W3L1 UTI

Question 1

Host defense mechanisms?

Answer 1

A- Preventing bacteria from colonizing vagina
B- Eliminating bacteria that enter the bladder
C- Urine

Question 2

Definition UTI?

Answer 2

• Presence >105 CFU/ml urine with/out symptoms

- Inflammatory response of urothelium to organism invasion leading to symptoms

Question 3

Classification Bacteriuria & Pyuria?

Answer 3

1. Bacteriuria
   - Symptomatic
   - Asymp
2. Pyuria
   - Sterile
   - Infection

Question 4

Etiology?

Answer 4

1. Causative organism
   - Bacterial: E coli (80%)
   - fungal: candida alb
   - Protozoal: T vaginalis
   - parasitic: Bilharziasis Oxyuris
2. Route of inf
   - Asc-bl-lymph-others

3. Predis Factor
A.General:
- DM
- Immune compromized patients 
- Chronic debilitating diseases 
B. Local:
- Stones
- Indwelling catheters
- VUR
- Obstruction

Question 5

Classification UTI

Answer 5

1. Uncomplicated UTI:
   - Episode UTI in otherwise healthy individual
   - No predisposing factors
   - No functional/structural abnormalities
   - Occasional lower UTI in women
2. Complicated UTI:
   - All other UTIs.
   - Factors predicting :
   • RF, DM, Tx
   • Obstructive uropathy
   • Perioperative
   • Radiation/chemical injury

Question 6

Nonspecific UTI?

Answer 6

1. Urethritis
2. Cystitis
3. Pyelonephritis
4. Epididymitis
5. Epididymoorchitis
6. Prostatitis

Question 7

ACUTE PYELONEPHRITIS Incidence?

Answer 7

• > females
• Childhood
• Puberty
• Soon after marriage
• pregnancy
• menopausal

Question 8

Clinical Features AP?

Answer 8

• Prodromal symptoms: Anorexia, headache, malaise
• Pain
• Fever
• Cystitis
• Tender loin

Question 9

Investigations AP?

Answer 9

• Pyuria

- Leukocytosis

Question 10

Management AP?

Answer 10

1. Broad spectrum ab until
2. Not very unwell:
   - No need for hospitalization
   - Ab: fluoroquinolone oral(10-14d)
   - Symptomatic
3. Very ill patient
   - Hospitalization.
   - IV antibiotic:3rd gen cephalosporin IV/IM(10-14d)

Question 11

Causes CHRONIC PYELONEPHRITIS?

Answer 11

• Recurrent attacks of acute pyelonephritis
• VUR
• Stone disease
• Previous surger

Question 12

Pathology CP?

Answer 12

1. Interstial inflammation & scarring renal parenchyma.
2. Tubules atrophy
3. THEN glomeruli (fibrosis & hyaline change)

Question 13

Clinical Features CP?

Answer 13

- Constitutional symptoms: Anorexia,
headache, malaise
- Pain: Dull aching
- Fever: Low grade in attacks
- Cystitis
- HTN
- Anemia

Question 14

Management CP?

Answer 14

• Ttt causes (stones)
• Chronic suppresive therapy
• Nephrectomy

Question 15

CP/Inv PERINEPHRIC ABSCESS?

Answer 15

• Loin pain & tenderness
• Attacks high grade fever
• Oblitrated posas shadow(KUB)
• US & CT(diagnostic)

Question 16

Management PA?

Answer 16

• Unilocular: PCTD

- Multilocular: open drainage

Question 17

Incidence/ PF/ Organism CYSTITIS?

Answer 17

- >females (25%)
PF:
- Incomplete empty bladder(BPH, stricture)
- Foregin body(stone, tumor)
- Colonization perineal skin(E.coli)
- Estrogen deficiency

Question 18

CP/Inv Cyst?

Answer 18

• Urinary frequency (earliest symptom) - Painful micturition
• Pyuria
• Hematuria
• Suprapubic tenderness
• Urine analysis / C&S

Question 19

DD Cy

Answer 19

• Acute urethritis

- Acute vaginitis

Question 20

Management Cy

Answer 20

• General & symptomatic: Increase fluid intake
• Simple urinary antiseptics/Antimicrob
• If persistent symptoms: investigate for predisposing factors

Question 21

Classification PROSTATITIS?

Answer 21

1. Acute bacterial prostatitis (ABP)
2. Chronic bacterial prostatitis (CBP)
3. Chronic pelvic pain syndrome (CPPS)
   A: inflammatory B: non inflammatory
4. Asymptomatic inflammatory prostatitis (histological prostatitis)

Question 22

CP/Inv ABP?

Answer 22

• Fever & rigors
• LUTS
• Pain (SP, perineal, genital)
• DRE: Tender prostate boggy swelling if abcess is present
• Culture organism(diagnostic)

Question 23

Management ABP?

Answer 23

• General & symptomatic: Increase fluid intake/ Antipyretic/ Bed rest
• Specific: Ab >=1m(IV till acute phase subside)
• Drainage of the abscess if present

Question 24

CP/Inv CBP?

Answer 24

• Recurrent UTI.
• Asymptomatic between episode
• Intermittent low grade fever
• DRE: normal/slightly enlarged
  tender prostate/not indurate, nodular
• Prostatic massage: pus cells & bacteria in prostatic fluid

Question 25

Management CBP?

Answer 25

- Specific: Ab >= 3m according to C&S - Fluoroquinolones(choice) - Consider prophylaxis

Question 26

CHRONIC NON BACTERIAL PROSTATITIS

Answer 26

``` ▪AE unknown. ▪Symptoms (pain and LUTS) ▪>3 months ▪Wax and wane with time ▪No bacterial infection. ```

Question 27

ASYMPTOMATIC INFLAMMATORY PROSTATITIS

Answer 27

▪Asymptomatic ▪Detected only in histology ▪No treatment except surgical procedure is needed

Question 28

Etiology, Route of infection and predisposing factors Acute Epidiymo- orchitis?

Answer 28

``` ▪Ascending infection( most common) ▪Hematogenous ( mumps) ▪UTI ▪Instrumentation. ▪Prostate or bladder surgery. ▪ST ```

Question 29

CP/Inv AEO

Answer 29

``` ▪General: FHMA ▪Pain ▪LUTS ▪Tender scrotal swelling ▪Urine analysis/ C&S ▪Scrotal US & doppler ```

Question 30

Management AEO?

Answer 30

1. General: - Bed rest - Local: lead subacetate fomentations testicular elevation - Systemic: analgesic & antipyretic 2. Specific: - STD: ( Gono&Non Gono-Coccal) - Ceftriaxone IM - Doxycycline(100mgx2 daily) - Azathioprine(14d) - Non STD: - well: oral quinolone - un well: IV ab(1m)