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8. Urology (Medical Knowledge) > Pathology of Urinary Tract Infections > Flashcards

Pathology of Urinary Tract Infections Flashcards

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USMLE® Step 1 flashcards
1
Q

What is the presentation of UTI?

A
  • Dysuria (pain on micturition), frequency, smelly urine
  • But in very young
    • Unwell, failure to thrive
  • In very old
    • Incontinence, off their feet
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2
Q

What does UTI stand for?

A

Urinary tract infection

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3
Q

What is the medical term for pain on micturition?

A

Dysuria

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4
Q

What percentage of cardiac output is renal blood flow?

A

20-25%

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5
Q

What does CO stand for?

A

Cardiac output

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6
Q

What can urine output vary with?

A

Urine output changes with oral intake of fluids:

  • Resorption of fluid is diminished if increase fluid intake causing increased urine output
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7
Q

Do the uterters have continuous trickle of urine or do they store urine?

A

Ureters have continuous trickle of urine, they do not store urine and they enter the bladder at an angle

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8
Q

Do the ureters enter the bladder perpendicular or at an angle?

A

At an angle

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9
Q

What happens to the ureters as the bladder fills?

A

They increase pressure of bladder as it fills, closing off ureter and stops reflux of urine

So the flow of urine is a one way continuous flow until the bladder is full

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10
Q

What are some bacteriostatic properties of the urinary tract?

A
  • Free flow of urine through normal anatomy
  • Low pH, high osmolarity and high ammonia (NH3) content of normal urine
  • Prostatic secretions are bacteriostatic (bacteriostatic agent is a biological or chemical agent that stop bacteria from reproducing)
  • Anti-bacterial antibodies
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11
Q

What is a bacteriostatic agent?

A

A biological or chemical agent that stop bacteria from reproducing

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12
Q

Is the urinary tract sterile or non-sterile?

A

The whole urinary tract, except for the terminal urethra, is sterile

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13
Q

Do urinated specimen contain any bacteria?

A

Urinated specimen is always contaminated by terminal urethra flora

Initial voiding will flush out many terminal urethral floral bacteria

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14
Q

Before taking a urine sample, what should be done to flush out many terminal urethral floral bacteria?

A

Initial voiding will flush out many terminal urethral floral bacteria

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15
Q

How is a urine sample collected without the contamintion of flora?

A

Initial urine is heavily contaminated, so collect after initial void:

  • Patient voids and stops mid-stream, discarding urine then collects next volume of urine
  • Known as mid-stream specimen of urine (MSSU)
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16
Q

What does MSSU stand for?

A

Mid-stream specimen of urine

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17
Q

What is the kind of urine sample known as where the patient voids first to get rid of a lot of flora bacteria?

A

Mid-stream specimen of urine (MSSU)

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18
Q

In MSSU is the urethral flora present?

A

In a MSSU the urethral flora is diminished but always present, and will then grow in culture:

  • Therefore is no such thing as a negative result
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19
Q

What is a quick method of performing MSSU culture?

A

Quick way to perform MSSU culture is the dip slide method (but usually send for formal microbiology culture

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20
Q

How is a urine sample normally analysed?

A

Formal microbiology culture, but sometimes dip slide method can be performed which is quicker

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21
Q

What kind of growth do bacteria display?

A

Multiply in log phase growth

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22
Q

What are the boundaries of amount of bacteria and likelyhood of infection in MSSU?

A
  • 105/ml is usually infection
    • <1/100 chance of contamination if asymptomatic
  • 103 to 104/ml is an infection sometimes
    • Probable infection if have symptoms
    • 50% chance of infection if no symptoms
  • <103 usually means no infection
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23
Q

What does a bacteria concentration of 105 normally indicate?

A
  • 105/ml is usually infection
    • <1/100 chance of contamination if asymptomatic
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24
Q

What does a bacteria concentration of 103-104/ml usuall indicate?

A
  • 103 to 104/ml is an infection sometimes
    • Probable infection if have symptoms
    • 50% chance of infection if no symptoms
25
Q

What does a bacteria concentration of <103 indicate?

A

Usually means no infection

26
Q

MSSU is difficult to collect in who?

A

Yound children and elderly

27
Q

Why can there sometimes be a problem with interpretation in a urine specimen?

A
  • Some bacterial species are not normally present in terminal urethra/rectal flora and may be pathogenic at low colony numbers
28
Q

What bacteria often causes UTI?

A
  • Gut flora, especially E. Coli
29
Q

Do viruses often cause UTI?

A

Viral infection is rare

30
Q

Is route of infection usually ascending or descending?

A

Almost always ascending

31
Q

Where has infection in the kidneys usually come from?

A

Spread from bladder

32
Q

What are the two kinds of UTI?

A

Upper urinary tract infection

Lower urinary tract infection

33
Q

Is upper or lower urinary tract infection more serioues?

A

Upper urinary tract infection

34
Q

What does a urinary tract infection lead to?

