Urinary Tract Infection Flashcards
1
Q
What is the common presentation of UTI?
A
Dysuria
Increased frequency
Smelly urine
2
Q
What is dysuria?
A
Pain when peeing
3
Q
What does urine output change with?
A
Oral intake of fluids
4
Q
Do the ureters store urine?
A
No
5
Q
How do the ureters enter the bladder?
A
Enter at an angle
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
7
Q
Is the whole urinary tract sterile?
A
Yes
Except from the terminal urethra
8
Q
Why are urinated specimens always contaminated?
A
Contaminated by terminal urethral flora
9
Q
Describe the contamination of an initial urine specimen?
A
Always heavily contmainated
10
Q
What type of urine sample do we want to collect for UTI testing?
A
MSSU
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
12
Q
Is urethral flora present in MSSU?
A
Yes but it is always diminished
13
Q
Is there such thing as a negative result for MSSU?
A
No
14
Q
How do you tell a contaminated specimen from an infected specimen?
A
10 to power of 5
99% of time is infection
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
16
Q
What is the UTI probability of <10 to power of 3?
A
Usually no infection
17
Q
Is viral infection common in UTI?
A
No rare
18
Q
What are the main bacteria causatives of UTI?
A
Gut flora especially E.coli
19
Q
Where does infection urually spread in TUI?
A
Usually ascending
Infection moves upwards
20
Q
What is inflammation in the urethra?
A
Urethritis
21
Q
What is cystitis?
A
Inflammation in the bladder
22
Q
What is ureteritis?
A
Inflammation in the ureters
23
Q
What is acute pyelonephritis?
A
Acute Kidney inflammation
24
Q
What are the predisposing factors of a UTI?
A
Stasis of urine
Pushing bacteria up urethra from below
Generalised predisposition to infection
25
What are the common causes of urine stasis?
Obstruction
| Loss of feeling of full bladder
26
What is the knock on effect of bilateral ureter obstruction?
Bilateral hydroureter
Bilateral hydronephrosis
Can lead to chronic renal failure
27
What is the effect of unilateral ureter obstruction?
Unilateral hydroureter
| Unilateral hydronephrosis
28
What investigations are used to pin point ureter obstruction?
USS
CT
MRI
29
What is the triad that obstruction causes with UTI?
Obstruction
Infection
Increased calculous formation
More infections
30
What is the most important cause of obstruction in children?
Vesicoureteric reflux
31
What is vesicouretic reflux?
Decreased angulation of ureter at entering of the bladder
32
What is the management of children presenting with renal tract obstruction?
Always investigate and send to paediatric surgeons
33
What are the common causes of obstruction in men?
Benign prostatic hyperplasia
34
What are the common causes of obstruction in females?
Uterine prolapse
35
What are the common causes of obstruction in both sexes?
Tumours
| Calculi
36
What is the effect of a loss of feeling of a full bladder?
Decreased sensation
No sense of when to micturate
Do not empty bladder completely
Stasis of urine
37
What is the most common cause of pushing bacteria up the urethra from below?
Sexual activity in females
38
Why are females more prone to UTI?
Short urethra
Vagina and urethra lie closely anatomically
Lack of prostatic bacteriostatic secretion
Closeness of urethral orifice to rectum
39
What measure can be takes to help avoid UTIs after sex?
Voiding after intercourse
40
How else can bacterial be pushed up the urethra from below apart from sexual activity?
Catheterisation
41
What is an example of a generalised predisposition to infection?
DM
42
Are UTIs common?
Yes very
43
What is a common cause of UTI in late teenage females?
Sexual activity
44
What is a common cause of UTI in older males and females?
Tumours
Stones
Prostate problems
Uterine prolapse
45
What are the acute complications of UTIs?
Severe sepsis and septic shock
46
What are the chronic complications of UTIs?
Chronic kidney damage with repeated infection
47
When should UTIs be investigated further?
If repeated
| Or if the cause for the sex and age seems unusual
48
What is the knock on effect of calculi in the urinary tract?
Obstruction
Hydronephrosis
Hypertension
Chronic renal failure
49
What is the classic presentation of UTI?
```
Dysuria
Frequency of urination
Suprapubic tenderness
Polyuria
Urgency
Haematuria
```
50
What are some predisposing factors for UTI?
