Learning tool GU UTI Pyelonephritis.docx - Learning Tool...

Learning Tool GU
UTI Vesicoureteral Reflux (VUR) Pyelonephritis
Pathophysiology
:
Include
explanation,
usual ages, and
common causes
Lecture:
1. Etiology/Patho
a. Alteration of defense mechanisms
b. Organisms introduced via ascending
route
c. Less common route
i. Bloodstrem
ii. Lymphatic system
d. Contributing factors are urologic
instrumentation and previous injuries to
urinary tract
2. One of the most common conditions of
childhood; 10% of children have a febrile UTI
in the first 2 years of life
3. Most important host factor is urinary stasis
4. Uncircumcised male infants are at higher
risk
5. Classification of UTI’s
a. Asymptomatic bacteriuria (different
from UTI) → significant bacteriuria with
no clinical symptoms
b. Symptomatic bacteriuria →bacteriuiria
with physical signs, such as dysuria,
Lecutre:
1. Etiology/Patho
a. Preexisting factor (usually)
i. Vesicoureteral reflux
ii. Dysfunction of lower urinary tract
function
1. Obstruction (stone, congenital
abnormalities)
2. Stricture (narrowing)
2. Cause
a. Inflammation caused by bacteria,
fungi, protozoa, or viruses infecting
the kidneys
i. often E-coli, Proteus, Klebsiella,
and Enterobacter
b. Starts in medulla and spreads to
cortex
c. Recurring episodes lead to a scarred,
poorlyfunctioning kidney and chronic
pyelonephritis
d. Can lead to septic shock and death in
15% of cases

suprabuic discomfort, hematuria, and
fever
c. Upper tract infeciton involve the renal
parenchyma, pelvis, and uterus →
typically causes fever, chills, and flank
pain
d. Lower tract infection involves the lower
urinary tract → usually no systemic
manifestations
ATI:
1. Risk factors
a. Uriary stasis
b. Urianary tract anomalies
c. Reflux within the urinarytract system
d. constipation
e. onset o ftoiltet training
f. Inadqute hugien of an uncircumcised
penis
g.