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SA DX & TX II > Exam 4 - Urinary Tract Infections > Flashcards

Exam 4 - Urinary Tract Infections Flashcards

1
Q

what is included in the lower urinary tract system?

A

ureters, bladder, & urethra

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2
Q

what are signs of lower urinary tract inflammation?

A

pollakiuria, hematuria, stranguria, dysuria, periuria, & +/- incontinence

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3
Q

what are some examples of causes of lower urinary tract inflammation?

A

bacterial infection, sterile inflammation (including stones), & neoplasia

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4
Q

what is pollakiuria?

A

increased frequency of urination

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5
Q

what is hematuria?

A

blood in the urine

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6
Q

what is stranguria?

A

straining to urinate

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7
Q

what is dysuria?

A

difficulty urinating

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8
Q

what is periuria?

A

urinating in inappropriate places

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9
Q

what is urinary incontinence?

A

unintentional loss of urine

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10
Q

what is a urinary tract infection?

A

adherence, multiplication, & persistence of an infectious agent in the urinary system

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11
Q

what is bacteriuria?

A

presence of bacteria in the urine - doesn’t mean UTI!!!!! (may just be there due to contamination)

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12
Q

what is pyuria?

A

presence of WBC > 3-5/hpf in the urine collected by cystocentesis

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13
Q

T/F: pollakiuria is often caused by inflammation but can also be caused by decreased storage capacity

A

true

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14
Q

what does complete urethral obstruction manifest as?

A

attempts to urinate without passing urine & leads to severe systemic illness that can be life threatening

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15
Q

_______ __ ____ is important to evaluate in patients with incontinence

A

age of onset

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16
Q

what should be done on physical exam when working a patient up for a urinary tract infection?

A

palpate bladder before & after voiding - palpate size, bladder wall thickness, & assess for pain (may be able to feel stones but rarely feel masses)

rectal palpation of prostate & urethra

assess for vaginal/preputial discharge

may need to do a neuro exam

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17
Q

how should a urine sediment be done when working a dog up for a potential UTI?

A

centrifuge at least 3 mls of urine to evaluate for hematuria, pyuria, bacteriuria, crystalluria, & casts

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18
Q

when may you get a false negative on urine culture/susceptibility?

A

if you store it in the fridge longer than 24-48 hours

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19
Q

why take abdominal rads for a patient with a UTI?

A

radiopaque uroliths

look at bladder distension & positioning

emphsematous cystitis

concurrent/related problems

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20
Q

what should you look for on abdominal ultrasound for a patient with a UTI?

A

hydronephrosis, hydroureter consistent with ureteral obstruction

uroliths

bladder masses, thickening of wall

lesions in proximal urethra

useful for assessing residual urine volume after voiding

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21
Q

how may urinary catheterization help you work up a cause of a UTI?

A

helps you determine if there is an anatomic obstruction of the urethra (gritty feeling, difficult/impossible to pass)

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22
Q

when may you use traumatic catheterization for a patient with a UTI?

A

used to collect cytologic samples for patients with bladder or urethral neoplasia

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23
Q

when would you do a prostatic wash or collect an ejaculate sample in a patient with signs of a UTI?

A

for suspected bacterial prostatitis

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24
Q

when may BRAF testing be used for a patient with signs of a UTI?

A

helpful in dogs to distinguish between urothelial carcinoma from other causes of lower urinary tract inflammation - good sensitivity 86% & specificity 100%

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25
Q

T/F: 14% of dogs have a UTI in their lifetime with an increased incidence in spayed females

A

true

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26
Q

in cats under 10 years of age with lower urinary tract signs, how many of them will have a UTI? what about cats older than 10?

A

<10% will have a UTI

the older they get, the rate of incidence increases

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27
Q

T/F: the proximal to mid-urethra is sterile

A

true

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28
Q

when do we presume UTIs to occur?

A

when there is a breach in systemic or local defense mechanisms along with exposure to an infectious agent

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29
Q

once a UTI is established, what portions of the urinary system are susceptible?

A

all!!! bladder, urethra, kidneys, prostate in intact males

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30
Q

what is the usual bacterial source causing UTIs?

A

gi bacteria that colonizes external genitalia & ascends the urethra

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31
Q

what are some consequences if a UTI goes untreated?

A

formation of struvite stones, prostatitis, prostatic abscesses, discospondylitis, & pyelonephritis

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32
Q

what are the 4 general mechanisms of altered host defenses that lead to urinary tract infections?

