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UTI
Clinical Medicine II
| Question | Answer |
|---|---|
| UTI | urinary tract infection along ANY part of the urinary tract |
| What is a LUTI | cystitis or urethritis |
| Lower bladder mucosal defenses | emptying, protective layer (mucus), urine properties (pH, osmolarity, urea, glycoproteins) |
| causes of UTI | via blood, lymph, fisturla, MC urethra |
| MC bacterial cause of UTI | E. coli (~90%), Staph. Saprophyticus (~5-10%) |
| When is UTI very crucial to diagnose | neonates→leads to sepsis |
| When do we see UTIs in males | >50, uncommon <50. |
| Recurrent UTI’s in children, what do we need to suspect | sexual abuse |
| How does a UTI occur | colonized area, fimbriae and biofilm works up the urethra and colonizes in the bladder |
| What are the poor host defense mechanisms that may occur | damaged epithelial cells, urethral spincter, ↓ glycoproteins, poor emptying, urine pH/ osmolarity imbalance, change in flora |
| What are predispostiions for men for UTIs | obstruction (prostate) and no circumcision |
| Classic presentation of UTI | Frequency, urgency, Dyruria (burning) |
| Is it nl for blood to be in the urine w/ UTI | yes, |
| Male, child, elderly s/s | M: hesitancy, hard to go, C: fever, listless, lethargy, E: dementia/delirum, behavior changes |
| When are UTI’s asymptomatic | pregnancy, or immunodepressed |
| Uncomplicated UTI | nl anatomic fxn, rare kidney damage even w/ recurrent |
| Complicated UTI | abnl anatomy, fxn, pre |
| 3 ways to get UA | clean catch, cath, suprapubic aspiration (usually on infants), wee bag |
| When do we culture UTIs | >65, preggo, DM, gross hematuria, sxs>3days, Tx w/I 2 weeks, |
| Recurrent UTI’s suggest | abuse, anataomical abnl |
| what are + lab findings | nitrates, leukocyte esterase, pyruira, bacteriuia (>10^5) |
| how do we assume the UA has been contaminated | epithelial cells present?, single species? |
| When do we culture urine samples | underlying conditions: >65, preggo, DM, immunodepressed, known UTI abnl, Sxs: gross hematuria, >3 days duration, fever, chills, flankpain, recurrent unresolved sxs post tx |
| What determines functional/anatomic abnormalities | excretion urography (IV and contrast) |
| Why would we do a KUB w/ US | define emptying see for stones/obstructions, scars/abscesses (limited) |
| What determines abnl bladder emptying | voiding cystourethrogram |
| Is a VCUG used for acute UTI’s | no |
| Why would we do a cystoscopy | explude bladder lesion, abnl emptying, hematuria, abacteriuria |
| When are sxs more vague | until age 2, others: constipation hygiene techniques? |
| When should we refer | relapsing ifx, anomalys, painless hematuria, childhood |
| Tx for UTIs | abs, fluids, |
| Pregnancy complications from UTIs | low birth wt, miscarriage, sepsis |
| Childhood problems for UTIs | HTN, proteinuria, renal fxn decline |
| Prevention of UTIs | fluids, frequent voiding, hygiene and wiping |
| What is acute pyelonephritis | infection of pyelo-calical system |
| What is chronic pyelonephritis | progressive inflammation with destructive changes |
| How does pyelonephritis occur | extension of LUTI, from the blood, age (>40 M:F <40 F>M) |
| If S. aureus pyelo, comes from where | comes from blood |
| Sxs pyelo | FAST: dysuria, frequency, urgency, flank, loin, back pain/tenderness, |
| What are sxs for elderly | ↑ nero signs, ↓ temp |
| PE findings for pyelo | fever, CVAT, abd tenderness, pyuria, abscess? |
| RFs for pyelo | uretrevesicular refluc, intrarenal reflux, dilated ureters, indwelling catheters, stones, immunosuppression, previous pyelo, elderly, preggo, neuro conditions |
| What is specific for pyelo in the labs | WBC casts |
| When do we admit patients for pyelo | prego, extremes of age, acute distress/sepsis, persistent V/pain, comorbidities, lack of improvement, stable? Adherent? |
| Tx for pyelo | abx, fluids, ultrasound, culture |
| Emphysematous pylo | death w/ DM |
| What causes chronic pyelo | most seen w/ obstructions |
| If pyelo common in kids | reflux tends to go away with puberty |
| Sequelae of chronic pyelonephritis | HTN→chronic/severe→renal insufficiency →ESRF |
| Nl specific gravity, pH of UA | <1.003 |
| What is nl RBC and WBC | <2 |
Created by:
becker15
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