Genitourinary Tract Infections Flashcards Preview

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Flashcards in Genitourinary Tract Infections Deck (63):
1

Genitourinary Tract Infections types?
7

Acute Cystitis
Acute Pyelonephritis
Acute Bacterial Prostatitis
Chronic Bacterial Prostatitis
Infectious Stone Disease
Epididymitis
Fournier’s Gangrene

2

Cystitis refers to inflammation of the urinary bladder due to what?
5

Bacterial Infections (most common)
Stones
Interstitial Cystitis
Radiation
Bladder cancer

3

What is the most common GU infection in women?

Bacterial Cystitis

4

It is uncommon for men until around the age of 50. Why is it common then?

when the prostate enlarges and can cause bladder outlet obstruction.

5

What are the most common nosocomial infection?

Catheter-associated infections

6

Risk factors for Acute cystitis?
4

1. Incomplete bladder emptying
2. Sexual intercourse
3. Benign Prostatic enlargement
4. Stones

7

What conditions would cause incomplete bladder emptying?
4

-BPH
-Diabetes
-Neurologic
-Multiple Sclerosis

8

What is the most common bacteria accounting for 85% of community-acquired infections and 50% of nosocomial infections?

Escherichia coli (most commonly found in bowel)

9

What other organisms are common in UTI?
5

1. Proteus,
2. Klebsiella,
3. Pseudomonas,
4. Enterococcus faecalis, and 5. Staphylococcus saprophyticus

10

Which bacteria increase the urine pH and can lead to stone formation?
3

Proteus,
Klebsiella pneumoniae, and Staph. Saprophyticus

11

Acute cystitis Clinical Presentation?

5

Irritative voiding symptoms
1. Frequency
2. Urgency
3. Dysuria
4. Hematuria
5. Suprapubic discomfort

12

Dont ever treat someone who has a chronic indwelling catheter. Why?

Just creating resistance

13

What would be a finding on a physical exam for acute cystitis?

Patient’s may have suprapubic tenderness other wise the exam is usually normal

14

What lab work would we do for acute cystitis?
2

UA
Urine culture

15

How would we treat acute cystitis?

which drugs are first line and how often?
3 drugs

1-3 days of single dose antibiotic therapy

Antibiotic therapy
First-line drugs include:
1. Nitrofurantoin (first)
2. Trimethoprim-sulfamethoxazole
3. Cephalosporins

16

When should we use floroquinolones for acute cystitis?

Fluoroquinolones should be used for complicated infections due to increasing resistant E-coli strains

17

What is Acute Pyelonephritis?

Pyelonephritis is an infection of the upper urinary tract including the renal pelvis and renal parenchyma

18

What are the most common bacteria?
(Acute Pyelonephritis)

In general?
Specific bacteria? 5

Gram-negative bacteria are the most common

E-coli
Proteus
Klebsiella
Enterobacter
Pseudomonas

19

Risk factors for Acute Pyelonephritis?
4

1. Obstruction of the urinary tract


2. Vesicoureteral reflux

3. Diabetes mellitus

4. Female gender

20

What are some examples of obstructions of the urinary tract?
2

Stones
UPJ obstruction

21

Pathogenesis
of Acute Pyelonephritis?

Bacteria ascend from the lower urinary tract into collecting ducts

22

Acute Pyelonephritis can also infect through the Hematogenous route. What bacteria usually infect this way?
2

Staphylococcus aureus or Candida in the bloodstream

23

Acute Pyelonephritis can also enter through the lymphatics. How does this happen?

Lymphatic
Very unusual

Gains access into kidney from an intraperitoneal abscess

24

Acute Pyelonephritis
clinical presentation?
6

Fever
Chills
Flank pain
Malaise
Nausea and vomiting
Irritative voiding symptoms

25

Finding on physical exam for Acute Pyelonephritis?

Costovertebral angle tenderness (CVA) may be prominent finding

26

Lab work for acute pyelonephritis?4

Lab work
1. CBC


2. UA

3. Urine culture positive

4. Blood cultures may also be positive

27

What would a CBC show for posiitve acute pyelonephritis?

What would a UA show for posiitve acute pyelonephritis?3

Leukocytosis


Hematuria
Bacteriuria
Pyuria

28

Imaging for acute pyelonephritis?2

Renal Ultrasound
Abdominal and pelvic CT scan with and without contrast

29

Treatment of acute pyelonephritis?


4 options

How long?

Treatment
Management is usually 10-14 days
Parenteral or oral antibiotics
1. IV ampicillin or gentamicin
2. IV cefazolin
3. IM ceftriaxone (Rocephin)
4. Trimethoprim-sulfamethoxazole or fluoroquinolone

30

Acute Bacterial Prostatitis
is what and what bacteria usually cause it?
5

Infection and inflammation of the prostate by:
1. E-coli
2 Klebsiella
3. Proteus mirabilis
4. Enterobacter
5. Staphylococcus aureus

31

Acute Bacterial Prostatitis
Risk Factors?
6

BPH
Urethral stricture disease
Urethral catheterization
Neurogenic bladder
Calculi
Diabetes

32

Acute Bacterial Prostatitis pathogenesis?

