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Year Two - Urinary System > Urinary Tract Infections > Flashcards

Urinary Tract Infections Flashcards

1
Q

What is an infection in the kidneys called?

A

Pyelonephritis

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2
Q

What is an infection in the urinary bladder called?

A

Cystitis

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3
Q

What is an infection in the urethra called?

A

Urethritis

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4
Q

What is an infection in the prostate called?

A

Prostatitis

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5
Q

What are the two classification of UTIs?

A

Uncomplicated Urinary Tract Infections

Complicated Urinary Tract Infections

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6
Q

What are uncomplicated UTIs?

A

They are defined as those that occur in women under the age of 65 – with no underlying causative pathology

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7
Q

What are complicated UTIs?

A

They are defined as those that occur in women over the age of 65, pregnant patients, male patients, children and catheterised patients

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8
Q

What are the nine risk factors of UTIs?

A

Female Gender

Sexual Activity

Menopause

Congenital Abnormalities

Enterovesical Fistula

Urinary Tract Obstruction

Urinary Catheterisation

Central Nervous System Injury

Immunosuppression

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9
Q

Why are females at an increased risk of UTIs?

A

They have a shorter urethra and their urethral orifice is closer to the rectum

Therefore, it is easier for bacteria to reach the urinary bladder

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10
Q

Why is sexual activity associated with UTIs?

A

Sexual intercourse can push bacteria from the perineum up into the urethra

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11
Q

How is menopause associated with UTIs?

A

This is due to the fact that reduced oestrogen levels cause changes in the urinary tract that make it more vulnerable to infection

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12
Q

How do we manage UTIs which are associated with menopause?

A

Oestrogen cream

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13
Q

What two congenital abnormalities are associated with UTIs?

A

Duplex Kidney

Vesicoureteral Reflux

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14
Q

What is duplex kidney?

A

A condition in which patients are born with duplicated ureters

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15
Q

What is vescicoureteral reflux?

A

A condition on which urine flows from the bladder back up the ureters

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16
Q

Why investigation is used to diagnose vescicoureteral reflux?

A

Micturating cystogram

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17
Q

What is an enterovesical fistula?

A

It is an abnormal connection between the bladder and the bowel

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18
Q

In which two patient groups do enterovesical fistulas occur in?

A

Bladder cancer

Bowel cancer

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19
Q

What is a clinical feature of enterovesical fistulas present?

A

Bowel gas during urination

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20
Q

How are enterovesical fistulas associated with UTIs?

A

The bowel contains several pathogenic organisms, which can now easily pass into the bladder

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21
Q

How are urinary tract obstructions associated with UTIs?

A

They result in decreased urinary flow which means that bacteria are unable to be flushed out of the urinary tract

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22
Q

What three urinary tract obstructions are associated with UTIs?

A

Renal Calculi

Urinary Tract Tumours

Benign Prostatic Hyperplasia

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23
Q

What is the pathophysiological consequence of obstruction at the urethral level?

A

There will be urethral and bladder dilatation

This will eventually develop into bilateral hydroureter and bilateral hydronephrosis

Due to the fact that both kidneys are affected, chronic renal failure can occur

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24
Q

What is the pathophysiological consequence of obstruction at the renal pelvis level?

A

There will be unilateral hydroureter and unilateral hydronephrosis

Due to the fact that only one kidney is affected, chronic renal failure doesn’t occur

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25
Q

How is urinary catheterisation associated with UTIs?

A

They allow direct inoculation of microorganisms into the bladder during insertion

They provide a biofilm surface for bacterial adhesion

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26
Q

How are central nervous system injuries associated with UTIs?

A

There is a decreased sensation within the urinary bladder due to interruption of the micturition reflex

This means that patients are unable to sense when to the bladder is full and empty, therefore leaving urine in the bladder for prolonged periods of time and leaving residual volumes after voiding

This results in the stasis of urine and therefore the development of infections

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27
Q

How is immunosuppression associated with UTIs?

A

This is due to the fact that an impaired immune system is unable to resist infection

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28
Q

What is a common immunosuppressive disease associated with UTIs?

A

Diabetes

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29
Q

What are the seven clinical features of UTIs?

A

Fever

Cloudy Offensive Urine

Dysuria

Polyuria

Urinary Urgency

Lower Abdominal Pain

Acute Confusion

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30
Q

What is dysuria?

A

It is defined as painful urination

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31
Q

What is polyuria?

A

It is defined as increased urination frequency

32
Q

In which patient group is acute confusion a common presentation of UTIs?

A

Elderly

33
Q

What four investigations are used to diagnose UTIs?

A

Urine Dipstick

Urine Culture

Ultrasound Scan

Micutrating Cystogram Scan

34
Q

When are urine dipsticks recommended to investigate UTIs?

A

In women under 65 years old, who don’t have risk factors for complicated UTI

35
Q

In which three circumstances are urine dipsticks not recommended to investigate UTIs?

A

Women over the age of 65

Male patients

Catheterised patients

36
Q

What is the next appropriate management step when a patient’s urine dipstick is positive for haematuria, nitrites and leukocytes?

A

UTI Treatment

Urine Culture

37
Q

What is the next appropriate management step when a patient’s urine dipstick is positive for only nitrites?

A

UTI Treatment

Urine Culture

38
Q

What is the next appropriate management step when a patient’s urine dipstick is positive for only leukocytes?

