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Clin Med GI > UTIs > Flashcards

UTIs Flashcards

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1
Q

If you are not symptomatic for a UTI despite having a postive culture, do you treat?

A

No, typically not

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1
Q

What is suggestive of a UTI? Is this diagnostic?

A

100,000 cfu/mL (colony function units)
pyuria is also not diagnostic, but it is helpful

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2
Q

What is asymptomatic pyuria and when is it typically.

A

10^5 cfu
Less estrogen makes it easier to invade

This is why we only check if symtomatic

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3
Q

What is unsolved bateriuria and what can cause it?

A

Failure to sterilize urinary tract during UTI tx

Not taking meds correctly, resistance to AB

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4
Q

What can cause persistent bacteruria?

A

When the tract is sterilized, but there is a source of bacteria elsewehere:

Infected stone, prostatitis, foreign bodies, fistulas

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5
Q

What is the MC way UTIs spread and why does this make UTIs more common in women?

A

Ascending (90-95%)

Ascent up the urethra, bladder, ureters
Short urethra in women → much higher UTI incidence

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6
Q

Other than ascending, what are other ways UTIs spread?

A

Direct Extension - from local infected tissue (e.g., intraperitoneal abscess)

Hematogenous - rare - Staph aureus

Lymphatic - rare

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7
Q

What are some risk factors of UTIs?

A

Abnormal voiding (including vesicoureteral reflux)
Diminished renal blood flow (decreases immune response)
Intrinsic renal disease
Abnormal urine pH, osmolality (creates a more favorable environment)
Deficient mucosal coating

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8
Q

How does intercourse make it more common for women to get UTIs?

A

Honeymoon cystitis because intercourse pushes bacteria closer to bladder

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9
Q

What type of male is more likely to have a UTI?

A

Prostatitis
Foreskin (allows areas for bacteria to grow)

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10
Q

What is acute cystitis and what is the MC bacteria?

A

Typically what people have when they say “I had a bacterial infection)

Almost all bacteria
E coli is MC

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11
Q

If a male has recurrent UTIs, what should you investigate?

A

Underlying etiology like vesicouretal efflux

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12
Q

What is the classic triad of acute cystitis?

A

irritative voiding (dysuria, frequency, urgency),
suprapubic pain, +/- gross hematuria +/- malaise

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13
Q

What is the PE of acute cystits?

A

Exam - suprapubic tenderness possible
Minimal/no signs of systemic toxicity

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14
Q

When would you see CVA tenderness?

A

If pyleo - if just the bladder, you do not see it

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15
Q

What are the labs of acute cystitis?

A

Pyuria, hematuria, bacteriuria
Leukocyte esterase, urinary nitrate
Urine culture + for causative organism

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16
Q

When would you order a UA for acute cystits?

A

Don’t have to order (but can) unless

drug resistance, hospital stay, recent AB

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17
Q

What is the first-line AB therapy for acute cystits?

A

Macrobid, because it only concentrates in the urine (aka Nitrofurantoin)

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18
Q

What are other AB therapy for cystits that might not be first line (but still not second-line)

A

Bactrim (or trimethoprim if sulfa allergy)
Fosfomycin

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19
Q

What are the second-line and third line AB therapy of acute cystitis?

A

Amoxicillin/clavulanic acid, Cephalosporins

Third line
Fluroquinolones

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20
Q

What is the Phenazopyridine and SE?

Study These Flashcards
A

Urinary analgesics
unknown MOA
CI: renal insuffiency or HTN
SE: discolored urine

rare: AKI, hemolytic anemia, methemoglobinemia

21
Q

What is methanine?

Study These Flashcards
A

Urinary analgesics/antimicrobials
MOA becomes ammonia
SE: rash, nausea

can elevate LFTs

22
Q

What is a Sitz bath?

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A

A bath for cystits, sit on the toilet (warm bath)

23
Q

What are some other supplemetal treatments of Acute cystits?

