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PCM III Final > UTI, pyelonephritis, sepsis > Flashcards

UTI, pyelonephritis, sepsis Flashcards

1
Q

Urethritis

A

-no upper tract symptoms

predisposing factors

1) Frequent intercourse
2) Multiple partners
3) Inconsistent condom use

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2
Q

best test for urethritis due to STI

A

Antigen for GC & Chlamydia**- risk of STI;
will not show on standard urine dip, micro
or cultures

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3
Q

predisposing factors for UTI’s in women

A

Use of spermicide as with diaphragm for
contraception
Frequent sexual intercourse
20 – 30 % have recurrence

Diabetic women 2-3 times higher
incidence of UTI’s than non-diabetics
(There isn’t sufficient information
regarding diabetic men)

Recurrence in post-menopausal females
thought related to:
- History of pre-menopausal UTI’s
- Anatomic factors affecting bladder emptying
○ Cystoceles
○ Urinary Incontinence
○ Residual urine
- Tissue effect of estrogen depletion
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4
Q

predisposing factors of UTI in men

A

Prostatic hypertrophy
Non-circumcised – E coli more likely to
colonize glans & prepuce (foreskin)

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5
Q

Asymptomatic bacteriuria (ABU):

A 
urine sample is obtained for another
reason & shows bacteria on microscopic
evaluation
- Health screening
- Diabetes follow-up

*dont treat unless symptomatic

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6
Q

uncomplicated UTI

A

Non-pregnant female
No anatomic abnormalities
No instrumentation of the urinary tract

UTI much more common in females until
mid-life

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7
Q

complicated UTI occurs in

A

ANY pregnant female since:

  • 2 patients
  • Can lead to premature labor
  • Low birth-weight babies
Complicated UTI’s can occur in men or women
- Anatomic variant eg polycystic kidneys
- Foreign body in the urinary tract
○ Stones
○ Urinary catheters
○ Nephrostomy tubes/ureteral stents
- Extrinsic compression of ureter/bladder
○ Tumors
○ Profound constipation
○ Other anomalies
- Immune suppression conditions
○ Diabetes
○ Drug induced
○ HIV/AIDS
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8
Q

Untreated Asymptomatic Bacteriuria in pregnant pts

A

likely to
result in symptomatic pyelonephritis in a
pregnant patient
- More likely to develop sepsis

*TREAT

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9
Q

whats the most imp thing to do with complicated UTIS

A

-take HISTORY

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10
Q

urethral stent

A

– placed to help pass stones or
keep ureter open with extrinsic masses eg
colon or GYN

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11
Q

Differential Diagnosis – Dysuria

in female

A

Urethritis

  • Gonorrhea
  • Chlamydia
  • Herpes

Cystitis – frequency, urgency, nocturia,
hesitancy, hematuria

Vaginitis

  • Candida
  • Trichomonas

Cervicitis

  • Chlamydia
  • Neisseria

Non-infectious vaginal or vulvar irritation

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12
Q

interstitial cystitis

A 
Aka “Painful Bladder Syndrome”
 Chronic – in contrast to acute infectious
process
 Etiology unknown
 Possible contributing factors
- Chronic bladder infection
- Inflammatory factors
- Unusual pain sensitivity
- Functional co-morbidities
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13
Q

Differential Diagnosis – Dysuria

in males

A

Urethritis

  • Gonorrhea
  • Chlamydia

Cystitis

Prostatitis

Pyelonephritis

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14
Q

diagnostics for dysuria

A

UA (Urinalysis)

  • Urine dipstick (aka reagent strip)
  • Urine microscopic

Urine culture and sensitivity – will not
identify GC and Chlamydia

Must order urinary antigen for GC and
Chlamydia if STI (Sexually Transmitted
Infection) is suspected**

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15
Q

when is a urine culture not indicated?

