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URINARY > Urinary tract infection > Flashcards

Urinary tract infection Flashcards

1
Q

what are the different types of UTI and where do they occur

A

kidney

  • acute pyelonephritis
  • chronic pyelonephritis

bladder
- cystitis

urethra
- urethritis

prostate
- prostatitis

epididymis/testis
- epididymo-orchitis

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2
Q

what are general factors that predispose to UTI

A

immunosuppression
steroids
malnutrition
diabetes

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3
Q

what are more specific predisposing factors to UTI

A

Female sex (short urethra)

Sexual intercourse and poor voiding habits

Congenital abnormalities e.g. duplex kidney

Stasis of urine e.g. due to poor bladder emptying

Foreign bodies eg catheters, stones

Oestrogen deficiency in postmenopausal women

Fistula between bladder & bowel

Spermicide coated condoms and diaphragms

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4
Q

what are the most common organisms that cause UTI

A 
usually bowel organisms 
E.COLI
proteus
klebsiella
enterococcus
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5
Q

how are organisms transferred into the urinary tract

A 
Transurethral route:
- Perurethral area contaminated (Recurrent UTIs, diaphragms, ? bubble baths)
- Urethra to bladder
Intercourse, catheterisation
- Bladder (and up ureters)

Bloodstream

Lymphatics

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6
Q

what are the 5 stages of UTI that can lead to acute kidney injury

A
  1. colonisation
  2. uroepithelial penetration
  3. ascention
  4. pyelonephritis
  5. acute kidney injury
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7
Q

what are the clinical features of UTI in children

A 
Diarrhoea	
Excessive crying
Fever
Nausea and vomiting
Not eating
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8
Q

what are the clinical features of UTI in adults

A 
Flank pain
Dysuria (“like passing broken glass”)
Cloudy offensive urine
Urgency
Chills
Strangury
Confusion (very old people)
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9
Q

what are the clinical features of acute pyelonephritis

A 
Pyrexia
Poor localisation
Loin tenderness (renal angle)
Signs of dehydration
Turbid urine
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10
Q

what investigations should be carried out for suspected UTI

A

mid-stream sample urine

urinalysis in ward
-blood, leukocytes, protein, nitrates

microbiology in lab
- Microscopy and Gram staining, Bacteruria >105 CFU /ml, Culture and sensitivity

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11
Q

what radiological investigations may be useful in children, men or patients with multiple UTIs

A

US or IVU

isotope studies to rule out reflux and scarring

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12
Q

what are the 2 main principles of UTI management

A
  1. identify the infecting organism and institute appropriate treatment
  2. identify predisposing factors and treat if possible
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13
Q

what are the treatments for UTI

A 
fluids
antibiotics
- amoxicillin (3-5 day course or 3g x 2)
- cephalosporin
- trimethoprim

severe infections:
IV antibiotics

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14
Q

what are the consequences of functionally normal UTI i adults

A

normal anatomy on imagine so even repeated/persistent UTIs seldom result in renal damage

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15
Q

what are the consequences of abnormal urinary tract UTIs

A

anatomical/neurological abdnormalities can lead to stones and diabetes which may all cause infections and can lead to renal impairment

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16
Q

what is reflux nephropathy

A

UTIs in children

damage caused by reflux and infection

micturating cystogram - assess progression by US and biochemistry

surgery ultimately needed

17
Q

what can you do to reduce risk of recurrent infections

A

fluid intake 2L/day

void every 2-3 hours by day

void before bedtime and before and after intercourse

18
Q

how would you manage a patient with an indwelling urinary catheter

A

use aseptic techniques
increase fluid intake
colonisation inevitable so antibiotics only if patient symptomatic

replace catheter

19
Q

how is chronic pyelonephritis diagnosed

A

radiologically

20
Q

what is chronic pyelonephritis characterised by

A

scarring and clubbing of the calyces

21
Q

what can chronic pyelonephritis lead to

A

hypertension
chronic renal failure
?reflux

22
Q

SUMMARY: list 3 common causative organisms

A

e coli
klebsiella
proteus

23
Q

SUMMARY: List four general systemic factors that might predispose an individual to a UTI

A

immunosuppression
steroids
malnutrition
diabetes

24
Q

SUMMARY: What specific urological problems might lead to an increased risk of UTI?

A

Female sex (short urethra)

Congenital abnormalities e.g. duplex kidney

Stasis of urine e.g. due to poor bladder emptying

Foreign bodies eg catheters, stones

Oestrogen deficiency in postmenopausal women

Fistula between bladder & bowel

25
Q

SUMMARY: Describe the typical symptoms & signs of a UTI

A 
Flank pain
Dysuria (“like passing broken glass”)
Cloudy offensive urine
Urgency
Chills
Strangury
Confusion (very old people)
26
Q

SUMMARY: How are UTIs managed?

A 
fluids
antibiotics
- amoxicillin (3-5 day course or 3g x 2)
- cephalosporin
- trimethoprim

severe infections:
IV antibiotics

27
Q

SUMMARY: What advice would you give for recurrent UTI in young women?

A

fluid intake 2L/day

void every 2-3 hours by day

void before bedtime and before and after intercourse

URINARY (27 decks)

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