Muscle -> Elevation of Testis
46
Define Epididymo-Orchitis
Acute Infection of Testis/Epididymis
47
What is the CAUSATIVE ORGANISM of Epididymo-Orchitis in YOUNG Men
Chlamydia Trachomatis, Neisseria Gonorrhoea
48
What is the CAUSATIVE ORGANISM of Epididymo-Orchitis in OLD Men
Coli Forms (Escherichia Coli)
49
List some Non-Bacterial Causes of Epididymo-Orchitis
Viral Mumps | Drug-Induced (AMIODARONE)
50
What are the Symptoms of Epididymo-Orchitis
Prodromal Infective Symptoms (Urethral Discharge) | SLOW ONSET of Unilateral Scrotal Pain
51
What are the SIGNS of Epididymo-Orchitis
Scrotal Erythema, Tenderness localised to the Epididymis (Behind the Testicle- Absence of Testicular Tenderness) +VE Prehn’s Sign, Cremasteric Reflex Present
52
Define Prehn’s Sign
Scrotal Elevation relieves Pain
53
What is the Management of Epididymo-Orchitis
First Void Urine for Chlamydia PCR, MSU Culture, USS (Exclude Abscess/Tumour) 14 day course of Oral Ciprofloxacin (+ Doxycycline in YOUNG Men) IV Antibiotics if Septic/Unwell
54
Describe the Presentation of the Scrotum following Antibiotics to treat Epididymo-Orchitis
Scrotum remains SWOLLEN for 4-6 weeks
55
Define Testicular Torsion
Twist of the Spermatic Cord resulting in Strangulation of the Blood Supply to the Testis and Epididymis (Testicular Artery)
56
What is the Age of ONSET for Testicular Torsion
<40 years old (Particularly TEENAGERS)
57
What are the Symptoms of Testicular Torsion
Rapid ONSET of SEVERE Pain in Hemi-Scrotum (Pain WAKES Patient from Sleep), Scrotal Swelling History of Mild Trauma to Testis hours before onset of Pain Similar Episodes in the Past with Spontaneous resolution of Pain
58
What are the Signs fo Testicular Torsion
High-Riding, Laterally Orientated Testis (Testis may lie Horizontally due to Twisting of the Spermatic Cord) Scrotal Erythema, Testicular Tenderness, -VE Prehn’s Sign, ABSENT Cremasteric Reflex
59
What is the 1st line Management fo Testicular Torsion
Emergency Scrotal Exploration of BOTH Testis
60
Why MUST BOTH Testis undergo Emergency Scrotal Exploration when Testicular Torsion is suspected
Bell-Clapper Abnormality which Predisposes to Testicular Torsion occurs Bilaterallty
61
What is the NEXT STAGE of Management if a VIABLE Testis is identified following Emergency Surgical Exploration of diagnosed Testicular Torsion?
Reduction and Orchiopexy (Surgery to move Undescended Testis/Cryptorchid into Scrotum and Permanently Fix it)
62
What is the NEXT STAGE of Management if a NON-VIABLE Testis is identified following Emergency Surgical Exploration of diagnosed Testicular Torsion?
Orchidectomy (Surgical Removal of Testis)
63
What are the COMPLICATIONS if Emergency Scrotal Exploration is Delayed for Testicular Torsion?
``` Permanent Ischaemic Damage to Testis (Atrophy, Loss of Hormone/Sperm Production) Sympathetic Orchidopathia (Auto-Immune reaction against Contralateral Testis secondary to Breakdown of Blood-Testis Barrier) ```
64
What is the MOST APPROPRIATE Management if there is ANY DOUBT of Diagnosis between Epididymo-Orchitis and Testicular Torsion
Emergency Scrotal Exploration is the Safest Option
65
What are the differences in Presentation between Epididymo-Orchitis and Testicular Torsion
Epididymo-Orchitis= Absence of Testicular Tenderness, +VE Prehn’s Sign, Cremasteric Reflex, Slow Onset of Scrotal Pain Testicular Torsion= Testicular Tenderness, -VE Prehn’s Sign, Absence of Cremasteric Reflex, Rapid Onset of Scrotal Pain

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