Urinary Tract Infection

Question 1

What is the typical presentation of UTI?

Answer 1

Dysuria

Frequency

Smelly urine

Question 2

What is the typical presentation of UTI in the very young?

Answer 2

Dysuria

Frequency

Smelly urine

Unwell

Failure to thrive

Question 3

What is the typical presentation of UTI in the very old?

Answer 3

Dysuria

Frequency

Smelly urine

Incontinence

Off of feet

Question 4

The renal blood flow received how much of the cardiac output?

Answer 4

20-25%

Question 5

How does passage occur in the ureters?

Answer 5

Continuous flow - no storage

Question 6

Where do ureters enter the bladder?

Answer 6

Angle of bladder

Question 7

How does the ureteric entrance change as the bladder fills?

Answer 7

Increased bladder pressure closes off ureter and stops reflux

Question 8

What are the bacteriostatic properties of urine?

Answer 8

Free flow of urine

Low pH

High osmolarity

High ammonia content

Bacteriostatic prostatic secretions

Anti-bacterial antibodies

Question 9

What parts of the normal renal tract are not sterile?

Answer 9

Terminal urethra

Question 10

What typical flora is found in the terminal urethra?

Answer 10

Skin and gut flora

Question 11

How do you flush out terminal urethral floral bacteria?

Answer 11

Initial voiding before given specimen (mid stream specimen)

Question 12

What urethral flora is found in MSSU?

Answer 12

Diminished but always present urethral flora

Question 13

How is urethral flora differentiated from pathological flora?

Answer 13

Dip slide method >10^5 = infection

Question 14

At what MSSU culture level is infection assumed?

Answer 14

>10⁵

Question 15

An MSSU culture of 10³ → 10⁴ suggests what?

Answer 15

Possible infection (50% without symptoms)

Probable with symptoms

Question 16

An MSSU culture of <10³ suggests what?

Answer 16

No infection

Question 17

MSSU is difficult to collect in which patients?

Answer 17

Young and Elderly

Question 18

What microorganisms cause UTI?

Answer 18

Gut flora esp E. coli

Question 19

What is the most common route of UTI?

Answer 19

Ascending from urethra

Question 20

What is acute pyelonephritis?

Answer 20

Acute kidney inflammation due to infection

Question 21

What factors predispose you to UTI?

Answer 21

a. Stasis of urine
b. Pushing bacteria up urethra
c. Generalised predisposition

Question 22

What factors can lead to urine stasis?

Answer 22

Obstruction

Spinal cord/brain injury (can’t feel bladder)

Question 23

What factors can cause bacteria to be pushed up urethra?

Answer 23

Sexual activity in females

Catheterisation

Question 24

Blockage at urethral level will lead to what structural changes?

Answer 24

Upper urethral & bladder dilation

Bilateral hydroureter

Question 25

Consistent bilateral hydroureter will lead to what?

Answer 25

Bilateral Hydronephrosis

Question 26

Bilateral hydronephrosis will lead to what?

Answer 26

Chronic renal failure

Question 27

Blockage of the pelvis on one side will lead to what?

Answer 27

Unilateral hydroureter Unilateral hydronephrosis

Question 28

What are the consequences of obstruction?

Answer 28

Proximal dilation Slowed urine flow → infection Slowed urine flow → stone formation

Question 29

What is the triad of urinary obstruction?

Answer 29

Calculi leading do obstruction Obstruction leads to infection Infection leads to more calculi

Question 30

When urinary obstruction presents in children, how is it managed?

Answer 30

Always investigate first presentation Send to surgeons

Question 31

What is the biggest cause of urinary obstruction in children?

Answer 31

Vesicoureteric reflux

Question 32

What is vesicoureteric reflux?

Answer 32

Biggest cause of obstruction in children The insertion of the ureter into the bladder has decreased angulation

Question 33

Vesicoureteric reflux leads to what?

Answer 33

Vesicoureteric reflux with hydroureter

Question 34

What are the most common causes of obstruction in adults?

Answer 34

Men: Benign prostatic hyperplasia Women: Uterine prolapse Both: Tumours, calculi

Question 35

How do spinal cord/brain injuries lead to a predisposition towards UTI?

Answer 35

Decreased sensation → cant feel when to micturate → urine left in bladder → **stasis of urine**

Question 36

At what age do UTIs become more common in females?

Answer 36

Jump at 15+ (sexually active) Again at \>50

Question 37

How does sexual activity increase the risk of UTI in women?

Answer 37

Sexual activity moves lower urethral flora up the tract

Question 38

What factors increase womens' predisposition to UTI?

Answer 38

Short urethra Lack of prostatic bacteriostatic secretion Urethra close to rectum Sexual activity Pregnancy

Question 39

How does pregnancy increase risk of UTI?

Answer 39

Pressure on ureters and bladder

Question 40

Why does Diabetes tend to increase risk of UTI?

Answer 40

Glucose in urine Poor function of WBC

Question 41

Why is there an increase in UTIs in patients over 50?

Answer 41

Prostate problems Uterine prolapse Tumours

Question 42

What are the acute complications of UTI?

Answer 42

Sever sepsis Septic shock

Question 43

What are the chronic complications of UTI?

Answer 43

Chronic damage -\> hypertension -\> chronic renal failure Calculi -\> Obstruction -\> Hydronephrosis -\> hypertension -\> Chronic renal failure