Bacteria ascend up the urethra into the bladder and infected urine reflux into the prostatic ducts

33

Acute Bacterial Prostatitis
Clinical Presentation
5

Present with vague pelvic and systemic symptoms
Irritative voiding symptoms
Dysuria
Perineal and low back pain
Difficulty voiding or retention

34

Acute Bacterial Prostatitis findings on physical exam?
2

Prostate may be enlarged, tender, or boggy
Avoid prostate massage

35

Acute Bacterial Prostatitis
Lab work
3

CBC

UA

Urine culture is positive

36

What will the CBC show for Acute Bacterial Prostatitis?

What about the UA?3

Leukocytosis

Positive leukocytes, blood, and nitrites

37

Acute Bacterial Prostatitis
Treatment

What should we treat with until the culture is back?
2

after patient is afebrile for 24-48 hours what should we do?

What should we treat for 4-6 weeks (oral antibiotics)?
2

Acutely ill patients require hospitalization

Management with broad-spectrum antibiotics (ampicillin and gentamicin) until culture is back

Switch to oral antibiotics

Trimethoprim-sulfamethoxazole or fluoroquinolone

38

For urinary retention with Acute Bacterial Prostatitis
what should we do?

a percutaneous suprapubic tube should be placed

39

Can be a sequela of acute bacterial prostatitis (ABP)?

Chronic Bacterial Prostatitis

Pathology is the same

40

What is the most common bacteria types for Chronic Bacterial Prostatitis?

General?
Most common and three others?

Gram-negative rods most common

1. E-coli 80% of cases

Klebsiella, Pseudomonas aeruginosa, and Proteus are less common

41

Whats the difference bewteen CBP and ABP?

Patients presents the same as ABP but less sick
Some patients require prostate massage

(first cup pee then massage prostate vigorously then pee again)

42

Whats the Meares-Stamey four glass test?

first cup pee
then midstream
then massage prostate vigorously then pee again)
then pee the rest

43

Chronic Bacterial Prostatitis
Treatment consist of what?
4

4-8 weeks of antibiotic
Anti-inflammatories
Hot sitz baths
Alpha-blocker

44

Struvite stones
Composed of what?
2

More common in females or males?

combination of magnesium ammonium phosphate and carbonate apatite

females

45

How are the stones formed?

What bacteria is the most common?

What are three other less common bugs it could be?

Formed from urease producing organisms that split urea into ammonia

Proteus mirabilis is most common

Other pathogens include:
Haemophilus influenzae
Staph aureus
Klebsiella

46

What is staghorn calculus?


What imaging can detect stones?
3

How should we treat it?
2

Struvite stone are known to encompass the entire collecting system of the kidney

CT scans, Renal Ultrasound, and KUB can detect the stone

Treatment
-Fluoroquinolone
-Percutaneous Nephrolithotomy

47

Most common cause of scrotal pain in adults in the outpatient setting is what?

What is it most commonluy caused by?

Epididymitis


Most commonly caused by infection
Acute or Chronic

48

Whats the most common bugs associated with Epididymitis in men under 35?2

Older men what bugs are more common?2

Chlamydia trachomatis and Neisseria gonorrhoeae most common organisms in men under age 35

Older men suspect Escherichia coli or Pseudomonas species

49

What symptoms would present with acute epididymitis?
3

What would palpation in a epididymis pt reveal?

If infection moves to the testicle what can develop?

1. Severe swelling and exquisite pain of surrounding structures
2. Fevers
3. Irritative voiding symptoms

reveals induration and swelling of involved epididymis with pain


hydrocele

50

How would you diagnose acute Epididymitis?
2

1. Made clinically and may be confirmed with urine studies
2. Scrotal US

51

How would we treat acute epididymitis?
2

Alternative?

Ceftriaxone 250mg IM one dose plus Doxycycline 100mg bid x 10 days

Z pack

52

Symptoms of chronic epidiymitis?
3

1. Scrotal or testicular swelling
2. Discomfort
3. Usually lack irritative voiding symptoms

53

Clinical findings of chronic epididymitis?
3

1. Subtle induration or tenderness, with or without swelling
2. May feel inflammatory nodule with nontender epididymis
3. UA usually negative

54

How do we treat chronic epididymitis?

conservatively

55

What is Fournier’s Gangrene?

Clinical features?5


How do we diagnose it? 2

Necrotizing fasciitis of the perineum caused by mixed infection of aerobic/anaerobic bacteria

1. Tense edema of the scrotal wall
2. Blisters/bullae
3. Subcutaneous gas
4. Fever
5. Tachycardia/hypotension


CT and MRI

56

Anaerobic species that are involved in Fournier’s Gangrene?2

Other pathogen that is aerobic and involved with it?

Bacteroides
Clostridium


Group A Streptococcus (hemolytic streptococcal gangrene)

57

Enterobacteriaceae involved with Fournier’s Gangrene?
4

E. coli
Enterobacter
Klebsiella
Proteus

58

Treatment of Fournier’s Gangrene?
2

Surgical
Empiric (antibiotics)

59

What antibiotic would you use for Fournier’s Gangrene?
4

1. Carbapenem or beta-lactam-beta-lactamase inhibitor,

plus
Clindamycin,

plus
Agent against MRSA
Vancomycin

60

If culture is negative for acute cystitis what do we need to rule out?
2

cancer

stones

61

What do we need to rule out for Acute Pyelonephritis?

obstruction

62

Who is Fournier’s Gangrene
most common in?

Obese uncontrolled diabetics

63

What is prostate massage contraindicated in?

Acute Bacterial Prostatitis

Very tender prostate

Chronic will not have tender prostate
and massage indicated