A

No Treatment

Urine Culture

39
Q

What is the next appropriate management step when a patient’s urine dipstick is negative for haematuria, nitrites and leukocytes?

A

No Treatment

40
Q

In which five circumstances is a urine culture recommended?

A

Women > 65 Years Old

Recurrent Urinary Tract Infection

Pregnant Women

Male Patients

Visible & Microscopic Haematuria

41
Q

What is defined as a recurrent urinary tract infection?

A

2 episodes in 6 months

3 episodes in 12 months

42
Q

What does a urine culture result of bacteriuria < 10^3 organisms per mL indicate?

A

No UTI

43
Q

What does a result of bacteriuria between 10^3 – 10^4 organisms per mL indicate?

A

A UTI diagnosis in symptomatic patients

44
Q

What does a result of bacteriuria > 10^5 per mL indicate?

A

UTI

45
Q

What is another function of urine culture in investigation UTIs?

A

It is also used to identify the causative organism responsible for the infection

46
Q

Which seven organisms tend to colonise urinary tract infections?

A

Escherichia Coli

Candida Albicans

Staphylococcus Saprophyticus

Klebsiella Pneumoniae

Proteus Mirabilis

Enterococcus

Pseudomonas Aeruginosa

47
Q

What is the most common causative organism of UTIs?

A

E.Coli

48
Q

What are the three features of E.Coli?

A

Gram negative

Anaerobic

Rod-shaped

49
Q

In which two patient groups does candida albicans tend to cause UTIs in?

A

Immunosuppressed

Diabetic

50
Q

In which four circumstances are ultrasound scans recommended to investigate UTIs?

A

Women > 65

Recurrent UTIs

Male patients

Children

51
Q

How are ultrasound scans used to diagnose a UTI?

A

They are used to detect any underlying anatomical abnormalities

52
Q

In which four circumstances are micturating cystogram scans recommended to investigate UTIs?

A

Women > 65

Recurrent UTIs

Male patients

Children

53
Q

What is a micturating cystogram?

A

It involves the injection of a radioactive isotope (99Tc) into the vein of the patient, which travels through the bloodstream and is taken up by the urinary tract

We then ask the patients to undergo micturition

A gamma camera is then used to produce images of the urinary tract, allowing us to identify the flow of urine through these structures

54
Q

How are micturating cystogram scans used to investigate UTIs?

A

They can identify urinary tract obstructions

55
Q

What is the management option for UTIs in non-pregnant women?

A

We administer a delayed course of trimethoprim or nitrofurantoin for three days

56
Q

In which two circumstances do we send a urine culture in non-pregnant women with a suspected UTI?

A

Women > 65 years old

Visible or microscopic haematuria

57
Q

What are the two side effects of trimethoprim?

A

Hyperkalaemia

Increased Creatinine Levels

58
Q

What drug does trimethoprim interact with? What is the effect?

A

Methotrexate

Bone marrow suppression or fatal pancytopenia

59
Q

What is the first line management option for UTIs in symptomatic pregnant patients?

A

A course of nitrofurantoin for seven days

60
Q

In which trimester should nitrofurantoin be avoided in? Why?

A

Third trimester

This is due to associated complications of haemolytic anaemia in the newborn

61
Q

What is the second line management option for UTIs in symptomatic pregnant patients - typically administered in the third trimester?

A

A course of amoxicillin or cefalexin for seven days

62
Q

What is the first line antibiotic of urinary tract infections in women who are breastfeeding?

A

Trimethoprim

This is due to the fact that nitrofurantoin can cause haemolysis in GP6D infants

63
Q

When should a urine culture be sent off in pregnant patients with a suspected UTI?

A

All cases

64
Q

What is the management option of UTIs in asymptomatic pregnant patients?

A

An immediate seven day course of either nitrofurantoin, amoxicillin or cefalexin

65
Q

Why do we administer antibiotics to manage UTIs asymptomatic pregnant patients?

A

There is a significant risk of acute pyelonephritis

66
Q

What is the next management step once asymptomatic pregnant patients have completed their UTI antibiotic course? Why?

A

A further urine culture

This is to test of cure

67
Q

Which UTI antibiotic is avoided during pregnancy? Why?

A

Trimethoprim

It has teratogenic effects in the first trimester

68
Q

What is the management option of UTIs in male patients?

A

An immediate course of trimethoprim or nitrofurantoin for seven days

69
Q

When should a urine culture be sent off in male patients with a suspected UTI?

A

All cases

70
Q

Do male patients need a referral to urology following one uncomplicated urinary tract infection?

A

No

71
Q

What are the two management options of UTIs in symptomatic catheterised patients?

A

An immediate course of trimethoprim or nitrofurantoin for seven days

The urinary catheter should be removed or changed as soon as possible if it has been in place for longer than seven days

72
Q

Do we treat asymptomatic UTIs in catheterised patients?

A

No

73
Q

What are the two management options of recurrent UTIs?

A

We administer an immediate course of trimethoprim or nitrofurantoin for seven days

We refer these patients for an ultrasound scan or micturating cystogram in order to detect any underlying pathology

74
Q

What is the management option of acute pyelonephritis?

A

We administer a course of broad spectrum cephalosporins or quinolones for a period of ten to fourteen days

75
Q

What are the four complications of UTIs?

A

Sepsis

Chronic Pyelonephritis

Acute Kidney Injury

Renal Abscess

Year Two - Urinary System (15 decks)

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