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11. Urinary > 7. Urinary Tract Infections and Diuretics > Flashcards

7. Urinary Tract Infections and Diuretics Flashcards

1
Q

Why is regular flushing of the urethra important?

A

It flushes the organism in the distal urethra, thus reducing risk of urinary tract infections.

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2
Q

Why are urinary tract infections more common in females?

A

They have a shorter urethra than men.

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3
Q

What are the defence mechanisms of the urinary tract against infection?

A

Regular voiding and antibacterial secretions into the urine and urethra.

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4
Q

What are the host factors that affect susceptibility to UTIs?

A

Shorter urethra, obstruction, neurological, and ureteric reflux.

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5
Q

What can obstruct the urinary tract?

A

Enlarged prostate, pregnancy, stones, and tumours.

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6
Q

What are the neurological things that affect susceptibility to UTIs?

A

Incomplete emptying, residual urine.

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7
Q

What can ureteric reflux cause?

A

Ascending infection from the urethra to the bladder.

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8
Q

What are the bacterial factors that affect susceptibility to UTIs?

A

Faecal flora, adhesion, K antigens, haemolysis, urease.

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9
Q

How can faecal flora cause UTIs?

A

Potential urinary pathogens colonise the periurethral area.

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10
Q

How can bacterial adhesion factors make UTIs more likely?

A

Fimbriae and adhesins allow attachment to urethral and bladder epithelium for infection.

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11
Q

What do K antigens make UTIs more likely?

A

Allow some E. coli to resist host defences by producing polysaccharide capsule.

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12
Q

How do haemolysins make UTIs more likely?

A

Damage membranes and cause renal damage.

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13
Q

How do ureases make UTIs more likely?

A

Produced by some bacteria, it breaks down urea for energy.

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14
Q

How do urinary tract infections vary?

A

Some are only mild, however some cause long term renal damage and even is the most common source of life threatening gram negative bacteraemia.

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15
Q

What is the commonest UTi?

A

Cystitis of the lower tract.

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16
Q

What is pyelonephritis?

A

An upper UTI that may be from haematogenous or ascending routes of infection.

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17
Q

What are the symptoms of bacterial cystitis?

A

Frequency and dysuria, often with pyuria and haematuria.

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18
Q

What are the symptoms of abacterial cystitis?

A

Frequence and dysuria, often with pyuria and haematuria. No significant bacteriuria.

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19
Q

What are the symptoms of prostatitis?

A

Fever, dysuria, frequency with perineal and lower back pain.

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20
Q

What are the symptoms of acute pyelonephritis?

A

Frequency and dysuria, often with pyuria and haematuria. Fever and loin pain.

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21
Q

What are the symptoms of chronic interstitial pyelonephritis?

A

Renal impairment following chronic inflammation from infection or another cause.

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22
Q

What are the symptoms of covert bacteriuria?

A

It is asymptomatic.

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23
Q

How is covert bacteriuria detected?

A

By culture.

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24
Q

In which populations is it important to detect covert bacteriuria?

A

In children and pregnancy.

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25
Q

What are the most common causative organisms of UTIs?

A

Gram negative rods, particularly enterobacteriaceae (coliforms).

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26
Q

What might the causative organism be in UTIs in young women and hospitalised patients?

A

Coagulase-negative staphylococci, e.g. staphylococcus saprophyticus.

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27
Q

Why is a catheter a risk factor for UTIs?

A

It acts as a surface, on which a biofilm may form.

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28
Q

What is the population that get uncomplicated UTIs?

A

Healthy women.

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29
Q

What are the populations that get complicated UTIs?

A

Pregnancy, treatment failure, suspected pyelonephritis, complications, males, paediatrics.

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30
Q

How are UTIs indicated in uncomplicated cases?

A

No need for urine culture, indicated by nitrite/leukocyte esterase dipstick testing.

31
Q

How are complicated UTIs investigated?

A

A mid-stream specimen is collect and the sample is transported at 4C with some boric acid to prevent false positives.

32
Q

How are samples collected from small children with suspected UTIs?

A

Adhesive bag placed over genital to collect flow.

33
Q

How are samples collected from catheters of patients with suspected UTIs?

A

Sample taken using a needle up a special tube in the catheter.

34
Q

How can bladder urine be sampled?

A

Supra-pubic aspiration by sticking a needle through the abdominal wall.

35
Q

What investigations are performed for suspected UTI samples?

A

Turbidity - look to see if the sample is cloudy. If cloudy, indicative of UTI.
Dipstick testing - leukocyte esterase is indicative of presence of WBCs, nitrite indicates presence of nitrate reducing bacteria, haematuria and proteinuria have many causes so not exclusively indicative of UTIs.

36
Q

When is microscopy used as an investigation with UTIs?

A

With kidney disease (loin pain, nephritis, hypertension, toxaemia, renal colic, haematuria, renal TB, casts), suspected endocarditis, children under 6 years, schistosomiasis, suprapubic aspirates, and when requested.

