Simple and complicated UTIs Flashcards

1
Q

What is a UTI

A

lower urinary tract infection - cystitis/urethritis

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2
Q

Ascending UTI

A

Pyelonephritis

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3
Q

Most common bacterium causing UTI

A

E.coli

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4
Q

How do e.coli adhere to cells?

A

Fimbrae

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5
Q

How does proteus spp adhere to cell

A

urease - promotes urolithiasis (stone formation) - allows organism to stay in tract

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6
Q

Risk factors for UTIs

A
  • Young women (sexual activity, short urethra)
  • Older gentlemen (enlarged prostate)
  • Diabetes
  • Benign prostatic hypertrophy
  • Dehydration (reduced flushing)
    Sexual activity (transfer of microorganism)
    Impaired immune response
  • Causes delirium in elderly
  • Can lead to sepsis
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7
Q

Symptoms of UTIs

A
  • Frequent urination
  • Painful/difficult urination
  • Suprapubic discomfort
  • Cloudy urine
  • Undifferentiated sepsis
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8
Q

pathology of UTIs

A
  • Gram -ve = ascending and systemic
  • Endotoxin - inflammatory response
  • Vasodilation reduces BP and results in inadequate end organ perfusion = septic shock
  • Renal abscess/collection may occur
  • Early morning sample - microorganisms in contact with urine overnight
  • Leukocytes and nitrites in urine are important - staph can’t convert nitrates to nitrites
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9
Q

Investigations for UTI

A
  • Urine dipstick
  • Agar
  • Midstream urine for MC
  • Separates e.coli from other bacteria dependent on whether can metabolise lactose - MacConkey agar
  • Blood test
  • Renal tract imaging
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10
Q

Leukocytes in urine

A

Immune reaction

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11
Q

Nitrites in urine

A

Bacterial presence

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12
Q

Protein in urine

A

Renal disease

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13
Q

Glucose in urine

A

Elevated serum glucose

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14
Q

Ketones in urine

A

Fat metabolism

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15
Q

Function of type 1 fibrae

A

Allow e.coli to stick together

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16
Q

How does sepsis occur

A

e.coli spread to bloodstream and secrete endotoxins

17
Q

Lipopolysaccharides

A

Endotoxins (lipopolysaccharide) are integrated parts of bacterial cell wall of gram -ve bacteria

18
Q

Is c.diff +ve or -ve

A

+ve

19
Q

Two types of toxins

A

endotoxins - integral parts of bacterial cell wall of gram -ve bacteria
secreted exotoxins

20
Q

Standard drug for UTI

A

Nitrofurantoin

21
Q

Drug for recurrent UTI

A

Nitrofurantoin

22
Q

Drug for pyelonephritis

A

Cefalexin

23
Q

What does a dipstick showing only leukocytes indicate?

A

Immune reaction but no evidence of bacteria infection

24
Q

Why might a urine dipstick only show leukocytes?

A
  • Microorganism doesn’t reduce nitrate to nitrite
  • Limited time for microorganisms to reduce nitrate
  • Interstitial cystitis
25
Q

Why might a urine dipstick only show nitrites?

A

microoganism present but no evidence of immune reaction or asymptomatic bacteria

26
Q

Where is lower UTI felt?

A

Hypogastric region

27
Q

Where is kidney infection felt?

A

R or L lumbar region