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Sem 2 Year 2 > Lower urinary tract and UTIs > Flashcards

Lower urinary tract and UTIs Flashcards

1
Q

What are the differences between the upeer and lower urinary tracts?

A

Lower= bladder and urethra
Upper= bilateral collecting systems and ureters

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2
Q

Why is there thicker bladder muscles in males?

A

The male bladder has a prostate gland below it- causes harder resistance for urine to pass through, so bladder muscles are thicker

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3
Q

What are the 3 layers of the bladder?

A

Urothelium- multilayered and has a barrier function
Lamina propria- functional centre, controls urothelium and detrusor muscles. Blood, vessels and nerve fibres are found here
Detrusor muscle- smooth and arranged in bundles.

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4
Q

What passively passes through the bladder/

A

It is not completely waterproof but it does resist water passage
There is passive passage of urea, Na+ and K+

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5
Q

How is voluntary voiding controls?

A

The spinobulbar reflex is modulated by the pontine micturition centre (PMC) in the pons.
Is known as Barrington’s nucleus
Also mediated by Onuf’s nucleus in the sacral area

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6
Q

What happens when voiding is initiated?

A

There is coordination of detrusor contraction and external urethral spihincter and urethral relaxation

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7
Q

What type of feedback loop is voiding controlled by?

A

Voiding is controlled by a positive feedback loop, as detrusor muscles contract, higher functions send efferent signals to increase detrusor contraction

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8
Q

What nerves are involved in volition?

A

Parasympathetic and pudendal

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9
Q

What is facilitation of voiding?

A

Early voiding e.g. in anxiety caused by higher centres

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10
Q

What are the excitory and inhibitory neurotransmitters involved in volition?

A

Excitory= ACh
Inhibitory= GABA and glycine

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11
Q

What can be used to check voiding patterns?

A

Can use frequency/volume chart which shows frequency, volumes passed and nocturia
Can also use a bladder diary that also shows input

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12
Q

What are lower urinary tract symptoms split into?

A
  • STORAGE= urgency, frequency, nocturia and urinary incontinence
  • VOIDING= hesitancy, poor flow, intermittency, terminal dribbling
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13
Q

What do storage symptoms reflect?

A

They reflect increased urinary production or decreased storage capacity
Could be excess fluid intake, MS, DM/DI

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14
Q

What is nocturia and what are the causes?

A

Nocturia- nocturnal frequency. Normal is < 2x a night. Caused by ageing bladder, bladder onstruction, dietary habits, decreased compliance
Renal concentrating ability decreases with age- less is absorbed so more urine produced

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15
Q

What are the voiding symptoms and what causes them?

A

Poor flow, hesitancy and dribble
Can be due to bladder outlet obstruction, urethral stricture (narrowing)
May also be due to an underactive/ hypocontractile bladder

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16
Q

What is incontience and what are the two types?

A

Defined as ‘involuntary loss of urine that is a social or hygienic problem and is objectively demonstrable
- Urge incontience= Involuntary loss of urine associated with strong desire to void (detrusor contraction)
- Stress incontience= –Involuntary loss of urine when intra-abdominal pressure rises without detrusor contraction eg with coughing, sneezing, laughing, straining, exerting

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17
Q

What is the international prostate symptom score?

A

Combines 7 questions and quality of life symptoms to get a score

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18
Q

What is a UroFlowMeter?

A

Uroflowmetry is a test that measures the volume of urine released from the body, the speed with which it is released, and how long the release takes.

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19
Q

What is Urodymanic assessment?

A

Pressure transducers placed to measure pressure in bladder and rectum. Subtracting rectal (abdominal) pressure from bladder = detrusor activity.
Helps find the cause

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20
Q

What does a normal urodynamic trace look like?

A
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21
Q

What does detrusor overactivity look like in a urodynamic trace?

A
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22
Q

What is the treatment for overactive detrusor activity?

A

Anti-muscarinic therapy or botox therapy

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23
Q

What does stress incontinence look like on a urodynamic trace?

A
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24
Q

What does high detrusor pressure associated with low urinary output volume indicate?

A

Bladder outflow obstruction

25
Q

What is the stepwise pattern of outflow obstruction?

A
  • Storage symptoms may come first then voiding symptoms and finally decompensation of the detrusor muscles
  • Can lead to residual urine, chronic retention, bladder failure and renal failure
26
Q

What is the treatment for an overactive bladder?

A

Lifestyle; cutting down on alcohol and caffine
Give anti-muscarinics and if these do not work intradetrusor botox

27
Q

What is the treatment of stress incontinence?

A

Pelvic floor exercise, weight loss, surgery

28
Q

What is the treatment for bladder outlet obstruction?

A

alpha blockers, 5 alpha reductase inhibitors or surgery

29
Q

What are the two types of urinary tract infection?

A
30
Q

What are the risk factors for UTIs?