A
  1. alterations in normal micturition
  2. anatomic variations or abnormalities
  3. altered mucosal defenses
  4. altered antimicrobial properties of urine
33
Q

how does alterations in normal micturition lead to the pathogenesis of UTIs?

A

diseases that impair frequency or volume of micturition

disorders that allow residual urine to remain in the bladder

34
Q

how do anatomic variations/abnormalities lead to the pathogenesis of UTIs?

A

recession of the vulva often associated with UTIs

congenital abnormalities may bypass normal anatomic defenses (high pressure in the urethra, peristaltic contractions of the urethra, oblique entrance of ureters into the bladder)

35
Q

how do altered mucosal defenses lead to the pathogenesis of UTIs?

A

surface glycosaminoglycans on uroepithelium prevent bacterial attachment & normal exfoliation of epithelial cells may impede colonization

mucosal damage from catheters, stones, neoplasia, etc may disrupt barrier

36
Q

how does altered antimicrobial properties of urine lead to the pathogenesis of UTIs?

A

dilute urine has lower urea concentrations which increases the risk of infection

urine contains IgG & IgA which may be decreased by corticosteroid therapy

37
Q

what part of bacterial virulence makes UTIs so bad?

A

some bacteria produce urease that can devitalize uroepithelial cells & cause smooth muscle paralysis

38
Q

what is the most common bacterial isolate from UTIs?

A

e. coli

39
Q

T/F: in patients with lower UTIs, they are usually afebrile

A

true

40
Q

why do you need to be careful when evaluating a dipstick when working a patient up for a possible UTI?

A

leukocytes on dipstick can give false negatives in dogs & false positives in cats

41
Q

when is a urinalysis with usg, dipstick, & sediment exam the sole diagnostic test used for a patient?

A

compatible clinical signs of a UTI & uncomplicated UTIs (sporadic bacterial cystitis) that has not been treated previously

42
Q

T/F: you may have a UTI without any bacteriuria or pyuria, especially if the urine is dilute

A

true

43
Q

what is the purpose of getting a urine culture & sensitivity? what is the best method used?

A

used to guide therapy!

best performed using the minimum inhibitory concentration method

44
Q

what represents significant bacteriuria in dogs & cats when the urine collection method used is cystocentesis?

A

dogs: > 1000 (10^3) cfu/ml

cats: > 1000 (10^3) cfu/ml

45
Q

what represents significant bacteriuria in dogs & cats when the urine collection method used is catheterization?

A

dogs: > 10,000 (10^4) cfu/ml

cats: > 1,000 (10^3) cfu/ml

46
Q

what represents significant bacteriuria in dogs & cats when the urine collection method used is voided/manually expressed?

A

dogs: > 100,000 (10^5) cfu/ml

cats: > 10,000 (10^3) cfu/ml

47
Q

how do you go about differentiating whether or not the UTI is lower or upper?

A

differentiating can be difficult - consider upper if the patient is febrile, cbc has an inflammatory leukogram, urine is dilute, & there is WBC casts in urine

also consider if infection persists after initial treatment

48
Q

what is an uncomplicated UTI?

A

sporadic bacterial cystitis - UTI with no underlying structural, neurologic, or functional abnormality

49
Q

what is a complicated UTI? what are some examples of associated conditions?

A

UTI associated with a defect in the patient’s defense mechanism

conditions - diabetes mellitus, cushing’s, ckd, anatomic defects, etc

50
Q

is a UTI in an intact male dog considered uncomplicated or complicated?

A

complicated!!!!! prostate is involved 90% of the time

51
Q

why have antibiotics caused some issues when treating UTIs?

A

overuse & misuse has lead to problems with resistance!

52
Q

for management of sporadic bacterial cystitis, what criteria must be considered before pursuing empirical antibiotic therapy?

A

dog - feline UTIs should always be cultured

first time UTI - or very infrequent UTIs

no antibiotic has been given in the past 4-6 weeks

53
Q

how should you select an antibiotic for empirical therapy in a dog with sporadic bacterial cystitis? what are some common choices? how long do we dose them for? when do you expect clinical signs to stop?

A

select one based off of gram stain & likely organism

amoxicillin, TMS - 3-5 days (used to be 10-14 days)

expect them to stop within 48 hours of starting antibiotics

54
Q

do you need to get a follow up culture after treating a dog for an uncomplicated UTI? what about a complicated UTI?

