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Urinary System > Pathology of Urinary Tract Infection > Flashcards

Pathology of Urinary Tract Infection Flashcards

1
Q

What is the presentation of a UTI?

A

Dysuria
Frequent urination
Smelly urine

In very young - generally unwell, failure to thrive
In very old - incontinence, immobility

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2
Q

What percentage of cardiac output does renal blood flow receive?

A

20-25%

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3
Q

In the normal renal tract, urine output changes with what?

A

Oral intake of fluids

Resorption of fluid is diminished if there is an increase in fluid intake and urine output will be increased

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4
Q

How does urine move through the ureters?

A

The movement of urine is continuous, the ureters do not store urine

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5
Q

What stops the reflux of urine?

A

The ureters enter the bladder at an angle, so as the bladder fills there is increasing pressure which closes off the ureter and stops the reflux of urine

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6
Q

What are the normal properties of urine?

A

Low pH
High osmolality
High ammonia

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7
Q

Prostatic secretions are

A

bacteriostatic

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8
Q

What parts of the urinary tract are sterile?

A

All of the urinary tract except for the terminal urethra

Subrapubic aspirate of urine will also be sterile

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9
Q

What is the main difference between a urinated sample of urine, compared to one obtained by a catheter?

A

A urinated sample will always be contaminated by the terminal urethral flora

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10
Q

What can be taken to obtain a sterile sample of urine?

A

A suprapubic aspirate of urine from the bladder

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11
Q

What process will flush out many of the terminal urethral floral bacteria?

A

Initial voiding - so initial urine will be heavily contaminated

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12
Q

When should urine specimens be collected?

A

After the initial void - ask the patient to void, stop mid-stream (discarding any collected urine), and then collect the next volume of urine - mid stream specimen of urine (MSSU)

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13
Q

Why is there no such thing as a negative MSSU?

A

The urethral flora is diminished by always present, so will always grow in a culture

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14
Q

What is the quick method for MSSU?

A

Dip slide method

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15
Q

When does an MSSU culture usually indicate an infection?

A

10^3 - 10^4 bacteria per ml sometimes indicates an infection

10^3 - 10^4 probable infection if symptomatic, 50% chance of infection if asymptomatic

If < 10^3 usually no infection

10^5 per ml represents infection

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16
Q

In what patients is an MSSU difficult to obtain?

A

In young children and the elderly

17
Q

What are the usual causative organisms of UTI?

A

Gut flora, particularly E. coli

Viral infection rare

18
Q

What is the normal route of infection of a UTI?

A

Almost always ascending i.e. from the terminal urethra to the bladder

Infection in the kidneys has usually spread from a bladder infection, upper UTIs more serious than lower

19
Q

What are the names for infections of the;

  • urethra
  • bladder
  • ureter
  • kidney
A

Urethra - urethritis
Bladder - cystitis
Ureter - ureteritis
Kidney - acute or chronic pyelonephritis

20
Q

What are the predisposing factors to a UTI?

A

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

21
Q

What is the cause of stasis of urine?

A

Obstruction - congenital or acquired

Loss of feeling of full bladder e.g. spinal cord/brain injury

22
Q

How does stasis of urine at the level of the urethra lead to UTI?

A

Bacteria that get higher up do not get flushed out

Upper urethral and bladder dilatation
-> Bilateral hydroureter (dilatation)
Or vice versa

Leads to bilateral hydronephrosis -> chronic renal failure

23
Q

How does stasis of urine at the level of the renal pelvis on one side lead to UTI?

A

Unilateral hydroureter

-> unilateral hydroureter and unilateral hydronephrosis

24
Q

What are the consequences of obstruction?

A

Proximal dilatation
Slowed urine flow -> can’t flush out bacteria -> infection
Slowed urine flow -> sediments form -> calculous formation -> obstruction
Obstruction from calculous -> more dilatation, more calculous formation, more infection

Triad - infection, calculi, obstruction

25
Q

What is the main cause of obstruction in children?

A

Renal tract abnormality

Most important example is vesicoureteric reflux

26
Q

What should be done when suspecting obstruction in a child?

A

Always investigate at first presentation and refer to paediatric surgeons due to likelihood of underlying structural abnormality

27
Q

What is vesicoureteric reflux?

A

Decreased angulation at insertion of ureter into the bladder, may occur with hydroureter, when bladder fills with urine, urine refluxes

28
Q

What are the common causes of obstruction in adults?

A

Men - benign prostatic hyperplasia, causing functional and anatomical obstruction
Women - uterine prolapse, typically in women who have had multiple children

Tumours and calculi in both sexes

29
Q

Why can spinal cord injury lead to UTI?

A

Decreased sensation - no sense of when to micturate and do not know to empty the bladder completely so leave urine in the bladder
Urine left in bladder -> high residual bladder -> stasis of urine

30
Q

What causes bacteria to be pushed up the urethra?

A

Sexual activity in females (not sexually transmissible)

Catheterisation and other urological procedures

31
Q

Why are females more prone to UTI?

A 
Shorter urethra
Lack of bacteriostatic secretion
Urethral orifice close to the rectum
Sexual activity moves flora 
Pregnancy - puts pressure on the ureters and bladder causing partial obstruction
32
Q

Why does catheterisation/urological procedure cause UTI?

A

Any instrumentation tends to move lower urethral flora up the tract

33
Q

What causes a general predisposition to infection?

A

Immunocompromise

Diabetes etc.

34
Q

What should be investigated at the first presentation of a child with a UTI?

A

Urinary tract abnormalities should be immediately investigated as leaving untreated can develop into chronic kidney failure

35
Q

What can be assumed when a woman presents with a UTI after first sexual activity?

A

That it is linked to the sexual activity - can be less concerned about underlying structural abnormality, may investigate if persistent

36
Q

What should be done for a male presenting with UTI in his 30s?

A

Further investigation should be done, consider an underlying problem

37
Q

What should be considered in UTI in over 50s?

A

Prostate problems in males
Uterine prolapse in females
Tumours/calculi in both sexes

38
Q

What are the complications of UTI?

A

Acute and chronic
Acute - severe sepsis and septic shock
Chronic - chronic damage to the kidneys if repeated infections, can lead to hypertension and chronic renal failures

Calculi -> obstruction -> hydronephrosis -> hypertension and chronic renal failure

Urinary System (22 decks)

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