A
  • Females (due to anatomy)
  • Those with a previous UTI
  • Sexual activity
  • Diabetes (pathogens like high levels of glucose)
  • Obesity (anatomy changes)
  • Genetic susceptibility
  • Older age- cognitive impairement and oestrogen deficiency
31
Q

What is the most common cause of secondary bloodstream infections?

A

Catheter associated UTIs (CAUTIs)

32
Q

What factors may cause a patient to develop a complicated UTI?

A

Urinary obstruction- vaginal prolapse, prostatic enlargement
Urinary retention- neurological disease
Immunosuppressed patients
Those with renal failure
Pregnancy
Prescence of foreign bodies e.g. catheters

33
Q

What are the most common pathogens to cause UTIs?

A

1 Uro-pathogenic E coli

#2 K pneumoniae
#3 Enterococcus spp.

34
Q

How do the pathogens cause an infection?

A

Have pili which helps adhere to the bladder wall. Can also be used to invade the wall and multiply then bursts out

35
Q

What inhibits bacteria growth in the urinary tract?

A

Extremes of osmolarity, low pH and high urea concentration inhibit bacterial growth
Urine flow flushes bacteria out
Inflammatory response

36
Q

What are the different areas in the lower urinary tract that can get infected?

A

Urethritis, prostatitis, epididymo-orchitis, cystisis (bladder), and pyleonephritis

37
Q

What is the clinical presentation of pyelonephritis?

A

Loin pain/ flank tenderness, fever, rigors, sepsis

38
Q

What are the clinical features of cystitis?

A

Dysuria, frequency urgency, suprapubic tenderness

39
Q

What symptoms can be seen in infants (<2 years) and the eldery with a UTI?

A

Infants= vomiting/fever
Elderly= confusion/ falls

40
Q

What are the differential diagnosis of dysuria in adults?

A

Dermatologic (dermatitis)
Infectious
Foreign body
Urethritis
Urethral structure abnormality
Drug related
Cancers

41
Q

The prescence of what in a urine dipstick test indicates a possible UTI?

A

Nitrates

42
Q

What age should urine dipstick tests be used for UTIs and why?

A

Only to be used in patients < 65
Presence of an infection in older people does not necessary mean UTI. Less efficient muscles flush out bacteria less efficiently and this causes 50% of people to have colonised bacteria

43
Q

What is important when gathering a urine sample?

A

Mid stream sample

44
Q

What is the difference between symptomatic and asymptomatic bacteruria?

A

Asymptomatic= significant bacteriuria in a patient without symptoms. Only treated in pregnant women
Symptomatic bacteruria= UTI

45
Q

What are the different urine cultures that can be done?

A

Flexicult= for primary care, rapid result for UTI
Molecular markers= check for bacteria, inflammation (more likely to have UTI with the two) and presence of antimicrobial resistance

46
Q

What are useful antibiotic guidelines?

A

Scottish antimicrobial prescribing group website

47
Q

What antibiotics are used usually for cystitis?

A

If there is no risk factors for trimethoprim (e.g. in a nursing home, taken them before) use trimethoprim
If there is risk factors and eGFR > 30 use nitrofurantoin

48
Q

What are antibiotics for in cystitis?

A

Makes symptoms better and shorterns them- not necessary for cure

49
Q

What can antimicrobial use increase the likelihood of in UTIs?

A

Increases risk of recurrent UTIs
Increases risk of antimicrobial resistance

50
Q

What antibiotic should not be given to patients with pyelonephritis?

A

Nitrofurantoin- does not reach therapeutic concentrations in the upper urinary tract

51
Q

What is the treatment for an upper UTI?

A

Gentamicin, consider adding amoxicillin
If have a penecillin allergy, consider adding vancomycin

52
Q

Why do you not use a urine dipstick test to diagnose catheter associated UTIs?

A

Urine culture is often positive in those with a catheter
CAUTI is diagnosed clinically

53
Q

How are catheter associated UTIs treated?

A

Secondary care- gentamicin, large singular dose and change catheter
Primary- treat as a lower UTI

54
Q

What is important to consider while treating pregnant women for UTIs?

A

Avoid contra-indicated antibiotics

55
Q

What is a common reason for kidney failure that children with a UTI might have?

A

Vesico-uteric reflux- urine moving back into the kidneys

56
Q

What simple advice should be given for patients with recurrent UTIs?

A

High fluid intake, avoid fizzy frinks and alcohol
Post coital voiding and lubrication for intercourse
Hygeine- wiping front to back
Avoid perfumed products
Smoking cessation, consider weight reduction

57
Q

What treatment options can be considered in patients with continued recurrent infections?

A

For post menopause women- topical vaginal oestrogen
Post coital antibiotics- trimethopin once or self start antibiotics after symptoms (still need urine culture)
Trial of methenamine with Vit C

58
Q

How does methenamine with vit C help with UTIs?

A

Non-micriobial treatment- makes urine full of formaldehyde and vit c makes it more acidic
Harder for bacteria to grow

Sem 2 Year 2 (16 decks)

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