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Renal/Urology > Lecture 8 - Pathology of Urinary Tract Infection > Flashcards

Lecture 8 - Pathology of Urinary Tract Infection Flashcards

1
Q

How does UTI tend to present?

A

Dysuria Frequency Smelly urine

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2
Q

Define dysuria

A

Pain on urination

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3
Q

How might very young people with UTIs present differently?

A

May present being unwell/FTT

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4
Q

How might very old people with UTIs present differently?

A

Incontinence Off their feet

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5
Q

What % of the CO becomes renal blood flow?

A

20-25%

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6
Q

Do the ureters store urine?

A

No, they have a continuous trickle of urine down them

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7
Q

Describe how the ureters enter the bladder?

A

At an acute angle

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8
Q

How is the reflux of urine from the bladder into the ureters prevented in physiology?

A

Increasing pressure from bladder as it fills closes off the ureter

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9
Q

What properties of the normal urinary tract make it bacteriostatic?

A

Free flow urine through normal anatomy Low pH, high osmolality and high ammonia in normal urine content Prostatic secretions are bacteriostatic Anti-bacterial antibodies

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10
Q

Is the normal urinary tract sterile?

A

Yes expect from terminal urethra (perineal and rectal flora)

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11
Q

Should a suprapubic aspirate of urine be sterile or not?

A

Should be sterile

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12
Q

Should a urinated specimen be sterile?

A

No it will always be contaminated by terminal urethral flora

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13
Q

What can get rid of a lot of the terminal urethral flora to allow you to get a less contaminated urine sample?

A

Initial voiding

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14
Q

What is a MSSU?

A

Mid-stream specimen of urine Patient voids and then stops midstream, discards urine and collects next volume of urine

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15
Q

In which groups of people can it be difficult to get an MSSU?

A

Young children Adults

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16
Q

Is a MSSU sterile?

A

No - but urethral flora will be diminshed

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17
Q

How do you tell MSSU contamination from infection?

A

Send to microbiology for culture under set conditions Bacteria multiply in log phase growth 10^5 usually indicates infection

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18
Q

What does an MSSU of 10^3-10^4 indicate?

A

Symptomatic - probable infection Asymptomatic - 50% chance of infection

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19
Q

What does an MSSU of <10^3 indicate?

A

Usually no infection

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20
Q

What are issues with urine culture intrepretation?

A

Some bacterial species not normally present in urethral/rectal flora + may be pathogenic at low numbers

21
Q

What organisms tend to cause UTIs?

A

Gut flora, esp. E. coli

22
Q

What is the most common route of infection in UTI?

A

Almost always ascending (from urethra)

23
Q

What is the most common route of infection in a kidney infection?

A

Spread up from bladder

24
Q

What does the infection in a UTI lead to?

A

Inflammation (urethritis, cystitis, ureteritis, acute/chronic pyelonephritis)

25
Q

What are the 3 key predisposing factors that cause UTIs?

A

Stasis of urine Pushing bacteria up urethra from below Generalised predisposition to infction

26
Q

What things may cause stasis of urine?

A

Obstruction (congenital/acquired) Loss of feeling of full bladder, e.g. spinal cord/brain injury

27
Q

What things may cause pushing up of bacteria up the urethra from below?

A

Sex in females Catheterisation + other urological procedures

28
Q

Give an e.g. of something that generally predisposes to infection?

A

Diabetes

29
Q

Why does stasis of urine lead to UTIs?

A

Bacteria that do get higher up are not flushed out

30
Q

What happens if there is an obstruction to the urethra?

A

Upper urethral and bladder dilatation

31
Q

What can bladder dilatation result in?

A

Bilateral hydroureter

32
Q

What can bilateral hydroureter result in?

A

Bilateral hydronephrosis –> chronic renal failure

33
Q

What occurs if there is obstruction at the level of the renal pelvis at one side only?

A

Unilateral hydroureter + hydronephrosis

34
Q

What are the consequences of blockages in the urinary tract?

A

Proximal dilatation Slowed urine flow –> cannot flush out bacteria –> infection Slowed urine flow –> sediments form –> calculous formation –> obstruction –> more of the above!

35
Q

What tends to cause obstruction in children?

A

Renal tract abnormalities

36
Q

Should you always investigate UTIs in kids?

A

Yes, investigate at first presentation + send to paediatric surgeons

37
Q

What is the most important thing causing UTIs in kids?

A

Vesicoureteric reflux

38
Q

What is the pathophysiology of vesicoureteric reflux?

A

There is decreased angulation of the ureter as it enters the bladder This means urine can reflux when the bladder is full

39
Q

What are common causes of obstruction of the urinary tract in adults?

A

Men - BPH –> enlarged prostate surrounding the urethra Women - urine prolapse Both - tumours, calculi

40
Q

Why can spinal cord/brain injury lead to stasis of urine?

A

Incomplete emptying of bladder due to reduced sensation so there is a higher residual volume –> stasis of urine

41
Q

When do MEN tend to get UTIs?

A

Late middle age

42
Q

When do women tend to get more UTIs?

A

During sexually active years

43
Q

What gender is more predisposed to getting UTIs?

A

Women

44
Q

What happens during sex that makes women more prone to UTIs?

A

Sexual activity tends to move lower urethral flora up the tract

45
Q

Why are the female sex more predisposed to UTIs?

A

Shorter urethra Lack of prostatic bacteriostatic secretions Closeness of urethral orifice to rectum Sex Pregnancy - pressure on ureters and bladder

46
Q

Why are diabetics more prone to UTIs?

A

Glucose in urine Poor WBC function

47
Q

So, what tends to cause UTIs in: A. Children B. Young females C. Older males D. Older females

A

A. Urinary tract abnormalities B. Sexual activity C. Prostatic problems/tumours D. Uterine prolapse/tumours

48
Q

What are acute complications of UTIs?

A

Severe sepsis and septic shock

49
Q

What are chronic complications of UTIs?

A

Chronic damage to kidneys if repeated infection (chronic pyelonephritis) –> HTN, chronic renal failure Calculi –> obstruction –> hydronephrosis –> HTN, chronic renal failure

Renal/Urology (29 decks)

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