37
Q

How is bacteriuria distinguished from contamination in urine culture?

A

The number of colony forming units, if over 100000 per ml then bacteriuria.

38
Q

How accurate is a single urine specimen in detecting UTIs?

A

80% predictive.

39
Q

How are urine cultures interpreted?

A

Clinical details - symptoms and previous antibiotics, quality of specimen, delays in culture, microscopy, organisms.

40
Q

What is sterile pyuria?

A

UTI is present but can’t be cultured. Pus in urine.

41
Q

What causes sterile pyuria?

A

Patient already treated with antibiotics, or infected with bacteria that are difficult to isolate or culture, or from tuberculosis, or appendicitis.

42
Q

What are the two causes of classic UTI symptoms in women?

A

50% significant bacteriuria, 50% urethral syndrome.

43
Q

What are the general treatments of UTIs?

A

Increase fluid intake, address underlying disorders, only treat once symptoms appear.

44
Q

What is the treatment for uncomplicated UTI?

A

3 day course of antibiotics - long enough to cure but with minimum selection pressure for resistance.

45
Q

What is the treatment for complicated UTI?

A

7 day course of antibiotics.

46
Q

What is the treatment of pyelonephritis/ septicaemia?

A

14 day course of antibiotics, more potent agent with systemic activity.

47
Q

When is prophylaxis used with UTI?

A

With three or more episodes in one year, no treatable underlying condition.

48
Q

How is prophylaxis given with UTI?

A

Single, low, nightly dose of antibiotics to prevent bacteria build up in static urine.

49
Q

What is the general principal of diuretics?

A

Block reabsorption of Na+ and therefore water by the kidney.

50
Q

What are the most powerful diuretics?

A

Loop diuretics.

51
Q

How do loop diuretics work?

A

Blocking the Na+K+2Cl- symporter in the apical membrane.

52
Q

How do thiazide diuretics work?

A

The act on the early distal convoluted tubule. They block the Na-Cl symporter.

53
Q

What is an example of a loop diuretic?

A

Furosemide, or bumetanide.

54
Q

What is an example of a thiazide diuretic?

A

Bendroflumethiazide.

55
Q

How do K+ sparing diuretics work?

A

Act on the late distal convoluted tubule to reduce Na+ channel activity. Reduces loss of K+.

56
Q

How do aldosterone antagonists work?

A

Act on late distal convoluted tubule to reduce Na+ channel activity. Reduce loss of K+.

57
Q

What is the danger of K+ sparing and aldosterone antagonsits?

A

Can produce life threatening hyperkalaemia.

58
Q

What is an example of a K+ sparing diuretic?

A

Amiloride.

59
Q

What is an example of an aldosterone antagonist?

A

Spironolactone.

60
Q

What is the adverse affect of loop and thiazide diuretics?

A

They increase loss of potassium in urine so may cause hypokalaemia.

61
Q

What is an adverse body reaction to the use of diuretics?

A

Reduced ECF volume will activate RAAS. This increases aldosterone secretion so Na+ absorption and K+ secretion are increased -> hypokalaemia.

62
Q

What are the risks of diuretics?

A

Hypovolaemia, hyponatraemia, increased uric acid in blood, glucose intolerance, raised LDL levels.

63
Q

Why are diuretics which act in the PCT by inhibiting the enzyme carbonic anhydrase not used?

A

They interfere with Na+ and HCO3- reabsorption so this can lead to metabolic acidosis.

64
Q

What are diuretics used to treat?

A

Conditions with ECF expansion and oedema, acute pulmonary oedema, hypertension, hypercalcaemia, cerebral oedema, glaucoma.

65
Q

What conditions with ECF expansion and oedema can diuretics be used to treat?

A

Congestive heart failure, nephrotic syndrome, kidney failure, ascites and oedema from cirrhosis of liver.

66
Q

What condition causing acute pulmonary oedema can diuretics be used to treat?

A

Left heart failure.

67
Q

How can loop diuretics treat hypercalcaemia?

A

They promote calcium excretion by the loop of Henle.

68
Q

What other substances have diuretic action?

A

Alcohol, coffee, and other drugs - lithium, demeclocyline.

69
Q

How does alcohol have a diuretic effect?

A

Inhibits ADH release.

70
Q

How does coffee have a diuretic effect?

A

Increases GFR and decreases tubular Na+ reabsorption.

71
Q

What diseases can cause diuresis?

A

Diabetes mellitus, diabetes insipidus, psychogenic polydipsia.

72
Q

How can diabetes mellitus cause polyuria?

A

Glucose in filtrate so osmotic diuresis.

73
Q

How can diabetes insipidus cause polyuria?

A

Cranial - decreased ADH released from posterior pituitary causing diuresis.
Nephrogenic - poor response of collecting ducts to ADH causing diuresis.

74
Q

How can psychogenic polydipsia cause diuresis?

A

Increased intake of fluid.

11. Urinary (12 decks)

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