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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
What are the most common causative organisms of UTIs?
Gram negative rods, particularly enterobacteriaceae (coliforms).
26
What might the causative organism be in UTIs in young women and hospitalised patients?
Coagulase-negative staphylococci, e.g. staphylococcus saprophyticus.
27
Why is a catheter a risk factor for UTIs?
It acts as a surface, on which a biofilm may form.
28
What is the population that get uncomplicated UTIs?
Healthy women.
29
What are the populations that get complicated UTIs?
Pregnancy, treatment failure, suspected pyelonephritis, complications, males, paediatrics.
30
How are UTIs indicated in uncomplicated cases?
No need for urine culture, indicated by nitrite/leukocyte esterase dipstick testing.
31
How are complicated UTIs investigated?
A mid-stream specimen is collect and the sample is transported at 4C with some boric acid to prevent false positives.
32
How are samples collected from small children with suspected UTIs?
Adhesive bag placed over genital to collect flow.
33
How are samples collected from catheters of patients with suspected UTIs?
Sample taken using a needle up a special tube in the catheter.
34
How can bladder urine be sampled?
Supra-pubic aspiration by sticking a needle through the abdominal wall.
35
What investigations are performed for suspected UTI samples?
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
When is microscopy used as an investigation with UTIs?
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
How is bacteriuria distinguished from contamination in urine culture?
The number of colony forming units, if over 100000 per ml then bacteriuria.
38
How accurate is a single urine specimen in detecting UTIs?
80% predictive.
39
How are urine cultures interpreted?
Clinical details - symptoms and previous antibiotics, quality of specimen, delays in culture, microscopy, organisms.
40
What is sterile pyuria?
UTI is present but can't be cultured. Pus in urine.
41
What causes sterile pyuria?
Patient already treated with antibiotics, or infected with bacteria that are difficult to isolate or culture, or from tuberculosis, or appendicitis.
42
What are the two causes of classic UTI symptoms in women?
50% significant bacteriuria, 50% urethral syndrome.
43
What are the general treatments of UTIs?
Increase fluid intake, address underlying disorders, only treat once symptoms appear.
44
What is the treatment for uncomplicated UTI?
3 day course of antibiotics - long enough to cure but with minimum selection pressure for resistance.
45
What is the treatment for complicated UTI?
7 day course of antibiotics.
46
What is the treatment of pyelonephritis/ septicaemia?
14 day course of antibiotics, more potent agent with systemic activity.
47
When is prophylaxis used with UTI?
With three or more episodes in one year, no treatable underlying condition.
48
How is prophylaxis given with UTI?
Single, low, nightly dose of antibiotics to prevent bacteria build up in static urine.
49
What is the general principal of diuretics?
Block reabsorption of Na+ and therefore water by the kidney.
50
What are the most powerful diuretics?
Loop diuretics.
51
How do loop diuretics work?
Blocking the Na+K+2Cl- symporter in the apical membrane.
52
How do thiazide diuretics work?
The act on the early distal convoluted tubule. They block the Na-Cl symporter.
53
What is an example of a loop diuretic?
Furosemide, or bumetanide.
54
What is an example of a thiazide diuretic?
Bendroflumethiazide.
55
How do K+ sparing diuretics work?
Act on the late distal convoluted tubule to reduce Na+ channel activity. Reduces loss of K+.
56
How do aldosterone antagonists work?
Act on late distal convoluted tubule to reduce Na+ channel activity. Reduce loss of K+.
57
What is the danger of K+ sparing and aldosterone antagonsits?
Can produce life threatening hyperkalaemia.
58
What is an example of a K+ sparing diuretic?
Amiloride.
59
What is an example of an aldosterone antagonist?
Spironolactone.
60
What is the adverse affect of loop and thiazide diuretics?
They increase loss of potassium in urine so may cause hypokalaemia.
61
What is an adverse body reaction to the use of diuretics?
Reduced ECF volume will activate RAAS. This increases aldosterone secretion so Na+ absorption and K+ secretion are increased -> hypokalaemia.
62
What are the risks of diuretics?
Hypovolaemia, hyponatraemia, increased uric acid in blood, glucose intolerance, raised LDL levels.
63
Why are diuretics which act in the PCT by inhibiting the enzyme carbonic anhydrase not used?
They interfere with Na+ and HCO3- reabsorption so this can lead to metabolic acidosis.
64
What are diuretics used to treat?
Conditions with ECF expansion and oedema, acute pulmonary oedema, hypertension, hypercalcaemia, cerebral oedema, glaucoma.
65
What conditions with ECF expansion and oedema can diuretics be used to treat?
Congestive heart failure, nephrotic syndrome, kidney failure, ascites and oedema from cirrhosis of liver.
66
What condition causing acute pulmonary oedema can diuretics be used to treat?
Left heart failure.
67
How can loop diuretics treat hypercalcaemia?
They promote calcium excretion by the loop of Henle.
68
What other substances have diuretic action?
Alcohol, coffee, and other drugs - lithium, demeclocyline.
69
How does alcohol have a diuretic effect?
Inhibits ADH release.
70
How does coffee have a diuretic effect?
Increases GFR and decreases tubular Na+ reabsorption.
71
What diseases can cause diuresis?
Diabetes mellitus, diabetes insipidus, psychogenic polydipsia.
72
How can diabetes mellitus cause polyuria?
Glucose in filtrate so osmotic diuresis.
73
How can diabetes insipidus cause polyuria?
Cranial - decreased ADH released from posterior pituitary causing diuresis. Nephrogenic - poor response of collecting ducts to ADH causing diuresis.
74
How can psychogenic polydipsia cause diuresis?
Increased intake of fluid.

11. Urinary (12 decks)

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