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Infection of the GU tract Flashcards

1
Q

What is affected in:

  • upper UTI
  • lower UTI?
A

Upper: renal pelvis, ureters

Lower: bladder, urethra, prostate, testes

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2
Q

What is pyelonephritis?

A

Inflammation caused by infection of the renal pelvis of the kidney

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3
Q

What is urethritis?

A

Inflammation caused by infection of the urethra

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4
Q

What is cystitis?

A

Inflammation caused by infection of the bladder

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5
Q

What is prostatitis?

A

Inflammation caused by infection of the prostate?

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6
Q

What is ureteritis?

A

Inflammation caused by infection of the ureter(s)

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7
Q

What is epididymitis?

A

Inflammation caused by infection of the epididymis

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8
Q

What is orchitis?

A

Inflammation caused by infection of the testicle(s)

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9
Q

What is bacteriuria?

A

Presence of bacteria in the urine which can be asymptomatic or symptomatic

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10
Q

What is pyuria?

A

Presence of leucocytes in the urine

Can be sterile or asterile

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11
Q

How do you classify UTIs (aside from by their location)?

A

Complicated or uncomplicated

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12
Q

What defines a UTI as complicated?

A

If they are:

  • male
  • pregnant
  • a child
  • immunocompromised

If there is:

  • recurrent / persistent infection
  • nosocomial infection
  • a known abnormality in GU tract
  • SIRS or sepsis
  • GU disease (stones, fistula)
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13
Q

What is meant by a ‘nosocomial infection’?

A

A hospital acquired infection

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14
Q

Which type of bacteria are usually responsible for UTIs?

Gram -ve or gram +ve
Cocci or bacilli

A

Usually gram negative bacilli

Such as E. coli

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15
Q

Which bacteria is most commonly the cause of UTIs?

A

E. coli

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16
Q

Name some pathogens that cause UTIs?

A 
E. coli
Staphylococci species
Enterococci species
Klebsiella species
Proteus mirabilis
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17
Q

How are E. coli specialised to infect the GU tract?

A

Fimbriae: to help them latch onto epithelium

Pili: bacterial conjugation

Acid polysaccharide coat that resists phagocytosis

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18
Q

What receptors do the fimbriae of E. coli attach to on uroepithelium?

A

Mannose receptors

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19
Q

Why does oestrogen depletion increase the risk of developing UTIs?

A

Normally the vagina is colonised with lactobacilli

These maintain a low pH in the vagina

Less oestrogen = fewer lactobacilli

Fewer lactobacilli means higher pH so pathogens can colonise more easily

Also commensals are unable to survive

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20
Q

What is the purpose of the acid polysaccharide coat found on E. coli?

A

It makes them resistant to phagocytosis

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21
Q

What is special about the Proteus species?

A

They are able to produce urease

Urease breaks urea into CO2 and ammonia

Ammonia raises the pH of the area, meaning it’s more hospitable for bacteria

And stones are more likely to form: ammonium staghorn stones

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22
Q

What does urease do?

A

Breaks urea into CO2 and ammonia

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23
Q

What host defence mechanisms do we have to prevent UTI?

A

Urine flushes tubes as it flows through

Tamm-Horsfal protein

Glycosaminoglycan layer

Low urine pH and high concentration

Commensal flora

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24
Q

What does Tamm-Horsfal protein do?

