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Renal/Urology > Lecture 27 - UTI > Flashcards

Lecture 27 - UTI Flashcards

1
Q

Which term describes inflammation of the kidney?

A

Chronic/acute pyelonephritis

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2
Q

Which term describes inflammation of the bladder?

A

Cystitis

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3
Q

Which term describes inflammation of the urethra?

A

Urethritis

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4
Q

Which term describes inflammation of the prostate?

A

Prostatitis

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5
Q

Which term describes inflammation of the epididymis/testis?

A

Epididymo-orchitis

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6
Q

How many times more likely is a woman to have a UTI than a man?

A

3x

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7
Q

What is the most common HAI?

A

UTI (38%)

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8
Q

What are some general predisposing factors to UTI?

A

Immunosuppression
Steroids
Malnutrition
Diabetes

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9
Q

What are some more specific predisposing factors to UTI?

A

Female sex
Sex + poor voiding habits
Congenital abnormalities, e.g. duplex kidney
Stasis of urine, e.g. due to poor bladder emptying
FBs, e.g. stones, catheters
Oestrogen deficiency in post-menopausal women
Fistula between bladder + bowel
Spermicide coated condoms/diaphragms

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10
Q

What is the most common organism causing UTIs?

A

E. coli

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11
Q

What are other organisms that can cause UTIs?

A

Usually proteus, klebsiella, enterococci

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12
Q

What are the different routes by which bacteria can spread and cause a UTI?

A

Transurethral - periurethral area contaminated
Urethra to bladder, e.g. intercourse, catheterisation
Bloodstream
Lymphatics

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13
Q

What part of the bacteria allows it to attach to bladder epithelial cells?

A

Fimbrae

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14
Q

What are features of UTIs in adults?

A 
Flank pain
Dysuria (like passing broken glass)
Cloudy offensive urine
Urgency
Chills
Strangury
Confusion (elderly)
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15
Q

What are features of UTIs in kids?

A 
Diarrhoea
Excessive crying
Fever
NV
Not eating
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16
Q

What are the clinical features of acute pyelonephritis?

A 
Pyrexia
Poor localisation 
Loin tenderness (renal angle)
Signs of dehydration 
Turbid urine
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17
Q

What investigations shouldbe done for suspected UTI?

A

MSSU

Urinalysis

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18
Q

What is done to the MSSU in the lab?

A

Microscopy + gram staining

Culture + sensitivity

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19
Q

What do you tend to see on urine dipstick in UTI?

A

Blood
Leucocytes
Protein
Nitrates

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20
Q

What other investigations should be done for UTI in children, men or when UTI are frequent?

A

UV/IVU

Isotope studies to rule out reflux/scarring

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21
Q

What are the principles of managing UTIs?

A

Identify organism + start treatment

Identify predisposing factors + treat

22
Q

What is the treatment of UTIs?

A

Amoxicillin (3-5d course)
Cephalosporin
Trimethoprim
Fluids

Severe - IV antibiotics

23
Q

Who tends to get reflux nephropathy?

A

Kids

24
Q

What is the damage in reflux nephropathy due to?

A

Reflux + infection

25
Q

How should you investigate a suspected reflux nephropathy?

A

Micturating cystogram

Assess progression by US and biochemistry

26
Q

How is reflux nephropathy treated?

A

Surgery

27
Q

What advice should you give to people who are getting recurrent UTIs?

A

Fluid intake 2L/day
Void every 2-3 hours every day
Void before bed and before + after sex

28
Q

How should you treat UTI with a catheter in situ?

A

Antibiotics if symptomatic + replace catheter

29
Q

Define bacteriuria

A

> 10^5 CFU

30
Q

How is chronic pyelonephritis diagnosed?

A

Radiologically

31
Q

What can you see in the kidney of someone who has chronic pyelonephritis?

A

Scarring + clubbing

32
Q

What can chronic pyelonephritis cause?

A

Chronic renal failure

HTN

33
Q

What are the features of lower UTIs in adults?

A 
Dysuria
Urinary frequency
Urinary urgency
Cloudy/offensive smelling urine
Lower abdominal pain
Low grade fever
Malaise
34
Q

How do UTIs present in infants?

A

Poor feeding, vomiting, irritability

35
Q

How do UTIs present in younger children?

A

Abdominal pain, fever, dysuria

36
Q

How do UTIs present in older children?

A

Dysuria, frequency, haematuria

37
Q

What features of UTIs in children may suggest an upper UTI?

A

Temperature >38

Loin tenderness/pain

38
Q

When should you check a urine sample in a child?

A

Signs/symptoms suggestive of UTI
Unexplained ever of 38+
Alternative site of infection but who remains unwell

39
Q

What is the preferable urine collection method in kids?

A

Clean catch

If not possible urine collection pads should be used

ONLY use in invasive methods like suprapubic aspiration if non-invasive methods not possible

40
Q

How are UTIs in children managed?

A

<3 months –> refer immediately to paediatrician
>3 months + upper UTI –> refer to hospital or give cephalosporin/co-amoxiclav for 7-10 days
>3 months + lower UTI - 3 days trimethoprim, nitrofuratoin etc.
Ask parents to bring child back if still unwell after 24-48h

41
Q

Should you investigate a UTI in a child?

A

Yes - you should try and find the underlying cause

42
Q

What are the common organisms causing UTIs in kids?

A

E. coli (80%)
Proteus
Pseudomonas

43
Q

What are predisposing factors to UTIs in kids?

A

Incomplete bladder emptying - infrequent voiding, hurried micturition, obstruction by full rectum due to constipation, neuropathic bladder

VUR

Poor hygeine

44
Q

How are lower UTIs managed in non-pregnant women?

A

Trimethoprim/nitrofuratoin for 3 days

45
Q

When should you send a urine culture for a non-pregnant women presenting with a lower UTI?

A

Only if age >65 or visible/nonvisible haematuria

46
Q

How should a pregnant woman presenting with a UTI be managed?

A

Urine culture sent

Antibiotics for 7 days - nitrofuratoin (avoid near term), amoxicillin or cefalexin

47
Q

How should asymptomatic bacteruria be treated in pregnancy?

A

Treat as UTI to prevent progression to acute pyelonephritis

Send off culture after treatment is finished as test of cure

48
Q

Should you treat asymptomatic bacteruria in a catheterised patient?

A

No

49
Q

Should should symptomatic UTI in a catheterised patient be managed?

A

7 day antibiotic course

50
Q

How is acute pyelonephritis managed?

A

Hospital admission

Broad spectrum cephalosporin/quinolone for 10-14 days

51
Q

What is the most common cause of acute pyelonephritis?

A

Ascending infection (usually E. coli) from lower urinary tract

Can also occur from bloodstream spread of infection

52
Q

What clinical features are associated with acute pyelonephritis?

A

Fever, rigors
Loin pain
Vomiting
White cell casts in urine

Renal/Urology (29 decks)

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