Pathology of Urinary System (UTI)

Question 1

What is the general presentation of UTI?

Answer 1

Dysuria
Frequency change
Smelly urine

Question 2

Why do the ureters enter the bladder at an angle?

Answer 2

Prevents back flow

Question 3

What is the only part of the urinary tract that is unsterile?

Answer 3

Terminal urethra

Question 4

What are the bacteriostatic properties of a normal urinary tract?

Answer 4

Free flow of urine through normal anatomy
Low pH, high osmolarity, high ammonia
Anti bacterial antibodies

Question 5

Why should a MSSU be collected for UTI?

Answer 5

Urethral flora diminished but always present
Urethral flora will always grow in culture
No such thing as a negative result

Question 6

What is mid stream specimen urine?

Answer 6

Patient voids and stops mid-stream, discarding urine, then collects next volume of urine

Question 7

Numerically, what confirms a UTI is present?

Answer 7

10^5

10^3-10^4 means infection sometimes present

Question 8

What is the problem with MSSU?

Answer 8

Difficult to collect in young children and elderly

Question 9

What are the problems with interpretation of urine cultures?

Answer 9

Some bacterial species are not commonly present in terminal urethra/rectal flora and may be pathogenic at low colony number s

Question 10

What are the microorganisms that cause UTI?

Answer 10

Bacteria mostly (E. Coli) 
Viral infection rare

Question 11

What is the route of infection of UTI?

Answer 11

Almost always ascending

Question 12

What inflammatory responses can occur from infection?

Answer 12

Urethritis (Urethra)
Cystitis (Bladder)
Ureteritis (Ureter)
Acute/chronic pyelonephritis (Kidney)

Question 13

What are the predisposing factors for UTI?

Answer 13

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

Question 14

What can cause stasis of urine?

Answer 14

Obstruction (congenital or acquired)

Loss of “feeling” of full bladder (spinal cord/brain injury)

Question 15

What can cause pushing of bacteria up urethra from below?

Answer 15

Sexual activity in females
Catheterisation
Urological procedure

Question 16

What can cause generalised predisposition to infection?

Answer 16

Diabetes

Question 17

What happens if there is an obstruction at the level of the urethra?

Answer 17

Bladder dilatation
Bilateral hydroureter
Bilateral hydronephrosis
Chronic renal failure

Question 18

What happens if there is an obstruction at the level of renal pelvis on one side?

Answer 18

Unilateral hydroureter

Unilateral hydronephrosis

Question 19

What are the consequences of obstruction?

Answer 19

Proximal dilatation
Slowed urine flow, cant flush out bacteria infection
Sediments form, calculous (stone) formation, obstruction

Question 20

What can cause obstruction in children?

Answer 20

Renal tract abnormalities

Vesicoureteric reflux

Question 21

What are common causes of obstruction in adults?

Answer 21

Men (bengin prostatic hyperplasia)
Female (uterine prolapse
Both (tumours and calculi)

Question 22

What happens if a loss of “feeling” bladder fullness occurs?

Answer 22

Decreased sensation, don’t know when to micturate or how to empty bladder completely, urine left in bladder, stasis of urine

Question 23

What is an acute complication of UTI?

Answer 23

Severe sepsis

Septic shock

Question 24

What are the chronic complications of UTI?

Answer 24

Chronic damage to kidneys if repeated infections, hypertension, renal failure