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Block 9 Week 5 Meg > Hunter: UTIs > Flashcards

Hunter: UTIs Flashcards

1
Q

Two infections of the lower urinary tract

A

urethritis

cystitis (bladder)

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2
Q

The most common upper urinary tract infection is called (blank) (kidney and ureter)

A

pyelonephritis

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3
Q

Less common but more serious complication of pyelonephritis

A

perinephric abscess

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4
Q

These populations have higher rates of UTI

A

women (30:1)
older age
increased sexual activity
postmenopausal women because of bladder and uterine prolapse and hormonally induced changes
men in the 5th decade of life due to benign prostatic hypertrophy

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5
Q

(blank) is the most common cause of uncomplicated UTI in all age groups (80-90%)

A

E. coli

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6
Q

(blank) is the second most common cause of these infections, particularly in sexually active females between the ages of 13 and 40

A

Staphylococcus saprophyticus

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7
Q

Most common causes of complicated UTI, such as those resulting from anatomic obstructions from catheterization

A 
E. coli
Proteus mirabilis
Klebsiella
Enterococcus spp.
Pseudomonas aeruginosa
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8
Q

This fungus can cause UTIs

A

candida spp

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9
Q

UTIs are frequently caused by (blank) organisms

A

multi-drug resistant

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10
Q

Risk factors for UTI

A

women (closer proximity of urethra to anus)
sexual intercourse (contamination of urethral opening with fecal organisms)
Benign prostatic hypertrophy (or anything obstructing elimination of urine)
Urethral catheters
Stones in the urinary tract
Physiologic changes leading to incomplete emptying of the bladder (pregnancy)
Reflux of urine from bladder to kidney

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11
Q

What is vesicoureteral reflux?

A

Reflux of urine from the bladder to the kidney

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12
Q

How does a UTI occur?

A

bacterial organisms in the feces contaminate the periurethral region
these bugs can ascend up the urethra to the bladder, and sometimes they can even reach the kidney

**ascension of organisms is facilitated by bacterial fimbrae that bind to uroepithelium

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13
Q

What are some host factors that protect against UTI?

A

normal daily urine flow
constant uroepithelial cell sloughing
large numbers of lactobacilli in the vaginal mucosa (pH)

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14
Q

Blood borne infections of the urinary tract are infrequent, but can be due to (blank)

A

Staph aureus

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15
Q

What are some virulence factors of E.coli?

A

Type 1 fimbriae
P fimbrae
hemolysin

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16
Q

Bind to mannose-containing host epithelial receptors; Cystitis&raquo_space; pyelonephritis patients

A

Type I fimbriae (fimH)

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17
Q

Bind to glycosphingolipid host epithelial receptors (abundant in kidney epithelium); P-fimbriated strains cause pyelonephritis (90%) and can cause bacteremia

A

P fimbrae (papGAP)

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18
Q

Most uropathogenic strains of E.Coli have a (blank) that can damage uroepithelium

A

hemolysin

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19
Q

Genes for these virulence factors are carried on (blank)

A

pathogenicity islands

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20
Q

Signs and symptoms of cystitis?

A

urgency and frequency of urination
voiding small volumes of urine
painful urination
suprapubic tenderness just before or immediately after voiding

21
Q

How to treat patients with a cystitis in an outpatient setting

A

trimethoprim-sulfamethoxazole (bactrim)

or cipro for 3 days

22
Q

Why do you do a urinalysis if you suspect a UTI?

A

to determine urine pH (most bacterial causes like E.coli do not elevate the pH, but urease-producing organisms like Proteus mirabilis do elevate the pH)
you also want to look for white blood cells in urine (pyuria) and bacteria in urine

23
Q

The pH of the urine is usually determined using a (blank)
The pH is not elevated with most bacterial causes of urinary tract infection.
If the pH is greater than 7.9 and the urine contains bacteria and white blood cells, the patient usually has a UTI due to (blank)

A 
dipstick test;
Proteus mirabilis (urease producing organism)
24
Q

Pyuria can be determined using traditional microscopic wet mount examination of spun urine, a cell-counting chamber technique, or a dipstick test for (blank)

A

leukocyte esterase

25
Q

Bacteriuria can be determined using a dipstick test to check for the presence of (blank) in the urine

A

nitrites

*many uropathogens convert nitrates to nitrites when growing in urine (e.g., E. coli and P. mirabilis)

26
Q

For cultures, how should you obtain a urine specimen? How should you analyze the culture?

