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ESA3 > Urinary 8 - UTIs > Flashcards

Urinary 8 - UTIs Flashcards

1
Q

Name the normal defence mechanisms of the body against UTIs:

A
  • Antimicrobial secretions

- Regular flushing during micturition

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2
Q

What factors may predispose someone to UTIs?

A
  • Shorter urethra (women)
  • Obstruction (enlarged prostate, pregnancy, stones, tumours)
  • Neurological (incomplete emptying = residual urine)
  • Vesicoureteric reflux
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3
Q

Name 4 factors which may obstruct the urinary tract:

A
  • Enlarged prostate
  • Pregnancy
  • Stones
  • Tumours
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4
Q

Which antigens allow some E coli to produce a polysaccharide capsule, to protect it against host defences?

A

K antigen

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5
Q

What is the importance of K antigens to E coli survival in the urinary tract?

A

Allows E coli to produce a polysaccharide coat, to resist host defences ie antibacterial secretions.

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6
Q

Name 3 types of UTI associated with the lower urinary tract:

A
  • Bacterial cystitis
  • Abacterial cystitis
  • Prostatitis
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7
Q

Name 2 types of UTI associated with the upper urinary tract:

A
  • Acute pyelonephritis

- Chronic interstitial nephritis

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8
Q

List the symptoms associated with cystitis:

A
  • Increased freq. of urination
  • Dysuria (pain or burning sensation on urination)
  • Low grade fever
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9
Q

How can you tell bacterial and abacterial cystitis apart?

A

Bacteriuria test

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10
Q

List the symptoms associated with Prostatitis:

A
  • Fever
  • Dysuria (pain or burning sensation on urination)
  • Increased freq. of urination
  • Perineal and low back pain
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11
Q

List the symptoms associated with Acute Pyelonephritis:

A
  • Increased freq. of urination
  • Dysuria (pain or burning sensation on urination)
  • Fever
  • Loin pain
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12
Q

List the symptoms associated with Acute Interstitial Nephritis:

A
  • Fever
  • Haematuria
  • Drowsiness
  • Confusion
  • Nausea
  • Fluid retention
  • Change in urine output
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13
Q

Define uncomplicated infection:

A

Infection with a typical organism in a patient with normal urinary tract, and normal urinary function.
May occur in men and women of any age, however men, children and pregnant women are usually treated as complicated.

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14
Q

Define complicated infection:

A

When 1+ factors present which predispose a patient to persistent/recurrent infection, or treatment failure:

  • Atypical virulent organism (S aureus)
  • Abnormal urinary tract (catheter, vesicoureteric reflux)
  • Impaired host defences
  • Impaired renal function
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15
Q

What are the most common pathogens causing UTIs?

A

Gram negative rod bacteria

- Enterobacteriaceae: E coli, Klebsiella, Salmonella, Shigella

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16
Q

Which 2 types of bacteria are more likely to cause UTIs in a hospitalised patient?

A
  • Staph. aureus

- Pseudomonas

17
Q

Describe the investigation of a UTI:

A

MSU:

  • Turbidity
  • Dipstick testing (Leukocyte esterase, Nitrite, Haemat-/Protein-uria)
  • Microscopy
  • Culture
18
Q

What are the 3 main factors a dipstick tests urine for to exclude a UTI?

A

1) Leukocyte esterase
2) Nitrite
3) Haemat-/Protein-uria

19
Q

Explain ‘sterile pyuria’:

A

Presence of WBCs in urine, but no bacteria present

20
Q

List some causes of Sterile Pyuria:

A
  • Recent course of Antibiotics
  • Urethritis (chlamydia/gonorrhoea)
  • Neoplasm
  • Vaginal infection/inflammation
  • Urinary TB
  • Chemicals
21
Q

How should uncomplicated cystitis be treated?

A
  • Increased water intake
  • Address underlying disorders
  • 3 day course of oral antibiotic (Trimethoprim or Nitrofurantoin)
22
Q

How should complicated cystitis be treated?

A
  • Increased water intake
  • Address underlying disorders
  • 5-7 day course or oral antibiotic (Trimethoprim or Nitrofurantoin, or Cephalexin)
  • Post-treatment cultures for children/pregnant women
23
Q

Name 2 antibiotics used to treat cystitis:

A
  • Trimethoprim
  • Nitrofurantoin
  • Cephalexin
24
Q

What class of antibiotic is Nitrofurantoin?

A

Aminoglycoside

25
Q

What class of antibiotic is Trimethoprim, and how do they work?

A

Dihydrofolate Reductase Inhibitors

- Inhibit synthesis of Thymidine, Purines and amino acids (inhibit folate acid synthesis)

26
Q

What class of antibiotic is Cephalexin, and how do they work?

A

Beta-lactam (Cephalosporins)

- Inhibit cell wall synthesis by expressing beta-lactamase genes

27
Q

Describe acute sepsis management:

A

Sepsis 6:

  • Give high flow O2
  • Take blood sample (ABG)
  • Start fluid challenge
  • Give IV antibiotics (Meropenem)
  • Measure urine output
  • Measure lactate
28
Q

How should acute pyelonephritis be treated?

A
  • Increased water intake
  • Address underlying disorders
  • 10-14 day course of oral/IV antibiotic (Co-Amoxiclav, Gentamicin, Ciprofloxacin)
29
Q

At what point should treatment be started if a catheterised patient has a UTI?

A

If systemic symptoms are present

30
Q

What prophylaxis is available for people prone to UTIs, with no treatable underlying condition?

A

Single nightly dose of Trimethoprim or Nitroofurantoin

ESA3 (48 decks)

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