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Urology > Urinary Tract Infection > Flashcards

Urinary Tract Infection Flashcards

1
Q

What is the common presentation of UTI?

A

Dysuria
Increased frequency
Smelly urine

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2
Q

What is dysuria?

A

Pain when peeing

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3
Q

What does urine output change with?

A

Oral intake of fluids

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4
Q

Do the ureters store urine?

A

No

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5
Q

How do the ureters enter the bladder?

A

Enter at an angle

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6
Q

How do the ureters stop urine reflux?

A

Increasing pressure from the bladder as it fills closes off ureters and stops reflux of urine

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7
Q

Is the whole urinary tract sterile?

A

Yes

Except from the terminal urethra

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8
Q

Why are urinated specimens always contaminated?

A

Contaminated by terminal urethral flora

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9
Q

Describe the contamination of an initial urine specimen?

A

Always heavily contmainated

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10
Q

What type of urine sample do we want to collect for UTI testing?

A

MSSU

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11
Q

What is MSSU?

A

Mis stream specimen of urine
Patients void and stop mid-stream
Discarding urine then collecting next volume of urine

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12
Q

Is urethral flora present in MSSU?

A

Yes but it is always diminished

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13
Q

Is there such thing as a negative result for MSSU?

A

No

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14
Q

How do you tell a contaminated specimen from an infected specimen?

A

10 to power of 5

99% of time is infection

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15
Q

What is UTI probability of 10 to power of 3 or 4 in urine culture?

A

Probably infection if symptomatic

50% chance of infection if asymptomatic

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16
Q

What is the UTI probability of <10 to power of 3?

A

Usually no infection

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17
Q

Is viral infection common in UTI?

A

No rare

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18
Q

What are the main bacteria causatives of UTI?

A

Gut flora especially E.coli

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19
Q

Where does infection urually spread in TUI?

A

Usually ascending

Infection moves upwards

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20
Q

What is inflammation in the urethra?

A

Urethritis

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21
Q

What is cystitis?

A

Inflammation in the bladder

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22
Q

What is ureteritis?

A

Inflammation in the ureters

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23
Q

What is acute pyelonephritis?

A

Acute Kidney inflammation

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24
Q

What are the predisposing factors of a UTI?

A

Stasis of urine
Pushing bacteria up urethra from below
Generalised predisposition to infection

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25
Q

What are the common causes of urine stasis?

A

Obstruction

Loss of feeling of full bladder

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26
Q

What is the knock on effect of bilateral ureter obstruction?

A

Bilateral hydroureter
Bilateral hydronephrosis
Can lead to chronic renal failure

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27
Q

What is the effect of unilateral ureter obstruction?

A

Unilateral hydroureter

Unilateral hydronephrosis

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28
Q

What investigations are used to pin point ureter obstruction?

A

USS
CT
MRI

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29
Q

What is the triad that obstruction causes with UTI?

A

Obstruction
Infection
Increased calculous formation
More infections

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30
Q

What is the most important cause of obstruction in children?

A

Vesicoureteric reflux

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31
Q

What is vesicouretic reflux?

A

Decreased angulation of ureter at entering of the bladder

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32
Q

What is the management of children presenting with renal tract obstruction?

A

Always investigate and send to paediatric surgeons

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33
Q

What are the common causes of obstruction in men?

A

Benign prostatic hyperplasia

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34
Q

What are the common causes of obstruction in females?

A

Uterine prolapse

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35
Q

What are the common causes of obstruction in both sexes?

A

Tumours

Calculi

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36
Q

What is the effect of a loss of feeling of a full bladder?

A

Decreased sensation
No sense of when to micturate
Do not empty bladder completely
Stasis of urine

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37
Q

What is the most common cause of pushing bacteria up the urethra from below?

A

Sexual activity in females

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38
Q

Why are females more prone to UTI?

A

Short urethra
Vagina and urethra lie closely anatomically
Lack of prostatic bacteriostatic secretion
Closeness of urethral orifice to rectum

39
Q

What measure can be takes to help avoid UTIs after sex?

A

Voiding after intercourse

40
Q

How else can bacterial be pushed up the urethra from below apart from sexual activity?

A

Catheterisation

41
Q

What is an example of a generalised predisposition to infection?

42
Q

Are UTIs common?

43
Q

What is a common cause of UTI in late teenage females?

A

Sexual activity

44
Q

What is a common cause of UTI in older males and females?

A

Tumours
Stones
Prostate problems
Uterine prolapse

45
Q

What are the acute complications of UTIs?

A

Severe sepsis and septic shock

46
Q

What are the chronic complications of UTIs?

A

Chronic kidney damage with repeated infection

47
Q

When should UTIs be investigated further?

A

If repeated

Or if the cause for the sex and age seems unusual

48
Q

What is the knock on effect of calculi in the urinary tract?

A

Obstruction
Hydronephrosis
Hypertension
Chronic renal failure

49
Q

What is the classic presentation of UTI?