```
F short urethra
Trauma to female urethra during childbirth
pregnancy
Renal cysts
Stones in urinary tract
Instrumentation of urinary tract
Foregin body presence
```
51
What is an uncomplicated UTI?
Occur in healthy sexually active young women
| Clear correlation between sexual activity and UTI
52
What organisms is considered ucomplicated UTI?
E.coli
53
What would be considered a complicated UTI?
```
Children
men
Patients with abnormal renal tracts
Immunosuppression
Foregin body in renal tract
```
54
What investigations are required for complicated UTI?
USS
CT
Cystocopy
Post-void bladder scan
55
When is laboratory diagnosis of UTI required?
```
In women with mild or limited symptoms
Suspected in men
Suspected acute polynephriitis
Pregnant women
Failed AB treatment
Recurrent UTI
```
56
What is defined as recurrent UTI?
>2 UTIs within 6 months
| or >3 within year
57
How is urine collected for UTI culture/
MSSU collected from non-catheterised patient
Collected in sterile vessel
Refrigerated
58
Where should catheter urine samples be collected from?
Catheter sampling port not the collecting bag
59
How is a urine sample taken in children?
MSSU can be difficult
Clean catch sample is recommended
Collection pads
60
What are the common TI organisms?
```
E.coli
Proteus sp.
Enterococcus Faecalis
Klebsiella sp.
Pseudomonas p.
Staph, Saprophyticus
```
61
What is the most common organisms of UTI?
E.coli
62
What is the consequence of proteus sp. producing ureas?
Splits to form urea and ammonia
Thus making urine alakline
Encouraging stone formation
63
What is the diagnostic culture criteria for pregnant women?
10 to power of 2
| Much lower
64
What is the presence of WBC in the urine a sign of?
Usually inflammatory sign
| Support infection rather than contamination
65
What is the typical presentation of acute cystitis>
```
Dysuria
Grequency
Urgency
Suprapubic pain
Polyuria
Haematuria
```
66
What is the treatment for suspected lower UTI in women?
3 days course of antibiotics
Trimethroprim
Nitrofurantoin
67
What is the next course of investigation for women with UTI who do not response to treatment?
Urine cultures should be taken
68
What is investigation for suspected UTI in men?
MSSU
69
Are UTI more common in F or M?
F
70
What can recurrent UTI in males be a sign of?
Prostatitis
71
What can cause UTI in younger sexually active males?
Chlamydia
72
What is the treatment of UTI in males?
10-14 day antibiotic course
73
What is a major cause of UTI in children that needs to be managed?
Vesico-ureteric reflux
74
What is the next investigation for UTI in children?
Refer to paediatric nephrologist
| or paediatric surgeons
75
What is UTI in pregnancy associated with?
Premature labour
76
What is the treatment for UTI in pregnancy?
Nitrofurantoin
| Trimethoprim is not considered safe!!
77
How should recurrent UTI be managed?
Reverse any risk factors
- drink plenty fluids
void after intercourse
Further investigations
Long term AB prophylaxis
78
What is cystitis?
Inflammation of the bladder
79
What can cause cystitis?
Due to infection or other causes
80
What is bacteriuria?
Presence of bacteria in the urine
81
Is the anterior urethra sterile?
No
82
What is asymptomatic bacteriuria?
Presence of bacteria in urine
| But asymptomatic
83
When is asymptomatsc bacteriuria indicative for treatment?
When pregnant
84
Who should be screened for asymptomatic bacteriuria?
Pregnant women
85
What is pyuria?
Presence of pus cells in urine
86
What does pyuria represent?
Inflammatory response
87
What is sterile pyruia?
Clinical scenario in which urine culture is negative
| But significant numbers of pus cells are present
88
What is acute polynephritis
Infection of upper urinary tract involving kidneys
89
What is the commonest renal disease?
Acute polynephritis
90
What are the symptoms of acute polynephritis?
Loin pain
Fever
Frequency
Dysuria
91
Where can polynephritis spread in severe cases?
To the blood causing sepsis
92
What is the treatment for acute polynephritis?
AB for 7 days
93
What is the treatment for catheter related infection?
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
What is chronic polynephritis?
Pathological condition with renal scarring
| With potential loss of renal function
