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Genitourinary > Infection of the GU tract > Flashcards

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
Q

What does the glycosaminoglycan (GAG) layer do?

A

Its a layer on the bladder wall that protects it by preventing bacteria in the urine gaining access to bladder wall

26
Q

How do commensal bacteria in the GU tract prevent UTI?

A

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
Q

What can disrupt commensal bacteria, leaving the urothelium susceptible to infection?

A

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
Q

What two types of bacteriuria are there?

A

Pathogenic: only one type of bacteria

Contaminant: lots of types, mixed growth

29
Q

You should always treat bacteriuria.

True or false?

A

False, often it is aymptomatic and causes no harm

Only treat in pregnancy

30
Q

Why should you treat bacteriuria in pregnancy?

A

Pregnant women have a higher chance of getting pyelonephritis

Also increased risk of pre-term labour

31
Q

Who gets bacteriuria?

A

Increased prevalence with age

More common in institutionalised (in care homes etc.)

100% of catheterised patients will have bacteriuria

32
Q

What are the risk factors of UTI?

A

Being female
Immunosuppression
Pregnancy
Menopause

Sexual intercourse
Use of spermicides
Stones
Catheter

33
Q

Why are females more susceptible to UTIs than males?

A

They have a shorter urinary tract

Proximity of urethral meatus to entrance of vagina and anus

34
Q

Why is it vital to do a urine dipstick test on pregnant women?

A

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
Q

Why does menopause increase the risk of UTI?

A

Menopause = less oestrogen

Less oestrogen = fewer lactobacilli in vagina = higher pH

Higher pH = more pathogenic bacteria colonise

Spread from vagina to urethra

36
Q

Clinical features of pyelonephritis?

A 
High fever
Rigors
Vomiting
Loin pain and tenderness
Oliguria
37
Q

Clinical features of cystitis?

A

Dysruria: painful or difficult urination

Increased frequency and urgency

Haematuria

Cloudy, offensive smelling urine

38
Q

Investigation of a UTI?

A

Mid-stream urine sample:

  • culture, microscopy, sensitivity
  • look for pyuria

Bloods if suspecting urosepsis

USS + Cystoscopy: look for stones, abscesses

39
Q

What are the problems with mis-stream urine samples?

A

High rates of contamination when the urine leaves the body

Contamination from vulva, penis

40
Q

Getting a mid-stream urine sample from children is difficult. How can you solve this problem?

A

Do a clean catch urine sample

Needle into suprapubic area into bladder to get a fresh sample of urine

41
Q

Treatment of a UTI?

A

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
Q

When prescribing a woman with antibiotics what do you need to advise?

A

Antibiotics can make the oral contraceptive pill less effective

Use another form of contraceptive

43
Q

Do you need to do an MSU sample in all cases of UTI?

A

No, only in complicated cases

44
Q

What causes recurrent UTIs?

A

Re-infection with same bacteria

Bacterial persistence

Unresolved infection:

  • poor compliance with treatment
  • resistant organism
45
Q

Investigation of recurrent UTIs?

A

MSU

Digital rectal and vaginal examination

Post void bladder scan

USS or renal tract

X-ray to look for stones

Cystoscopy

46
Q

Prevention of UTIs?

A

Drink plenty of fluids

Antibiotic prophylaxis:

  • post coital
  • continuously

Self start treatment: when feel UTI starting

Cranberry (not much effect at low concentrations)

47
Q

What causes a UTI to develop into urosepsis?

A

Very virulent / resistant organism

Immunosuppression

Raised pressure in the urinary tract

48
Q

What is urosepsis?

A

Sepsis that has been caused by a UTI

49
Q

What causes raised pressure in the urinary tract?

A

Obstruction of tract:

  • stone
  • tumour

Poor bladder emptying

Catheterisation

50
Q

How do you manage urosepsis?

A

ABCDE

BUFALO

51
Q

Which age group is most susceptible to prostatitis?

A

Men below 50

52
Q

Clinical features of prostatitis?

A

Flu-like symptoms
Lower backache
Problems with urination

Pain post ejaculation and erection

Tender, boggy prostate

53
Q

Investigation of prostatitis?

A

Urinalysis, MSU

Semen cultures

Blood cultures

STI screen

USS, CT of abdomen + pelvis

54
Q

What usually causes urethritis?

A

STIs

55
Q

What is Epididymo-orchitis?

A

Inflammation of testicle and epididymis

Caused by infection

56
Q

What should you consider when faced with a patient with epididymo-orchitis?

A

Testicular torsion!

57
Q

Clinical features of Epididymo-orchitis?

A

Swollen, tender, warm testes

Pain on urination
Fever
Malaise

58
Q

Investigation of pyelonephritis?

A

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
Q

Management of pyelonephritis?

A

Antibiotics IV: ciprofloxacin, co-amoxiclav

Treat any obstructions

Catheterise

Analgesia

60
Q

What complications can arise from pyelonephritis?

A

Renal abscess
Emphysematous pyelonephritis

Long term renal damage

61
Q

What is Emphysematous pyelonephritis?

A

Involves gas forming organisms
Very serious

May involve emergency nephrotomy

62
Q

What’s the mnemonic for UTIs…

A

WET

Women
E. coli
Trimethoprim

Genitourinary (13 decks)

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