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Urinary Tract Infection Flashcards

1
Q

Definition of micturition

A

Urination

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2
Q

Presentation of UTI

A 
Dysuria
Frequency 
Smelly urine
Cloudy urine 
Flank pain 
Urgency 
Chills
Strangury 
Very young
- unwell 
- failure to thrive
Very old
- incontinence
- off their feet
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3
Q

Definition of dysuria

A

Pain (usually suprapubic) on micturition

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4
Q

How much of the CO does the renal blood flow get?

A

20 - 25%

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5
Q

What does urine output change with?

A

Oral intake of fluids

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6
Q

If increased fluid intake, how does that lead to increased urine output?

A

Resorption of fluid is diminished

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7
Q

Do ureters store urine?

A

NO - they have a continuous flow of it

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8
Q

What stops the reflux of urine up the ureter from the bladder?

A

Increasing pressure from the bladder as it fills, which closes off the ureter

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9
Q

What are the normal properties urine?

A

Low pH
High osmolarity
High ammonia (NH3)

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10
Q

What properties do prostatic secretions have?

A

Bacteriostatic

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11
Q

What parts of the urinary tract are sterile?

A

All of it except from the terminal urethra

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12
Q

Would a suprapubic aspirate of urine be non-sterile or sterile?

A

Sterile

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13
Q

What is a urinated specimen always contaminated with? What may get rid of this?

A

Terminal urethral flora

Initial voiding will flush out any terminal urethral floral bacteria

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14
Q

What does MSSU stand for?

A

Mid stream specimen of urine

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15
Q

How does a MSSU work?

A

Patient voids and then stops mid stream, discarding urine, then collects next volume of urine

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16
Q

In a MSSU, will there still be urethral flora present?

A

YES - it is diminished but always present

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17
Q

What level of bacteria on MSSU usually shows an infection?

A

10 ^ 5

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18
Q

If the MSSU shows bacteria of 10^3 to 10^4, what may this indicate?

A

Sometimes an infection is present

  • probably if have symptoms
  • 50% chance of infection if no symptoms
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19
Q

If the MSSU culture has bacteria <10^3, what does this indicate?

A

Usually NO symptoms

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20
Q

Who is a MSSU difficult to collect in?

A

Elderly

Young children

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21
Q

What is the most common organism to cause UTI?

A

Bacteria - E coli

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22
Q

How common is it to get a viral infection that causes a UTI?

A

Rare

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23
Q

What route of infection of a UTI is it almost always?