A

use a clean-catch urine specimen;
if more than 100,000 colony-forming units per mL, the patient has clinically significant bacteriuria

**often times the bacteriuria is asymptomatic

27
Q

Three groups of patients with asymptomatic bacteriuria have been shown to benefit from treatment:

A

pregnant women
renal transplant pts
pts who are going to undergo GU surgery

28
Q

What are these symptoms suggestive of?

fever (38+ C)
nausea and vomiting
flank pain and tenderness
costovertebral angle tenderness

A

pyelonephritis

29
Q

What should be used to treat pyelonephritis?

A

trimethoprim-sulfamethoxazole (Bactrim) for 14 days

30
Q

the kidney is somewhat enlarged, and discrete, yellowish, raised abscesses are apparent on the surface

A

acute pyelonephritis

31
Q

What is the pathognomonic histologic feature of acute pyelonephritis?

A

suppurative necrosis or abscess formation w/i the renal substance

32
Q

One or both kidneys contain gross scars and there are inflammatory changes in the pelvic wall with papillary atrophy and blunting
The parenchyma shows interstitial fibrosis with an inflammatory infiltrate of lymphocytes, plasma cells, and occasionally neutrophils

A

chronic pyelonephritis

33
Q

How to treat a perinephric abscess?

A 
IV antibiotics (ceftriaxone & gentamicin)
drain the abscess
34
Q

A motile gram-negative rod that can cause UTI; it has swarming growth on agar
It can cause stones to form when it produces urease which catalyzes the breakdown of urea to ammonia and carbon dioxide

A

Proteus mirabilis

35
Q

Proteus mirabilis releases urease, which converts urea to ammonia and CO2. What kind of stones can you get from ammonia buildup in urine?

A

magnesium ammonium phosphate stones

**struvite calculi

36
Q

Risk factors for Proteus mirabilis infection?

A

catheterization
recurrent UTI
anatomical defects

37
Q

How to treat Proteus mirabilis infection?

A

ceftriaxone

38
Q

How to treat acute vs severe pyelonephritis?

A

acute: bactrim for 14 days as outpatient
severe: treat inpatient with IV antibiotics until 24 hrs after fever breaks, then oral antibiotic for 14 days

39
Q

How to prevent UTIs?

A 
high fluid intake (to ensure good urine output)
cranberry juice (tannins prevent binding of the bacteria to uroepithelial cells)
empty the bladder as soon as you feel the need to urinate
40
Q

What can sexually active women do to prevent UTI recurrence?

A

take a spermicide-containing contraceptive

or take an antimicrobial agent before having intercourse

41
Q

How can postmenopausal women prevent recurrent UTI?

A

take oral or vaginal estrogen which will shift the vaginal flora to lactobacilli –> this lowers the vaginal pH and reduces colonization of the vagina

42
Q

Most common cause of acute bacterial prostatitis

A

E. Coli

43
Q

Other bacteria that can cause prostatitis

A 
Klebsiella
Pseudomonas
Enterobacter
Serratia
Proteus
44
Q

Who gets prostatitis?

A

sexually active males
males with previous episodes of prostatitis
**most common malady of prostate in pts younger than 35

45
Q

How does prostatitis occur?

A

The E. coli strains that cause prostatitis appear to use the same virulence factors that cause other UTI
Infected urine refluxes into the glandular prostatic tissue via the ejaculatory and prostatic ducts
Infiltrating neutrophils around the acini are associated with intraductal desquamation and cellular debris
Tissue invasion by lymphocytes, plasma cells, and macrophages

46
Q

How can you diagnose prostatitis?

A

urine specimen via midstream catch procedure –> should have 100,000+ CPU/mL
rectal exam –> prostate will be warm, swollen, tender to touch
PSA testing –> if asymptomatic, may have elevated PSA in bloodstream

47
Q

Symptoms of prostatitis

A

fever
chills, aches esp in lower back
painful and frequent urination

48
Q

How to treat prostatitis?

A

Trimethoprim-sulfamethoxazole (Bactrim) or cipro for 10-14 days

49
Q

T/F: Some infections of the prostate can be prevented using a condom during sex

A

T

Block 9 Week 5 Meg (5 decks)

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