A

Infection leads to inflammatory response:

  • Urethritis in urethra
  • Cystitis in bladder
  • Urethritis in ureter
  • Acute pyelonephritis in kidney
  • Chronic pyelonephritis in kidney if recurrent/prolonged infection
35
Q

What is inflammation in the urethra known as?

A

Urethritis

36
Q

What is inflammation in the bladder known as?

A

Cystitis

37
Q

What is inflammation in the ureter known as?

A

Ureteritis

38
Q

What is inflammation in the kidney known as?

A

Acute pyelonephritis

Or chronic pyelonephritis if recurrent/prolonged infection

39
Q

What are the different categories of predisposing factors to UTI?

A
  • Stasis of urine
    • Obstruction
      • Whether congenital (presents in childhood) or acquired (adults)
    • Loss of ‘feeling’ of full bladder
      • Spinal cord/brain injury
  • Pushing bacteria up urethra from below
    • Sexual activity in females
    • Catheterisation (and other urological procedures)
  • Generalised predisposition to infection
    • Diabetes
40
Q

What are the 2 different kinds of stasis of urine?

A
  • Obstruction
    • Whether congenital (presents in childhood) or acquired (adults)
  • Loss of ‘feeling’ of full bladder
    • Spinal cord/brain injury
41
Q

What can push bacteria up the urethra from below?

A
  • Sexual activity in females
  • Catheterisation (and other urological procedures)
42
Q

What is an example of a general predisposition to urinary tract infection?

A

Diabetes

43
Q

What are consquences of obstruction in the urinary tract?

A
  • Proximal dilation
  • Slow urine flow
    • Meaning cannot flush out bacteria and causing infection
    • Also allows sediments to form, causing calculous (stone) formation cause further obstruction, and this obstruction causes more dilation, more infections and increased calculous formation
44
Q

Why does obstruction lead to UTI?

A
  • Slow urine flow
    • Meaning cannot flush out bacteria and causing infection
    • Also allows sediments to form, causing calculous (stone) formation cause further obstruction, and this obstruction causes more dilation, more infections and increased calculous formation
45
Q

How are the consequences of obstruction a triad?

A
46
Q

What should you do when children present with obstruction of the urinary tract?

A
  • Numerous renal tract abnormalities
  • Always investigate at 1st presentation and send to paediatric surgeons
  • Most important example is vesicoureteral reflux (condition which urine flows retrograde, or backwards from the bladder into the ureters/kidneys)
    • Causes decreased angulation of ureter into bladder
    • Leads to hydroureter
47
Q

What is the most important example of urinary tract obstruction in children?

A
  • Most important example is vesicoureteral reflux (condition which urine flows retrograde, or backwards from the bladder into the ureters/kidneys)
    • Causes decreased angulation of ureter into bladder
    • Leads to hydroureter
48
Q

What is vesicoureteral reflux?

A

Condition which urine flows retrograde, or backwards from the bladder into the ureters/kidneys

49
Q

What are the consequences of vesicoureteral reflux?

A
  • Causes decreased angulation of ureter into bladder
  • Leads to hydroureter (dilation of the ureter)
50
Q

What is the medical term for dilation of the ureter?

A

Hydroureter

51
Q

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

A
  • Men
    • Benign prostatic hyperplasia (not a tumour)
      • Functional and anatomical obstruction
      • Basically enlarged prostate surrounding urethra
  • Woman
    • Uterine prolapse
  • Both sexes
    • Tumours and calculi (kidney stones)
52
Q

How can a spinal cord/brain injury impact the urinary tract?

A

Decreased sensation causes no sense of when to micturate and do not know to empty the bladder complete:

  • Leaving urine in bladder (high residual volume) causing stasis of urine
53
Q

How can sexual activity cause a UTI in a female?

A

In females, sexual activity tends to move lower urethral flora up the tract (back wall of urethra is just in front of vagina

54
Q

What are some predisposing factors for UTi due to pushing bacteria up the urethra in woman?

A
  • Short urethra
  • Lack of prostatic bacteriostatic secretion
  • Closeness of urethral orifice to rectum
  • Sexual activity
    • Helps if void after intercourse
  • Pregnancy
    • Pressure on ureters and bladder
55
Q

Why can diabetes lead to UTI?

A
  • Glucose in urine
  • Poor function of WBC
56
Q

What is the cause of urinary tract infections usually dependent on?

A

Age

57
Q

What are some complications of UTI?

A
  • Acute
    • Severe sepsis and septic shock
  • Chronic
    • Chronic damage to kidneys if repeated infections (chronic pyelonephritis) causing hypertension and chronic renal failure
    • Calculi causing obstruction, then hydronephrosis, then hypertension and chronic renal failure
58
Q

What are complications of acute UTI?

A
  • Severe sepsis and septic shock
59
Q

What are consequences of chronic UTI?

A
  • Chronic damage to kidneys if repeated infections (chronic pyelonephritis) causing hypertension and chronic renal failure
  • Calculi causing obstruction, then hydronephrosis, then hypertension and chronic renal failure

8. Urology (Medical Knowledge) (17 decks)

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