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(LUSUMA) Urinary System > S9) Urinary Tract Infections > Flashcards

S9) Urinary Tract Infections Flashcards

1
Q

Identify and describe 4 causes of UTI’s (host factors)

A
  • Shorter urethra – more infections in females
  • Obstruction – enlarged prostate, pregnancy, stones, tumours
  • Neurological problems – incomplete emptying, residual urine
  • Ureteric reflux – ascending infection from bladder
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2
Q

Identify the different sites (A-C) of urinary tract obstruction and point out their respective causes

A

A – PUJ: calculi

B – Ureter: calculi, Ca2+, retroperitoneal fibrosis

C – Bladder: neuropathic bladder

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3
Q

Identify the different sites (D-G) of urinary tract obstruction and point out their respective causes

A

D – VUJ: calculi

E – Bladder neck: hypertrophy

F – Prostate: BPH / Ca2+

G – Urethra: stricture

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4
Q

Describe 4 causes of UTIs (bacterial factors)

A
  • Haemolysins damage host membranes and cause renal damage
  • Fimbriae allow attachment to host epithelium
  • K antigen permits production of polysaccharide capsule
  • Urease breaks down urea encouraging bacterial growth
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5
Q

What is the primary causative organism for UTI’s?

A

Coliforms (E. coli, etc)

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6
Q

Identify 5 clinical conditions where UTIs are commonly observed

A
  • Cystitis (lower UTI)
  • Acute pyelonephritis (upper UTI)
  • Chronic pyelonephritis
  • Asymptomatic bacteriuria e.g. pregnancy
  • Septiceamia (± shock)
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7
Q

Identify 4 signs and symptoms of lower urinary tract infections (cystitis)

A
  • Dysuria
  • Frequency
  • Urgency
  • Low grade fever (sometimes)
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8
Q

Identify 4 signs and symptoms of upper urinary tract infections (pyelonephritis)

A
  • Fever
  • Loin pain
  • Dysuria (sometimes)
  • Frequency (sometimes)
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9
Q

What is an uncomplicated UTI?

A

An uncomplicated UTI is an infection caused by a usual organism in a patient with a normal urinary tract and normal urinary function (occur in males & females of any age)

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10
Q

What is a complicated UTI?

A

A complicated UTI is an infection occurring when 1/more factors are present that predispose the person to persistent infection, recurrent infection, or treatment failure

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11
Q

Provide 4 examples of situations when a complicated UTI occurs

A
  • Abnormal urinary tract e.g. vesicoureteric reflux, indwelling catheter
  • Virulent organism e.g. Staph. aureus
  • Impaired host defences e.g. poorly controlled diabetes, immunosuppression
  • Impaired renal function
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12
Q

When would one investigate a UTI with a urine culture (microscopy)?

A

Complicated UTI – pregnancy, recurrent infections, suspected pyelonephritis, male, children

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13
Q

Identify 3 ways in which the urine specimen can be collected when treating a UTI

A
  • Supra-pubic aspiration
  • MSU (midstream urine sample)
  • Catheter sample
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14
Q

What does one test for in urine dipstick testing?

A
  • Leucocyte esterase
  • Nitrite
  • Haematuria
  • Proteinuria
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15
Q

What does one look out for in a visual inspection of a urine sample?

A

Turbidity

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16
Q

Compare and contrast the sensitivity, specificity and NPV urine dipstick testing and visual inspection

A
17
Q

When is dipstick testing useful?

A

Excludes UTI in:

  • Children >3yrs
  • Men with mild/non-specific symptoms
  • Elderly/institutionalised women
18
Q

When is dipstick testing not useful?

A
  • Acute uncomplicated UTI in women
  • Men with typical/severe symptoms
  • Catheterised patients
  • Asymptomatic bacteriuria (older patients)
19
Q

Outline a differential diagnosis for a symptomatic adult women

A
  • 50% significant bacteriuria
  • 50% urethral syndrome – vaginal infection/inflammation, STI, mechanical, physical & chemical causes
20
Q

Imaging of the urinary tract is valuable in septic patients to identify renal involvement.

What is visualised for males and females respectively?

A
  • Males: posterior urethral valves
  • Females: vesico – ureteric reflux
21
Q

What causes sterile pyuria?

A
  • Antibiotics
  • Urethritis (chlamydia/gonococci)
  • Vaginal infection/inflammation
  • Tuberculosis
  • Appendicitis
22
Q

Outline the general treatment of UTI’s (4 components)

A
  • Increase fluid intake
  • Treat underlying disorders
  • Antibiotics
  • Chronic spontaneous urticaria (only treat if systemically unwell)
23
Q

Outline the treatment of simple cystitis

A

Uncomplicated infections can be treated with trimethoprim or nitrofurantoin (3 day course)

24
Q

Outline the treatment of a complicated lower UTI

A
  • Trimethoprim, nitrofurantoin or cephalexin (5-7 day course)
  • Post treatment follow-up cultures in paediatric patients and pregnant women

Not amoxicillin – 50% resistance

25
Q

Outline the treatment of pyelonephritis / septicaemia

A
  • Co-amoxiclav (14 day course)
  • Ciprofloxacin (effective as a 7 day course)
  • Gentamicin (IV only – nephrotoxic)
26
Q

When is antibiotic prophylaxis given for UTIs?

A
  • 3/more episodes in one year
  • No treatable underlying condition
27
Q

Which antibiotics are prescribed for UTI prophylaxis?

A

Trimethoprim or nitrofurantoin (single nightly dose)

(LUSUMA) Urinary System (23 decks)

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