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Urogenital Block > L22-Urinary tract infection [2013.09.11] > Flashcards

L22-Urinary tract infection [2013.09.11] Flashcards

1
Q

What are the potential consequences of UTI?

A

Chronic renal failure, bacteremia and urinary stones

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2
Q

What are the host defense against UTI?

A

*** flushing effect of urine
Humoral immunity
Cell mediated immunity

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3
Q

What are the virulence factors of UTI?

A

Lipopolysaccharide capsular
Polysaccharide
Toxins : (1)hemolysin (2)aerobactin protease

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4
Q

What are the usual bacteria involved in UTI?

A

E.coli, group B streptococcus, enterococcus

Most caused by enteric or skin bacteria

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5
Q

What are the host factors that cause UTI?

A 
Length of the urethra 
Mechanical factors:
(1)sexual intercourse
(2)trauma
(3)contraceptive diaphragm 
(4)catheter
Density of bacterial receptors 
Hormonal effect on mucosa 
Underlying disease
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6
Q

What is the pathway of spreading of UTI?

A

Bladder -> Kidney -> Blood

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7
Q

What is the cause of urinary reflux?

A

Incompetent of ureterovesical valves

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8
Q

What is the cause of poor emptying?

A

Neurogenic bladder

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9
Q

What is the cause of dilation and decreased peristalsis of ureter

A

Pregnancy

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10
Q

What is the cause of obstruction

A

Stones

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11
Q

What is the cause of immune incompetence?

A

Diabetes mellitus

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12
Q

What is the cause of nidus of persistence?

A

Catheter

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13
Q

What kind of damage will polysaccharide bring?

A

Inhibit phagocytosis

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14
Q

What kind of damage will lipopolysaccharide bring?

A

Inflammation

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15
Q

What kind of damage will hemolysin of E. coli bring?

A

Tissue damage

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16
Q

What kind of damage will urease bring?

A

Stone formation

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17
Q

Give an account to uncomplicated UTI

A

Without structural abonomality

E. coli (80%) or S saprophyticus

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18
Q

Give an account to complicated UTI

A

With structural abnormalities
High likelihood of complications
Klebsiella, enterobacter, pseudomonas, Serratia

19
Q

What is the most common uropathogen causing UTI in patient aged between 15 and 50 years old?

A

E. coli (72%)

20
Q

What is the most common uropathogen causing UTI in patietn aged above 50 years old?

A

E. coli (53%)
Klebsiella (12%)
Enterococcus (12%)

21
Q

What are the symdromes of UTI?

A 
Acute pyelonephritis 
Perinephric abscess 
Cystitis 
Asymptomatic bacteriuria 
Prostatitis
22
Q

What are the criteria in diagnosing UTI?

A 
Both pyuria (WBC in urine) and 
bacteriuria
23
Q

What are the other microbiological tests that we could carry out to diagnose UTI?

A

Esterase

Nitrite detection

24
Q

What are the possible errors in using esterase as an indicator?

A

Some drugs may lead to false positve results

Positive results may occur from contamination of specimen by vaginal discharge

25
Q

What are the possible errors in using Nitrite detection?

A

Negative test may not rule out UTI

  • Some bacteria do not have that enzyme
  • may not retain in the baldder long enough
26
Q

What bacteria can be detected with nitrite detection method?

A

Lactose positive Enterobactericeae, Staphylococcus, Proteus, Salmonella and pseudomonas

27
Q

What is the use of quantitative or semi-quantitative culture in making a diagnosis for UTI?

A

To differentiate contamination or genuine bacteriuria

28
Q

What are the methods used in making the culture?

A

Standard loop

Paper strip, dip slide

29
Q

What is the medium used in making a diagnosis for UTI?

A

CLED agar; inhibit swarming, colony morphology

30
Q

Give an account for the use of Standard loop method

A

Quantitative way

Spread evenly on agar surface, to differentiate between lactose fermentor or non-lactose fermenter

31
Q

What can be interpretated from the culture results

A

For mid-stream or clean-catch urine specimens, More than or equal to 10^5 cfu per ml = significant growth

32
Q

Some patients who have UTI do not have elevated counts, who are they?

A

Pregnant women

Men

33
Q

What should be practised during specimen collection?

A

Avoid cleaning with antiseptic, which may contaminate urine (false negative)
Whip in backward direction

34
Q

What are the possible reasons for false positive results?

A

Heavy colonisation of vagina

Delay transport of urine sample (more than two hours)

35
Q

Name five complications of UTI

A 
Asymptomatic bacteriuria 
Recurrent UTI
Catheter related UTI
Acute bacterial prostatitis 
Chronic bacterial prostatitis
36
Q

Most of the cases of bacteriuria, no treatment is required for asymptomatic patient, however, what are the patient that require treatment?

A

Pregnant
Found before urological operation
Children under age of 5 yr when associated with vesico-urethro reflux

37
Q

What is the overall comments on urological evaluation in young women

A

Not cost effective

38
Q

When is urological evaluation in young women indicated?

A 
Haematuria 
Pyelonephritis 
Obstructive symptoms 
Urea-splitting bacteria 
Urinary calculi 
Severe diabetes
39
Q

How is catheter related UTI prevented?

A

Avoid/ removal of catheter
Hand washing
Maintain closed system

40
Q

What is biofilm?

A

Biofilm is when bacteria attach to foreign surface (urinary catheter material) to form biofilm

41
Q

What are the symptoms of acute bacterial prostatitis?

A

Dysuria, frequency
High fever -> common
Urinary retention -> common
Per rectal examination - very tender prostate

42
Q

What are the infectious agents of chronic bacterial prostatitis?

A

E. coli
Enterobacteriaceae
Pseudomonas aeruginosa
Enterococci

43
Q

What are the associated conditions of chronic bacterial prostatitis?

A

Retrograde spread of bacteria into prostatic ducts
Dysfunctional voiding
Previous instrumentation

44
Q

Give an account to the four glass test for chronic bacterial prostatitis.

A

First 10ml voided
Midstream (bladder)
Prostatic massage
EPS Prostatic secretion/ First 10 ml voided after massage

Urogenital Block (3 decks)

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