A

Bacteria with mannose sensitive fimbriae (E. coli) are trapped by THP

THP has mannose containing chains that trap bacteria

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25
What does the glycosaminoglycan (GAG) layer do?
Its a layer on the bladder wall that protects it by preventing bacteria in the urine gaining access to bladder wall
26
How do commensal bacteria in the GU tract prevent UTI?
Presence of commensals prevents infection because the vagina (for example) is already colonised, there's no room for the pathogen So it can't migrate to urinary tract
27
What can disrupt commensal bacteria, leaving the urothelium susceptible to infection?
Spermicides - used as a form of contraceptive - they also damage commensals Low oestrogen levels: - fewer lactobacilli (a normal commensal) Antibiotics: - can kill commensal as well
28
What two types of bacteriuria are there?
Pathogenic: only one type of bacteria Contaminant: lots of types, mixed growth
29
You should always treat bacteriuria. True or false?
False, often it is aymptomatic and causes no harm Only treat in pregnancy
30
Why should you treat bacteriuria in pregnancy?
Pregnant women have a higher chance of getting pyelonephritis Also increased risk of pre-term labour
31
Who gets bacteriuria?
Increased prevalence with age More common in institutionalised (in care homes etc.) 100% of catheterised patients will have bacteriuria
32
What are the risk factors of UTI?
Being female Immunosuppression Pregnancy Menopause Sexual intercourse Use of spermicides Stones Catheter
33
Why are females more susceptible to UTIs than males?
They have a shorter urinary tract Proximity of urethral meatus to entrance of vagina and anus
34
Why is it vital to do a urine dipstick test on pregnant women?
Because if they have bacteriuria they have a high risk of developing complications like pyelonephritis or pre-term labour Often bacteriuria is asymptomatic until a complication has developed, by then it is too late
35
Why does menopause increase the risk of UTI?
Menopause = less oestrogen Less oestrogen = fewer lactobacilli in vagina = higher pH Higher pH = more pathogenic bacteria colonise Spread from vagina to urethra
36
Clinical features of pyelonephritis?
``` High fever Rigors Vomiting Loin pain and tenderness Oliguria ```
37
Clinical features of cystitis?
Dysruria: painful or difficult urination Increased frequency and urgency Haematuria Cloudy, offensive smelling urine
38
Investigation of a UTI?
Mid-stream urine sample: - culture, microscopy, sensitivity - look for pyuria Bloods if suspecting urosepsis USS + Cystoscopy: look for stones, abscesses
39
What are the problems with mis-stream urine samples?
High rates of contamination when the urine leaves the body Contamination from vulva, penis
40
Getting a mid-stream urine sample from children is difficult. How can you solve this problem?
Do a clean catch urine sample Needle into suprapubic area into bladder to get a fresh sample of urine
41
Treatment of a UTI?
Antibiotics: nitrofurantoin, trimethoprim 3 days for women, 7 for men Pregnant women don't give trimethoprim Children, nitro, trimeth or amoxicillin Increase fluid intake Void pre and post intercourse Keep good hygiene Don't use spermicides
42
When prescribing a woman with antibiotics what do you need to advise?
Antibiotics can make the oral contraceptive pill less effective Use another form of contraceptive
43
Do you need to do an MSU sample in all cases of UTI?
No, only in complicated cases
44
What causes recurrent UTIs?
Re-infection with same bacteria Bacterial persistence Unresolved infection: - poor compliance with treatment - resistant organism
45
Investigation of recurrent UTIs?
MSU Digital rectal and vaginal examination Post void bladder scan USS or renal tract X-ray to look for stones Cystoscopy
46
Prevention of UTIs?
Drink plenty of fluids Antibiotic prophylaxis: - post coital - continuously Self start treatment: when feel UTI starting Cranberry (not much effect at low concentrations)
47
What causes a UTI to develop into urosepsis?
Very virulent / resistant organism Immunosuppression Raised pressure in the urinary tract
48
What is urosepsis?
Sepsis that has been caused by a UTI
49
What causes raised pressure in the urinary tract?
Obstruction of tract: - stone - tumour Poor bladder emptying Catheterisation
50
How do you manage urosepsis?
ABCDE | BUFALO
51
Which age group is most susceptible to prostatitis?
Men below 50
52
Clinical features of prostatitis?
Flu-like symptoms Lower backache Problems with urination Pain post ejaculation and erection Tender, boggy prostate
53
Investigation of prostatitis?
Urinalysis, MSU Semen cultures Blood cultures STI screen USS, CT of abdomen + pelvis
54
What usually causes urethritis?
STIs
55
What is Epididymo-orchitis?
Inflammation of testicle and epididymis Caused by infection
56
What should you consider when faced with a patient with epididymo-orchitis?
Testicular torsion!
57
Clinical features of Epididymo-orchitis?
Swollen, tender, warm testes Pain on urination Fever Malaise
58
Investigation of pyelonephritis?
Males: rectal exam to rule out prostatitis Females: vaginal exam to rule out ovarian pathologies Rule out appendicitis Blood cultures USS: to look for obstruction
59
Management of pyelonephritis?
Antibiotics IV: ciprofloxacin, co-amoxiclav Treat any obstructions Catheterise Analgesia
60
What complications can arise from pyelonephritis?
Renal abscess Emphysematous pyelonephritis Long term renal damage
61
What is Emphysematous pyelonephritis?
Involves gas forming organisms Very serious May involve emergency nephrotomy
62
What's the mnemonic for UTIs...
WET Women E. coli Trimethoprim

Genitourinary (13 decks)

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