A

nope

yes - culture 1 week after finishing abx & 1 month after finishing abx

55
Q

T/F: patients with recurrent infections, > 3 a year, are considered to have complicated UTIs

A

true

56
Q

T/F: in an animal with a complicated UTI, it is okay to make an empirical antibiotic choice for therapy

A

false - must base it off of culture & sensitivity

in the mean time while waiting for C&S results - can start empirical therapy

57
Q

how is pyelonephritis treated?

A

antibiotic must achieve therapeutic levels in the serum (tissue, not urine!!!!)

antibiotic based on C&S - required to do!

58
Q

what is a reasonable first line choice for treating pyelonephritis? why? how long do you treat these patients?

A

fluoroquinolones - gram negative enterobacteriaceae are often causative & these drugs achieve effective levels in the kidneys

traditionally, 4-6 weeks, ISCAID group recommends 10-14 days

59
Q

what does your recheck plan look like for a patient you are treating for pyelonephritis?

A

re-evaluate & re-culture in 7-14 days after finishing antibiotics

60
Q

what should you assume is also going on in any intact male patient with a UTI?

A

concurrent bacterial prostatitis

61
Q

what diagnostics are required for intact male dogs with UTIs?

A

C&S of the prostate & urine - prostate may grow different bacteria

62
Q

what is important about choosing an antibiotic for a dog with a UTI & concurrent bacterial prostatitis?

A

antibiotic must penetrate the blood prostate barrier (ideal antibiotic is a weak base with high lipid solubility & high volume of distribution) regardless of in vitro susceptibility

63
Q

what is generally the best antibiotic option for treating bacterial prostatitis? what are some other options?

A

enrofloxacin

TMS, chloramphenicol, & clindamycin (only if bacteria are confirmed to be susceptible)

64
Q

how long are patients treated for bacterial prostatitis? what does you recheck schedule & plan look like?

A

4-8 weeks

re-evaluate & re-culture 7-14 days after they finish their antibiotics

must neuter them as soon as possible - once systemically stable!!

65
Q

what should you consider for reasons for treatment failure of UTIs?

A

lack of owner compliance - especially with TID dosing

inappropriate abx choice/dose/duration

failure of abx to reach therapeutic concentrations due to poor gi absorption, impaired renal concentrating ability, kidney/prostate involvement, or prostatic abscessation

antimicrobial resistance

formation of a nidus of infection that is capable of re-colonizing (urolithiasis, urachal remnant, pyelonephritis, prostatitis, or neoplasia)

presence of an anatomic or functional abnormality of the urinary tract that lowers resistance to bacterial colonization

66
Q

what is a recurrent UTI?

A

repeated episodes of bacterial urinary tract infection - positive quantitative culture often with clinical signs

67
Q

what is a relapsing UTI?

A

UTI caused by the same organism that reoccurs after therapy is discontinued - usually recurs quickly

68
Q

what is reinfection in regards to UTIs?

A

UTI caused by a different organism after therapy is discontinued - variable time interval after therapy is discontinued

69
Q

what is persistent infection in regards to UTIs?

A

UTI in which the original causative infection continues to be present during therapy that should be effective based on C&S - diagnosis requires a culture while patient is on therapy

70
Q

what is a superinfection in regards to UTIs?

A

rare UTI in which a different organism establishes an infection during the during the course of treatment for the original organism

71
Q

what prevention is done for uncomplicated UTIs?

A

no prevention strategies

72
Q

what does prevention of UTIs include?

A

identify & resolve any complicating factors (remove uroliths, treat cushings)

pulse or low dose chronic abx therapy used anecdotally (after thorough workup & evaluation by an internist) - no data that supports this

73
Q

T/F: there is insufficient evidence for recommending methenamine as a urinary antiseptic as a way to prevent UTIs

A

true

74
Q

a dog presents with her 4th suspected UTI of the year - is this a complicated or uncomplicated UTI?

A

complicated - more than or equal to 3 UTIs in one year

75
Q

what does the sedivue machine look for in urine?

A

cells, bacteria, casts, & crystals

76
Q

what are some examples of anatomical abnormalities that predispose an animal to getting UTIs?

A

recessed vulva

ectopic ureters

urethral hypoplasia

77
Q

what’s wrong with this? how can you fix it?

A

recessed vulva - episioplasty/vulvoplasty

78
Q

can you use enrofloxacin for first choice therapy for a dog with an uncomplicated UTI?

A

nope!!!!

SA DX & TX II (62 decks)

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