Pathophysiology & Diagnosis of UTIs

Question 1

Defences of the urogenital system

Answer 1

• urination washes most bacteria out the urethra
• females = mucous secreting cells in the urethra trap bacteria
• males = length of urethra; prostate & associated glands produce secretions to help prevent bacterial invasion
• prevention of backflow

Question 2

Risk factors for UTIs

Answer 2

• womens urethra is shorter than a mans thus bacteria can reach the bladder more easily
• womens urethral opening is located closer to the anus so it makes it easier for bacteria to migrate from the anus
• for older women, urethra and bladder tissue become thinner and drier with age
• pregnancy = changes in urinary tract
• antibiotics
• diabetics

Question 3

Consultation

Answer 3

• signs and symptoms
• onset and evolution
• red flags
• pregnancy
• family history
• past medical history
• medication history ]- sexual history

Question 4

when referrals should be made

Answer 4

• recurrent UTIs
• complicated UTI
• UTIs in children
• pt very poorly
• diabetes
• suspected cancer

Question 5

Urinary dipstick interpretation

Answer 5

• Nitrites = positive test indicates UTI. UTI can also be present with a negative test
• Leukocyte esterase = positive test indicates the presence if white cells in the urine, this may be due to inflammation in urinary tract or kidneys
• Blood = presence of rbc, hb and myoglobin in the urine indicate UTI but also caused by renal stones, injury , malignancy of the urinary tract etc.

Glucose = there normally should not be glucose in the urine

pH = normal urinary pH = 4.5 - 8. Causes of raised urinary pH include UTIs

POSITIVE NITRITE ALONE OR POSITIVE LE & BLOOD MAY INDICARE LOWER UTI