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A

Sitz baths
Increased PO fluid intake
Cranberry juice or supplement
Probiotics
Vaginal estrogen

24
What are non-pharmalogical therapy of cystits?
Voiding Voiding after intercourse Minimizing urinary retention Other Patient Habits Adequate PO fluid hydration Avoiding causative meds Wiping “front to back” “Breathable” undergarments (cotton - not leather or spandix) Supplements Probiotics Cranberry juice/supplement D-mannose supplement (found in cranberries, sugar-based molecule that may coat the bladder)
25
What DM med can cause recurrent UTIs?
-glifazon SGLT2 inhibtors
26
Itsy bittsy spider memory?
Itsy bitsy spiders climb up water spout and then you pee the spiders out
27
What is consider frequent UTIs?
3+ UTIs in a 12-month period
28
When should you do prevention of UTIs?
3+ UTIs in a 12-month period and tried other non-pharm therapy TMP-SMZ 40/200 mg/d Trimethoprim 100 mg/d Nitrofurantoin 100 mg/d Cephalexin 250 mg/d Methenamine 500-1000 mg BID
29
What is pyelonephritis? What is the MC cause
Kidney infection MC d/t bacteria sometimes progression of cystits
30
What microbe can travel through hematologic route?
staph aureus
31
What are the s/s of pyelonephritis?
fever, chills, N/V/D, flank pain Exam - fever, tachycardia, CVA tenderness fever can be masked by ibruprofen
32
What do you order if you for imaging if you suspect pyelonephritis?
CT - preferred - can show renal inflammation, abscess US - can show hydronephrosis, may show abscess
33
What are the labs of pyelo?
Labs - pyuria, hematuria, bacteriuria, +/- WBC casts Leukocyte esterase, urinary nitrite possible Urine culture - + for heavy growth of causative organism CBC - leukocytosis with left shift Blood culture - may or may not be +
34
What color is fluid on a CT?
Dark
35
What is the outpatient therapy for pyelo?
Able to tolerate PO, have help, can do oral. Can start with IV before they go levofloxacin, ciprofloxacin, trimethoprim-sulfamethoxazole - amoxicillin/clavulanate treatment is longer then cystits
36
What is a CI of treatment for pyelo?
CI - nitrofurantoin, oral fosfomycin Because these only make it to the urine and do not get to the kidneys
37
When do you do inpatient therapy for pyelo?
Unable to tolerate PO fluids/meds, severe illness, complicated case (sepsis, obstruction), non-compliant
38
What is the inpatient therapy?
No risk for MDR G- : IV ceftriaxone, IV piperacillin-tazobactam, IV ampicillin/gentamicin, or IV/oral fluoroquinolones If MDR G+ suspected - add on vancomycin, linezolid or daptomycin 1+ risk factors for MDR G- : IV carbapenem (imipenem, meropenem, or doripenem) If highly resistant - IV extended-spectrum cephalosporin + BL inhibitor If MDR G+ suspected - add on vancomycin, linezolid or daptomycin May switch to PO as pt improves clinically and can tolerate PO intake - 14 d total tx
39
What are complication of pyelo?
Worried about damage to kidneys Sepsis/Septic shock Scarring and nephron loss Chronic pyelonephritis Requires antibiotic tx for 3-6 mo Similar medications to acute pyelonephritis Major renal abscess formation May necessitate surgical drainage
40
Why do abscess form quickly?
Kidney is delicate and the body wants to wall it off ASAP
41
What is acute urethritis and the MC cause?
Only the urethra is the problem typically an STD 1 cause Neisseria gonorrhoeae #2 cause Chlamydia trachomatis #3 cause - Mycoplasma genitalium #4 Trichomonas vaginalis also emerging as etiology ascends to the urethra
42
MC demographic of acute urethritis
MC in sexually active young men can occur in anyone
43
What are the s/s of acute urethritis?
irritative voiding (dysuria, frequency, urgency), pain/pruritus at urethral meatus, urethral discharge Discharge - from scanty/thin/watery to thick/purulent/copious Asymptomatic - Up to 10% of gonococcal urethritis and 42% of NGU
44
Which urethritis has the most discharge?
Gonorrohea
45
What is a NAAT used for?
diagnosis of gonorrhea/chlamydia can get back w/in 15-30 min
46
How do you do a UA for urethritis?
FIRST discharge because this is where the bacteria bost likely is
47
Treatment of gonorrhea
ceftriaxone
48
Treatment of chlamydia
azithromycin
49
Treatment of gonorrhea
doxycycline

Clin Med GI (10 decks)

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