urinary tract infection Flashcards
what are causes of uti in kidney bladder urethra prostate testis?
chronic/acute pylonephritis, cystitis, urteritis, prostatitis, epidiymo-orchitis
what is the incidence for utis?
6% of gp consultations
female to male 3:1
affects 30% women at some time in their life
what is the incidence of pylonephritis in women?
3 per 1000 women
what is the incidence of symptomatic uti in men?
5 per 10000
what are general predisposing factors to a uti?
immunosupression
steroids
malnutrition
diabetes
what are predisposing fators that are specific to the urinary tract?
female sex
sexual intercourse
congenital abnormalities
statis of urine
foreign bodies
oestorgen deficiency
fistula between bladder and bowel
what is the pathogenesis of utis?
usually bowel organisms - ecoli, proteus, klebsiella, enterococcus
what are modes of transfer for pathological organisms that cause uti?
trans urethral route
peurethral area contaminated, recurrent utis, diaphragms
urethra to bladder
bladder and up urethra
bloodstream
lymphatics
what are clinical features of a uti in children?
diarhoea
excessive crying
fever
nausea and vomiting
not eating
what are clinical features of uti in adults?
flank pain
dysuria
cloudy offensive urine
urgency
chilld
strangury
confusion
what is dysuria?
pain occuring from urinations
frewuently associated with urinary frequency and urgency
what are clinical features of acute pyelonephritis?
pyrexia, poor localisation, loin tenderness, signs of dehydation
turbin urine
what investigations are done for a uti?
mid stream sample of urine
urinarlysis (blood leukocytes, protein and nitrites)
microbiology in labratory
microscopy and gram staining
when will US or IVU be helpful
when in children or in men where utis are frequent
what are isotope studies done for?
to rule out reflux or scarring
what are the principles of management?
identify infecting organism and institue appropriate treatment
identify predisposing factors if possible
how are utis treated?
fluids
antibiotics
amoxicillin/cephalosporin/trimethroprim
severe - IV antibiotics
when may a urinary tract be abnormal?
anatomical/neurological abnormalities
stones
diabetes
what is reflux nephropathy?
uti in children
damage by reflux and infection
what imaging is done for reflux nephorpathy and how is it treated?
micturating cystogram
assess progression by US scan and biochemistry
surgically treated
what advice should be given to patients with recurrent utis?
fluid intake 2L / day
void every 2/3 h by day
void before bedtime and after intercourse
avoid bubble baths and constipation
what advice should be given for indwelling urinary catheters?
aseptic technique
fluid intake
colonisation inevitable
antibiotics if patient sympomatic
replace catheter
when should asymptomatic bacteriuria be treated?
in pregnant women
not if catheter related
how is chronic pyelonephritis diagnosed?
radiological diagnosis
scarring and clubbing
hypertension/CRF
reflux
15% progress to renal failure
