urinary tract infection

Question 1

what are causes of uti in kidney bladder urethra prostate testis?

Answer 1

chronic/acute pylonephritis, cystitis, urteritis, prostatitis, epidiymo-orchitis

Question 2

what is the incidence for utis?

Answer 2

6% of gp consultations

female to male 3:1

affects 30% women at some time in their life

Question 3

what is the incidence of pylonephritis in women?

Answer 3

3 per 1000 women

Question 4

what is the incidence of symptomatic uti in men?

Answer 4

5 per 10000

Question 5

what are general predisposing factors to a uti?

Answer 5

immunosupression
steroids
malnutrition
diabetes

Question 6

what are predisposing fators that are specific to the urinary tract?

Answer 6

female sex
sexual intercourse
congenital abnormalities
statis of urine
foreign bodies
oestorgen deficiency
fistula between bladder and bowel

Question 7

what is the pathogenesis of utis?

Answer 7

usually bowel organisms - ecoli, proteus, klebsiella, enterococcus

Question 8

what are modes of transfer for pathological organisms that cause uti?

Answer 8

trans urethral route
peurethral area contaminated, recurrent utis, diaphragms
urethra to bladder
bladder and up urethra

bloodstream
lymphatics

Question 9

what are clinical features of a uti in children?

Answer 9

diarhoea
excessive crying
fever
nausea and vomiting
not eating

Question 10

what are clinical features of uti in adults?

Answer 10

flank pain
dysuria
cloudy offensive urine
urgency
chilld
strangury
confusion

Question 11

what is dysuria?

Answer 11

pain occuring from urinations
frewuently associated with urinary frequency and urgency

Question 12

what are clinical features of acute pyelonephritis?

Answer 12

pyrexia, poor localisation, loin tenderness, signs of dehydation
turbin urine

Question 13

what investigations are done for a uti?

Answer 13

mid stream sample of urine

urinarlysis (blood leukocytes, protein and nitrites)

microbiology in labratory
microscopy and gram staining

Question 14

when will US or IVU be helpful

Answer 14

when in children or in men where utis are frequent

Question 15

what are isotope studies done for?

Answer 15

to rule out reflux or scarring

Question 16

what are the principles of management?

Answer 16

identify infecting organism and institue appropriate treatment

identify predisposing factors if possible

Question 17

how are utis treated?

Answer 17

fluids
antibiotics
amoxicillin/cephalosporin/trimethroprim

severe - IV antibiotics

Question 18

when may a urinary tract be abnormal?

Answer 18

anatomical/neurological abnormalities
stones
diabetes

Question 19

what is reflux nephropathy?

Answer 19

uti in children

damage by reflux and infection

Question 20

what imaging is done for reflux nephorpathy and how is it treated?

Answer 20

micturating cystogram
assess progression by US scan and biochemistry

surgically treated

Question 21

what advice should be given to patients with recurrent utis?

Answer 21

fluid intake 2L / day
void every 2/3 h by day
void before bedtime and after intercourse
avoid bubble baths and constipation

Question 22

what advice should be given for indwelling urinary catheters?

Answer 22

aseptic technique
fluid intake
colonisation inevitable
antibiotics if patient sympomatic

replace catheter

Question 23

when should asymptomatic bacteriuria be treated?

Answer 23

in pregnant women
not if catheter related

Question 24

how is chronic pyelonephritis diagnosed?

Answer 24

radiological diagnosis
scarring and clubbing
hypertension/CRF
reflux
15% progress to renal failure