A 
Dysuria 
Frequency of urination 
Suprapubic tenderness
Polyuria 
Urgency 
Haematuria
50
Q

What are some predisposing factors for UTI?

A 
F short urethra
Trauma to female urethra during childbirth 
pregnancy
Renal cysts
Stones in urinary tract
Instrumentation of urinary tract
Foregin body presence
51
Q

What is an uncomplicated UTI?

A

Occur in healthy sexually active young women

Clear correlation between sexual activity and UTI

52
Q

What organisms is considered ucomplicated UTI?

53
Q

What would be considered a complicated UTI?

A 
Children 
men 
Patients with abnormal renal tracts
Immunosuppression 
Foregin body in renal tract
54
Q

What investigations are required for complicated UTI?

A

USS
CT
Cystocopy
Post-void bladder scan

55
Q

When is laboratory diagnosis of UTI required?

A 
In women with mild or limited symptoms 
Suspected in men 
Suspected acute polynephriitis
Pregnant women 
Failed AB treatment 
Recurrent UTI
56
Q

What is defined as recurrent UTI?

A

> 2 UTIs within 6 months

or >3 within year

57
Q

How is urine collected for UTI culture/

A

MSSU collected from non-catheterised patient
Collected in sterile vessel
Refrigerated

58
Q

Where should catheter urine samples be collected from?

A

Catheter sampling port not the collecting bag

59
Q

How is a urine sample taken in children?

A

MSSU can be difficult
Clean catch sample is recommended
Collection pads

60
Q

What are the common TI organisms?

A 
E.coli
Proteus sp.
Enterococcus Faecalis 
Klebsiella sp.
Pseudomonas p.
Staph, Saprophyticus
61
Q

What is the most common organisms of UTI?

62
Q

What is the consequence of proteus sp. producing ureas?

A

Splits to form urea and ammonia
Thus making urine alakline
Encouraging stone formation

63
Q

What is the diagnostic culture criteria for pregnant women?

A

10 to power of 2

Much lower

64
Q

What is the presence of WBC in the urine a sign of?

A

Usually inflammatory sign

Support infection rather than contamination

65
Q

What is the typical presentation of acute cystitis>

A 
Dysuria 
Grequency
Urgency
Suprapubic pain 
Polyuria 
Haematuria
66
Q

What is the treatment for suspected lower UTI in women?

A

3 days course of antibiotics
Trimethroprim
Nitrofurantoin

67
Q

What is the next course of investigation for women with UTI who do not response to treatment?

A

Urine cultures should be taken

68
Q

What is investigation for suspected UTI in men?

69
Q

Are UTI more common in F or M?

70
Q

What can recurrent UTI in males be a sign of?

A

Prostatitis

71
Q

What can cause UTI in younger sexually active males?

72
Q

What is the treatment of UTI in males?

A

10-14 day antibiotic course

73
Q

What is a major cause of UTI in children that needs to be managed?

A

Vesico-ureteric reflux

74
Q

What is the next investigation for UTI in children?

A

Refer to paediatric nephrologist

or paediatric surgeons

75
Q

What is UTI in pregnancy associated with?

A

Premature labour

76
Q

What is the treatment for UTI in pregnancy?

A

Nitrofurantoin

Trimethoprim is not considered safe!!

77
Q

How should recurrent UTI be managed?

A

Reverse any risk factors
- drink plenty fluids
void after intercourse

Further investigations
Long term AB prophylaxis

78
Q

What is cystitis?

A

Inflammation of the bladder

79
Q

What can cause cystitis?

A

Due to infection or other causes

80
Q

What is bacteriuria?

A

Presence of bacteria in the urine

81
Q

Is the anterior urethra sterile?

82
Q

What is asymptomatic bacteriuria?

A

Presence of bacteria in urine

But asymptomatic

83
Q

When is asymptomatsc bacteriuria indicative for treatment?

A

When pregnant

84
Q

Who should be screened for asymptomatic bacteriuria?

A

Pregnant women

85
Q

What is pyuria?

A

Presence of pus cells in urine

86
Q

What does pyuria represent?

A

Inflammatory response

87
Q

What is sterile pyruia?

A

Clinical scenario in which urine culture is negative

But significant numbers of pus cells are present

88
Q

What is acute polynephritis

A

Infection of upper urinary tract involving kidneys

89
Q

What is the commonest renal disease?

A

Acute polynephritis

90
Q

What are the symptoms of acute polynephritis?

A

Loin pain
Fever
Frequency
Dysuria

91
Q

Where can polynephritis spread in severe cases?

A

To the blood causing sepsis

92
Q

What is the treatment for acute polynephritis?

A

AB for 7 days

93
Q

What is the treatment for catheter related infection?

A

No indication for urine culture or treatment in absence of symptoms of signs suggestive of UTI
AB should only be given if symptomatic
Precede by a change of the catheter

94
Q

What is chronic polynephritis?

A

Pathological condition with renal scarring

With potential loss of renal function

Urology (13 decks)

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