A

Ascending

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24
Q

Name of inflammation of urethra

A

Urethritis

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25
Name of inflammation of the bladder
Cystitis
26
Name of inflammation of the ureter
Ureteritis
27
Name of inflammation of the kidneys
Acute pyelonephritis
28
What does acute pyelonephritis if recurrent/prolonged infection lead to?
Chronic pyelonephritis
29
Predisposing factors to UTI (Pathology)
Stasis of urine Pushing bacteria up urethra from below Generalised predisposition to infection
30
Causes of stasis of urine
Obstruction | Loss of feeling of full bladder (spinal cord/brain injury)
31
Causes of bacteria being pushed up from urethra from below
Sexual activity in females | Catheterisation and other urological procedures
32
What is an example of a generalised predisposition to infection?
DM
33
What would obstruction at the level of the urethra lead to?
Upper urethral and bladder dilation
34
What would upper urethral and bladder dilatation lead to?
Bilateral hydroureter
35
What can bilateral hydroureter lead to?
Bladder dilatation -> Bilateral hydroureter -> Bilateral hydronephrosis -> Chronic renal failure
36
If there was obstruction in one ureter only, what would this lead to?
Unilateral hydroureter
37
What would unilateral hydroureter lead to?
Unilateral hydronephrosis
38
Consequences of obstruction
Proximal dilatation Slowed urine -> cannot flush out bacteria -> infection Slowed urine flow -> sediments form -> calculous (stone) formation -> obstruction More and more of these
39
What is the triad of the consequences of obstruction?
Infection Calculi Obstruction
40
Pathology of vesicoureteric reflux
Decreased angulation of insertion of ureter at an angle into the bladder
41
Most common cause of obstruction in children
Vesicoureteric reflux
42
Causes of male adult obstruction
Benign prostatic hyperplasia of prostate Tumours Calculi
43
Causes of female adult obstruction
Uterine prolapse Tumours Calculi
44
Predisposing factors for UTI in females
Female - short urethra Lack of prostatic bacteriostatic secretion Sexual activity Pregnancy
45
What reduces chance of UTI after sexual activity in females?
Voiding after intercourse
46
Why does pregnancy predispose you to UTIs?
Pressure on the ureters and the bladder
47
Complications of UTI
Severe sepsis and septic shock Chronic damage to the kidneys if repeated infections (chronic pyelonephritis) leading to HTN and chronic renal failure Calculi causing obstruction leading to hydronephrosis leading to HTN and CRF
48
Name if inflammation of the prostate
Prostatitis
49
Name if inflammation of the epididymis/testis
Epididymo-orchitis
50
Which gender gets UTIs more?
F > M 3:1
51
What % of women are affected by a UTI at somepoint in their lives?
30%
52
Why is UTI common in pregnancy?
Progesterones lead to relaxation of smooth muscle of the uretus - incidence of reflux is high
53
Why are urine infections very common in hospitals?
Catheters | Immunocompromised
54
Risk factors for UTI
``` Immunosuppression Steriods Malnutrition Diabetes CKD Female Age ```
55
Predisposing factors for UTI
Female - short urethra Sexual intercourse and poor voiding habits Congenital abnormalities e.g. duplex kidney Stasis of urine due to poor bladder emptying Foreign bodies e.g. catheters, stones Oestrogen deficiency in post menopausal women Fistula between bladder and bowel Spermicide coated condoms and diaphragms
56
Why does a short urethra predispose you to UTIs?
Easier for microorganisms to transfer from the perineum/rectum
57
Why are oestrogen deficient post menopausal women at risk of UTIs?
Lack of oestrogen leads to a dry perineal area
58
What can help prevent UTIs in any age of women?
General toilet hygiene - wiping from front to back
59
Causative organisms of UTI
``` E coli Proteus mirabilis Klebsella Enterobacter Pseudonomonas aeruginosa Coagulase negative staphylococci Enterococci Group B strep Staph aureus ```
60
Which of gram -ve or gram +ve bacteria are more common to cause UTIs?
Gram positive
61
Where do the organisms usually originate from in UTI?
Bowel
62
How do the organisms spread to the Urinary tract system?
Transurethral route - preurethral area contaminated (recurrent UTIs, diaphragms, bubble baths) - urethra to bladder (intercourse, catheter) - bladder and up ureters Bloodstream - certain parasites can attack the bladder via the blood e.g. schistosomiasis Lymphatics
63
Can UTIs eventually cause AKIs?
Yes
64
Presentation of UTI in children
``` Diarrhoea Excessive crying Fever N + V Not eating ```
65
What is strangury?
The uncomfortable feeling of wanting to void but not being able to Need to pee and a small amount comes out - then need to pee and nothing comes out - this is due to cystitis
66
Presentation of acute pyelonephritis
``` Pyrexia Poor localisation Loin tenderness at the renal angle Signs of dehydration Turbid urine ```
67
Investigations of UTI
``` MSSU Urinalysis - blood, leucocytes, protein, nitrites Microbiology in lab In children, men or frequent UTIs - USS - IVU ```
68
What does MSSU stand for?
Mid stream specimen of urine
69
What are the principles of management of a UTI?
1. Identify the infecting organism and treat | 2. Identify predisposing factor and treat if possible
70
Treatment of UTI
Oral fluids | Antibiotics
71
Why does oral fluids treat a UTI?
Flushes out the system
72
What antibiotics are used to treat UTI?
Amoxicillin Cephalosporin Trimethoprim
73
What abnormally urinary tract causes could cause UTI?
Anatomical/neurological abnormalities Stones DM
74
What can reflux nephropathy present with in children?
UTIs
75
How is reflux nephropathy assessed?
USS | Biochemistry
76
Treatment of reflux nephropathy
Surgery
77
Treatment of recurrent UTI infections
``` Fluid intake 2L/day Void every 2-3 hours by day Void before bedtime Void before and after intercourse Sometimes advised to not micturate in one go - stop and continue ```
78
Treatment of a catheter induced UTI
Antibiotics | Replace catheter
79
Presentation of chronic pyelonephrtiis
Scarring and clubbing HTN CRF Reflux
80
What % of people with chronic pyelonephritis progress to renal failure?
15%
81
Complication of nitrofurantoin
Lung fibrosis
82
What causes sterile pyuria?
``` Antibiotics Renal TB Appendicitis Prostate Chlamydia Renal calculi PCKD Pregnancy Catheter ```
83
Investigation of choice for reflux nephropathy
Micturating cystography

Renal Pathology (13 decks)

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