Urinary Tract Infection SR Flashcards
1
Q
Symptoms
A
- frequency
- urgency
- cramping pain (strangury: symptom described in Chinese traditional medicine of painful, frequent urination of small volumes that are expelled slowly only by straining and despite a severe sense of urgency, usually with the residual feeling of incomplete emptying)
2
Q
Diagnosis
A
- Urine dipstick - shows WBC and leucocyte esterase
2. Midstream urine - microscopy, culture and susceptibility ($35)
3
Q
Approach to treatment
A
- treat if dipstick shows pyuria
2, if there are further problems, reassess and send MSU to lab
4
Q
Contributing factors (females)
A
- pastUTI
- sexual intercourse
- diaphragm use
- pregnancy
- diabetes
- instrumentation
5
Q
Contributing factors (makes)
A
- lack of circumcision
- AIDS
- MSM
6
Q
Bacteria that cause cystitis
A
- E.coli (80%)
- Staph aureus (common in young women)
- other enterobacteriaceae
- streptococcus agalactiae (women in pregnancy)
- Enterococcus spp ( elderly men)
- pseudomonas aeruginosa (elderly with urological problems)
- candida albicans (urinary catheters)
7
Q
E.coli factors (3)
A
Type 2 causes pyelonephritis
Type 3 causes cystitis
- fimbriae - attachment to urothelium
- Fe3+ sequester iron (more virulent)
- Polysaccharide capsule resists pathogens
- alpha - haemolysin damages urothelium and neutrophils
Damaged urothelium releases IL-1 which recruits neutrophils and IL1 IL6 and TNF aloha which causes fever and malaise
8
Q
Normal defence against bacteria (6)
A
- microbial flora - lactobacilli produce H2O2 which kills competing flora
- urine - low pH, changes in pH and osmolarity and acids present
- urination
- Tamm- Horsfall protein - formed in loop of Henle to bind bacteria esp type 1 fimbriae
- prostatic fluid
- innate and adaptive immunity
9
Q
Treatment
A
Antimicrobials
- Trimethprim 300mg nocte for 3 days –> night time –> stays in urine overnight
- Nitrofuratoin 50mg QID for 3 days
10
Q
Properties of antibiotic
A
- can get to urine. –> kidney clearance
- active against E.coli and staph aureus
- safe and effective
- cheap
11
Q
Adverse effects of sulphanomides
A
- reduced folate and is bad during pregnancy
- high doses for long periods can suppress bone marrow function
- allergy
12
Q
Diagnosis of pyelonephritis
A
- urine sample
- blood tests (bacteremia)
- scan (if it is more than one episode)
13
Q
Treatment of pyelonephritis
A
- IV and then oral treatment such as gentamicin(aminoglycoside)(almost always caused by enteric gram-negatives) and cefuroxime/amoxycillin-clavulanate
- it is nephrotoxic. gets into the kidneys.
- augmentin or cephalosporin
