Lecture 12: Urinary Tract Infection

Question 1

clinical features of UTI in children

Answer 1

• diarrhoea
• excessive crying
• fever
• nausea and vomiting
• not eating

Question 2

clinical features of UTI in adults

Answer 2

• flank pain
• dysuria (‘like passing broken glass’)
• cloudy offensive urine
• urgency
• chills
• strangury
• confusion (very old people)

Question 3

if pain occurs at the initiation of urination, this may indicate the pathology is located within the?

Answer 3

urethra

Question 4

if pain occurs at the end of urination (stranguria), this commonly indicates?

Answer 4

bladder pathology

Question 5

clinical features of acute pyelonephritis

Answer 5

• pyrexia
• poor localisation
• loin tenderness (renal angle)
• signs of dehydration
• turbid urine

Question 6

UTI investigations

Answer 6

• mid-stream sample of urine
• urinalysis in wards: blood, leucocytes, protein and nitrites
• microbiology in laboratory: microscopy and gram staining, bacteruria > 10^5 CFU/ml culture and sensitivity

Question 7

UTI treatment

Answer 7

• fluids
• antibiotics: amoxicillin (3-5 day course or 3g x 2), cephalosporin, trimethoprim
• severe infections: IV antibiotics

Question 8

reflux nephropathy investigations management

Answer 8

• UTIs in children > damage caused by reflux and infection
• micturating cystogram (radionucleotide 99Tc techniques)
• assess progression by US and biochemistry
• surgery

Question 9

how to prevent recurrent UTIs

Answer 9

• fluid intake 2l/day
• void every 2-3 hours by day
• void before bedtime and after intercourse
• avoid bubble baths and constipation