Urinary Tract Infection Flashcards
urinary tract infeciton:
what is it called if the kidney is effected?
Acute Pyelonephritis
Chronic Pyelonephritis
urinary tract infeciton:
what is it called if the bladder is effected?
Cystitis
urinary tract infeciton:
what is it called if the urethra is effected?
Urethritis
urinary tract infeciton:
what is it called if the prostate is effected?
Prostatitis
urinary tract infeciton:
what is it called if the Epididymis/Testis is effected?
Epididymo-orchitis
is it more common in males or femaled?
Female:male 3:1
Affects 30% women at some time
Adults – rarely causes CRF
Children - less common but important cause of CRF
what are general predisposing factors?
General factors which make an individual more susceptible to UTI (or other infection) include:
Immunosuppression
Steroids
Malnutrition
Diabetes
What are some Predisposing Factors Specific to the Urinary Tract?
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
what is the pathogenesis?
• Usually bowel organisms - E coli, Proteus, Klebsiella, Enterococcus
Transfer:
- Transurethral route
- Perurethral area contaminated - Recurrent UTIs, diaphragms, ? bubble baths
- Urethra to bladder - Intercourse, catheterisation
- Bladder (and up ureters)
- Bloodstream
- Lymphatics
what are the clinical features in a child?
- Diarrhoea
- Excessive crying
- Fever
- Nausea and vomiting
- Not eating
what are the clinical featues in an adult?
- Flank pain
- Dysuria (“like passing broken glass”)
- Cloudy offensive urine
- Urgency
- Chills
- Strangury
- Confusion (very old people)
What are the Clinical features of acute pyelonephritis?
- Pyrexia
- Poor localisation
- Loin tenderness (renal angle)
- Signs of dehydration
- Turbid urine
what investigations may be done?
- Mid-stream sample of urine
- Urinalysis In ward - Blood, leucocytes, protein and nitrites
- Microbiology In laboratory
- Microscopy and Gram staining
- Bacteruria >105 CFU /ml
Culture and sensitivity
what is the management?
The principles of management are:
- Identify the infecting organism & institute appropriate treatment
- Identify predisposing factors and treat if possible
what is the treatment?
- Fluids
- Antibiotics:
Amoxicillin (3-5 day course or 3g x 2), cephalosporin
Trimethoprim
•Severe infections - Intravenous antibiotics
what things in an abnormal urinary tract is there that all may cause infections & sometimes lead to renal impairment?
Anatomical/neurological abnormalities
Stones
Diabetes
what is reflux nephropathy?
- UTIs in children
- Damage is caused by reflux + infection
- Micturating cystogram (radionuclide 99Tc techniques)
- Assess progression by ultrasound scan & biochemistry
- Surgery
Reflux nephropathy is kidney damage (nephropathy) due to urine flowing backward (reflux) from the bladder toward the kidneys
what can you do to deal with recurrent infections?
- Fluid intake 2l / day
- Void every 2-3 hours by day
- Void before bedtime & after intercourse
- Avoid bubble baths & constipation
What do you do in regards to Indwelling Urinary Catheters?
- Aseptic technique
- Fluid intake
- Colonisation inevitable
- Antibiotics only if patient symptomatic - Replace catheter
what is Bacteriuria?
the presence of bacteria in the urine
- >= 105
- But depends on clinical symptoms
- Asymptomatic bacteriuria
- Bacteriuria of pregnancy - 30% progress to symptomatic illness
What does Chronic Pyelonephritis and what needs to be done?
- Radiological diagnosis
- Scarring & clubbing
- Hypertension / CRF
- ? Reflux
- 15% progress to renal failure
Questions on UTI
- List 3 common causative organisms
- List four general systemic factors that might predispose an individual to a UTI
- What specific urological problems might lead to an increased risk of UTI?
- Describe the typical symptoms & signs of a UTI.
- How are UTIs managed?
- What advice would you give for recurrent UTI in young women?
