Urinary tract infection

Question 1

Presentation of UTI

Answer 1

dysuria, frequency and smelly urine

BUT can be unwell/failure to thrive or incontinence

Question 2

Do ureters store urine?

Answer 2

no - constant trickle

Question 3

How do the ureter enter the bladder?

Answer 3

at an angle

Question 4

Significance of ureters entering bladder at an angle

Answer 4

as bladder fills up and pressure increases this closes off ureter and stops reflux of urine

Question 5

4 normal urinary tract bacteriostatic propertier

Answer 5

prostatic secretions
anti-bacterial antibodies
free flow of urine through normal anatomy
low pH, high osmolarity and high ammonia

Question 6

What part of urinary tract is sterile?

Answer 6

all of it apart from terminal urethra

Question 7

2 commensal bacteria flora of terminal urethra

Answer 7

gut flora eg ecoli

skin - perineal

Question 8

If a suprapubic aspirate is taken will this be sterile or not?

Answer 8

sterile

Question 9

Is a urine specimen ever sterile?

Answer 9

NO -always atleast slightly contaminated by terminal urethra flora

Question 10

Which part of urine will be most highly contaminated?

Answer 10

first few mls

Question 11

Significance of MSSU

Answer 11

initial void discarded with most bacteria

still always present but flush out majority

Question 12

How is MSSU interpreted?

Answer 12

microbiology - bacteria grow in log phase

dip slide method to count colonies and bacteria

Question 13

time and temperature of MSSU incubation

Answer 13

24 hours 37 degrees

Question 14

What number means an infection in culture?

Answer 14

10 to the power of 5

Question 15

What does 10 to the power of 3/4 mean in culture?

Answer 15

probable infection if symptoms and 50% chance if no symptoms

Question 16

What people are MSSU difficult to collect?

Answer 16

children and elderly

Question 17

What microorganisms cause UTI?

Answer 17

bacteria eg ecoli

virus and fungi rare

Question 18

Is route of infection in UTI ascending or descending?

Answer 18

almost always ascending

Question 19

When is a UTI more serious?

Answer 19

kidney infection

Question 20

List the words used for inflammation of 
a - bladder 
b - urethra 
c - ureters 
d - kidney

Answer 20

a - cystitis
b - urethritis
c - ureteritis
d - acute pyelonephritis

Question 21

When can acute pyelonephritis become chronic pyelonephritis?

Answer 21

prolonged or recurrent infection

Question 22

3 broad predisposing factors of UTI

Answer 22

urine stasis
pushing bacteria up from above
generalised predisposition to infection

Question 23

2 reasons for stasis of urine

Answer 23

obstruction = congenital or acquired

spinal cord or brain injury

Question 24

reasons for pushing bacteria up from above

Answer 24

female, sex, catheter

Question 25

Reason for generalised predisposition to infection

Answer 25

diabetes

Question 26

Main reason stasis or urine causes UTI

Answer 26

bacteria that do get higher up do not get flushed out

Question 27

consequences of obstruction at urethra

Answer 27

urethral and bladder dilation bilateral hydroureter and hydronephrosis chronic renal failure

Question 28

Consequences of unilateral renal pelvis obstruction

Answer 28

unilateral hydroureter and hydronephrosis

Question 29

Consequences of obstruction of renal tract

Answer 29

proximal dilation slowed urine flow --> infection sediments form calculi --> more obstruction

Question 30

triad of obstruction of renal tract

Answer 30

calculi, more infection and more dilation

Question 31

Obstruction in children

Answer 31

vesicoureteric reflux

Question 32

Consequences of vesicoureteric reflux

Answer 32

hydroureter

Question 33

Common causes of renal tract obstruction in adults

Answer 33

women - uterine prolapse men - BPH tumours and calculi

Question 34

Why is a spinal cord/brain injury a cause of UTI?

Answer 34

cannot empty bladder fully - high residual volume | no sense when to micturate - stasis of urine

Question 35

Why is sexual activity a cause of UTI?

Answer 35

age move bacteria up from terminal urethra urethral back wall just infront of vagina

Question 36

Why are women ore predisposed to UTI than men?

Answer 36

short ureter no prostatic secretions urethral orifice close to rectum sexual activity - void after intercourse pregnancy - pressure on ureters and bladder

Question 37

Why is catheter risk of UTI?

Answer 37

move bacterial flora up | same with any urinary procedure

Question 38

Why is diabetes a risk factor for UTI?

Answer 38

glucose in urine and poor WBC function

Question 39

acute complications of UTI

Answer 39

sepsis and septic shock

Question 40

chronic complications of UTI

Answer 40

chronic damage to kidneys if repeated infection | hypertension, chronic renal failure, calculi and hydronephrosis