A

when dip and micro are negative

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16
Q

antibiotics for GC

A

ceftriaxone and Azithromycin

17
Q

antibiotics for chlamydia

A

-azithromycin or doxycycline

18
Q

antibiotics for cystitis

A

trimethoprim-sulfamethoxazole

19
Q

antibiotics for pyelonephritis

A

fluoroquinolone eg levofloxacin

20
Q

prostatitis

A 
Infectious or non-infectious
 With or without hypertrophy
 Can be chronic in prostatic hypertrophy
 Pain in prostatic, pelvic or perineal area
(“where I sit down"

Prolonged antibiotic course necessary
4-6 weeks

21
Q

when should you use a nephrostomy tube?

A
  • bad hydronephrosis

- bad metastatic cancer

22
Q

pyelonephritis

A 
Generally sicker
 Fevers/chills
 Body aches esp back (flank) pain
 Typically ascending from lower tract
infection
 Positive CVA (Costovertebral Angle)
tenderness
23
Q

test for pyelonephritis

A

-lloyds punch

24
Q

most common precursors of pyelonephritis

A 
Same as UTI
- Since most commonly ascending from lower tract
- Most common organism is E. Coli
 Bacteremia develops in 20-30 % of cases
 Can be hematogenous spread to kidney
instead of ascending, but very rare
- Candida
- Salmonella
- Staph aureus
25
Q

Three Major Subtypes/

Complications of Pyelonephritis

A
  1. Papillary Necrosis (muddy brown casts)
  2. Emphysematous pyelonephritis (gas producing organism)
  3. Xanthogranulomatous pyelonephritis
26
Q

papillary necrosis

A

Can occur in:

  • Obstruction
  • Diabetes
  • Sickle Cell
  • Analgesic nephropathy (NSAIDS)
27
Q

Emphysematous pyelonephritis

A

Production of gas in nephric and
perinephric area
Occurs almost exclusively in diabetic
patients

28
Q

Xanthogranulomatous pyelonephritis

A 
Chronic obstruction
 Chronic infections
 Causes suppurative destruction of renal
tissue
 Can lead to abscess formation

*white cells and white cell casts, muddy brown casts

29
Q

what symptom indicates sepsis?

A
  • hypotension

- indicates organ dysfunction and decreased oxygenation of organs and brain leading to confusion

30
Q

bacteremia

A

simply means blood cultures are positive

31
Q

sepsis (aka septicemia)

A
  • Suspected or documented infection and an acute increase
    in organ failure
  • Dysregulated host response to infection
32
Q

septic shock

A

– progressive organ dysfunction
leading to marked increase in mortality
- Subset of sepsis
- Vasopressor therapy needed to maintain mean arterial
pressure at 65 mmHg or greater
-Serum lactate greater than 2 mmol/L (18mg/dL)

33
Q

what do you give somebody in septic shock?

A

fluid bolus

34
Q

what happens to organs during sepsis?

A

Decreased oxygen delivery

Impaired removal of cellular waste

Kidney receives 20- 25% of cardiac output

DOUBLE WHAMMY to kidney: Direct tubular damage by
endotoxins and inflammatory cytokines

35
Q

signs and symptoms of septic shock

A

Signs of infection: fever or hypothermia

Tachycardia: cardiac response to hypoperfusion and
fever

Tachypnea: compensatory respiratory response

Hypotension*: may be unresponsive to fluid
resuscitation and need vasopressors

Circulating cytokines

Endothelial injury: decreased tone, increased permeability
Edema

Decreased oxygenation of tissues

Build up of lactic acid

36
Q

prevention of recurrent UTIS

A

“Preventive strategy is indicated if
recurrent UTIs are interfering with a
patient’s lifestyle” (HPM)

Antibiotic therapy

  • Continuous
  • Post-coital
  • Patient-initiated
37
Q

non medication preventive strategies in women for UTIS

A

Empty bladder as soon as reasonable after
intercourse

Wipe front to back after toileting

Showers instead of tub baths

Lactobacillus probiotics

Cranberry products

Vitamin C

Increased fluid intake*

PCM III Final (11 decks)

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