Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Urinary > 11.2 UTI's > Flashcards

11.2 UTI's Flashcards

1
Q

What is a common complication of UTI’s?

A

Gram-negative septicaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the defences of the urinary tract against UTI’s?

A

◦ Emptying of bladder during micturition
◦ Vesico-ureteral valves (stops backflow)
◦ Immunological factors
◦ Mucosal barriers (innate immune system)
◦ Urine acidity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the pathophysiology of UTI’s?

A

Ascending colonisation of bacteria from urethra up to bladder. If vesicoureteral valve is not in tact can travel up to the kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is cystitis?

A

Inflammation of the bladder. Usually caused by ascending UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is pyelonephritis?

A

Inflammation of the kidney and its pelvis, caused by bacterial infection (UTI’s)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why is there a spike in prevalence of UTI’s in infancy?

A

Babies with incontinent vesicoureteral valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are risk factors for UTI’s?

A

Female
Obstructive causes (stones, enlarged prostate, retroperitoneal fibrosis)
Neurological conditions affecting bladder emptying ( multiple sclerosis and stroke)
Pregnancy (enlarged uterus, hormonal effects on relaxation of musculature )
Abnormal renal tract (Vesico-ureteric reflux in children, indwelling urinary catheter)
Impaired host defence (diabetes mellitus, immunosuppression)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why are UTI’s more prevalent in women?

A

Shorter urethra. Shorter distance to bladder

External urethral orifice lies in close proximity to the vagina and/or anus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the most common causative agent of UTI’s?

A

Escherichia coli - Coliforms (gram negative rod-shade bacteria)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the virulence factors of escherichia coli?

A

Flagella - allow movement up the urinary tract
Pili - allow attachment to cells mucosal membrane
Capsular polysaccharide - colonisation
Haemolysin, toxins - damages host membrane and causes renal damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are clinical syndromes of UTI’s?

A

Cystitis (lower UTI)
Pyelonephritis (upper UTI)
Chronic pyelonephritis (scarring/fibrosis of kidneys)
Asymptomatic bacteriuria (ie. pregnancy)
Septicaemia (bacteria get into blood stream, bacteriaemia resulting in sepsis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the clinical presentation of cystitis?

A 
Dysuria
Cloudy urine 
Nocturia or frequency 
Urgency 
Suprapubic tenderness 
Haematuria 
Pyrexia (usually mild)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the clinical presentation of pyelonephritis?

A

High fever +/- rigors
Loin pain and tenderness
Nausea/vomiting +/- Symptoms of cystitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are potentially differentials for dysuria?

A 
UTI’s
Sexually transmitted infections 
Post sexual intercourse 
Contact with irritants
Symptoms of menopause, atrophic vaginitis or vaginal atrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is uncomplicated UTI?

A

Defined as infection by a usual organism in a patient with a normal urinary tract and normal urinary function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a complicated UTI?

A

1 or more factors that predispose to persistent infection, recurrent infection, or treatment failure:
– Abnormal urinary tract
– Virulent organism (ie. Staph aureus)
– Impaired host defence (immunosuppression, poorly controlled diabetes mellitus)
– Impaired renal function

17
Q

How are UTI’s investigated?

A

Uncomplicated/non-pregnant women = no need for urine culture
Complicated UTI/pregnancy/male/children/suspected pyelonephritis/treatment failure/recurrent infections = culture urine

18
Q

How is a sample of urine collected?

A

Mid-stream urine (MSU) - cleansing not required, ideally holding labia apart in women
Clean catch in children
Collection bag (20% false positives due to contamination from perineum)
Catheter sample (fresh)
Supra-pubic aspiration (invasive)

19
Q

What happens to the urine sample after collection?

A

Must be:

  • cultured within 4 hours of collecting or
  • refrigerated or
  • boric acid used as a preservative
20
Q

Other than a urine culture, what other investigations can be used for UTI diagnosis?

A

Urine dipstick. Test for leucocyte esterase, nitrates, blood, protein, pH

21
Q

When are urine dipsticks useful?

A

Useful in females <65 years with suspected uncomplicated UTI as an aid to diagnosis. Use symptoms as primary indicator of diagnosis

Useful in ruling out infection in children >3 months old

22
Q

When is a urine dipstick not useful?

A

◦ Patients >65 years old (asymptomatic infection
common, up to half of this population would have positive dipstick in absence of UTI)
◦ Catheterised patients

23
Q

What are urine samples screened for in microscopy?

A

White cells
Red cells
Epithelial cells
Bacteria

24
Q

How long does a urine culture take?

A

A day

25
Q

When is imaging of the urinary tract considered?

A

In all children with a UTI (may have predisposing factors)
Septic patients in identify renal involvement (pyelonephritis)
Males looking for posterior urethral valves
Females and children looking for vesico-ureteric reflux

26
Q

Why might patients present with sterile pyuria?

A

Usually due to prior antibiotics before sample taken
Urethritis (chlamydia/gonococci are not usually detected on urine culture)
Vaginal infection/inflammation
Tuberculosis of the vaginal tract
Appendicitis
?fastidious organisms

27
Q

What is pyuria?

A

Puss in urine

28
Q

What are fastidious organisms?

A

Organisms that grow very slowly on culture

29
Q

Who is most likely to have asymptomatic bacteriruia?

A

Elderly, in dwelling catheters

30
Q

When are asymptomatic bacteriuria screen for and treated?

A

In pregnancy - untreated leads to higher risk for premature labour and pyelonephritis

31
Q

What advice is given to treat UTI’s?

A

Increase fluid intake
Regular analgesia if painful
Address underlying disorders

32
Q

How long are antibiotics prescribed to patients with UTI’s?

A

3 day course for uncomplicated UTI
5-7 day course for complicated lower UTI ie, pregnant, male, underlying disorders
Catheter sample urine (CSU) : only treat if systemically unwell

33
Q

What antibiotics are given to treat uncomplicated UTIs?

A

Uncomplicated infections can be treated with nitrofurantoin, trimethoprim*, pivmecillinam or fosfomycin
3 day course as effective as 5 or 7 days

34
Q

Why is it beneficial to give patients with uncomplicated simple cystitis a 3 day course of antibiotics?

A

Limiting prescription to 3 days reduces the selection pressure for resistance

35
Q

Why is trimethoprim not always suitable to treat uncomplicated simple cystitis?

A

Up to 30% resistance in Leicestershire (2018-2019 data). Not suitable for those with a history of trimethoprim resistant UTI or received trimethoprim in last 3 months.

36
Q

What antibiotics are used to treat a complicated cystitis?

A

Nitrofurantoin (first line) , trimethoprim*, pivmecillinam, fosfomycin or cefelexin (pregnancy) may be used – review susceptibility report
5-7 day course

37
Q

How is pyelonephritis / septicaemia treated?

A

Pyelonephritis 7-10 days course
Use agent with systemic activity (NOT nitrofurantoin, fosfomycin)
Possibly IV initially unless good PO absorption and patient well enough/tolerating orally
◦ Co-amoxiclav
◦ Ciprofloxacin (effective as a 7 day course)
◦ Gentamicin NB IV only; nephrotoxic.

38
Q

What patients might need prophylaxis for UTI’s?

A

> 3 episodes in one year despite behavioural and personal hygiene measures
No treatable underlying condition

39
Q

What prophylaxis can be given to patients with recurrent UTI’s?

A

Low dose, long term antibiotics
Choice of antibiotics according to recent culture and susceptibility results (ie. trimethoprim or nitrofurantoin as a single nightly dose)

Urinary (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions