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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
How is urinary catheterisation associated with UTIs?
They allow direct inoculation of microorganisms into the bladder during insertion They provide a biofilm surface for bacterial adhesion
26
How are central nervous system injuries associated with UTIs?
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
27
How is immunosuppression associated with UTIs?
This is due to the fact that an impaired immune system is unable to resist infection
28
What is a common immunosuppressive disease associated with UTIs?
Diabetes
29
What are the seven clinical features of UTIs?
Fever Cloudy Offensive Urine Dysuria Polyuria Urinary Urgency Lower Abdominal Pain Acute Confusion
30
What is dysuria?
It is defined as painful urination
31
What is polyuria?
It is defined as increased urination frequency
32
In which patient group is acute confusion a common presentation of UTIs?
Elderly
33
What four investigations are used to diagnose UTIs?
Urine Dipstick Urine Culture Ultrasound Scan Micutrating Cystogram Scan
34
When are urine dipsticks recommended to investigate UTIs?
In women under 65 years old, who don’t have risk factors for complicated UTI
35
In which three circumstances are urine dipsticks not recommended to investigate UTIs?
Women over the age of 65 Male patients Catheterised patients
36
What is the next appropriate management step when a patient's urine dipstick is positive for haematuria, nitrites and leukocytes?
UTI Treatment Urine Culture
37
What is the next appropriate management step when a patient's urine dipstick is positive for only nitrites?
UTI Treatment Urine Culture
38
What is the next appropriate management step when a patient's urine dipstick is positive for only leukocytes?
No Treatment Urine Culture
39
What is the next appropriate management step when a patient's urine dipstick is negative for haematuria, nitrites and leukocytes?
No Treatment
40
In which five circumstances is a urine culture recommended?
Women > 65 Years Old Recurrent Urinary Tract Infection Pregnant Women Male Patients Visible & Microscopic Haematuria
41
What is defined as a recurrent urinary tract infection?
2 episodes in 6 months 3 episodes in 12 months
42
What does a urine culture result of bacteriuria < 10^3 organisms per mL indicate?
No UTI
43
What does a result of bacteriuria between 10^3 – 10^4 organisms per mL indicate?
A UTI diagnosis in symptomatic patients
44
What does a result of bacteriuria > 10^5 per mL indicate?
UTI
45
What is another function of urine culture in investigation UTIs?
It is also used to identify the causative organism responsible for the infection
46
Which seven organisms tend to colonise urinary tract infections?
Escherichia Coli Candida Albicans Staphylococcus Saprophyticus Klebsiella Pneumoniae Proteus Mirabilis Enterococcus Pseudomonas Aeruginosa
47
What is the most common causative organism of UTIs?
E.Coli
48
What are the three features of E.Coli?
Gram negative Anaerobic Rod-shaped
49
In which two patient groups does candida albicans tend to cause UTIs in?
Immunosuppressed Diabetic
50
In which four circumstances are ultrasound scans recommended to investigate UTIs?
Women > 65 Recurrent UTIs Male patients Children
51
How are ultrasound scans used to diagnose a UTI?
They are used to detect any underlying anatomical abnormalities
52
In which four circumstances are micturating cystogram scans recommended to investigate UTIs?
Women > 65 Recurrent UTIs Male patients Children
53
What is a micturating cystogram?
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
How are micturating cystogram scans used to investigate UTIs?
They can identify urinary tract obstructions
55
What is the management option for UTIs in non-pregnant women?
We administer a delayed course of trimethoprim or nitrofurantoin for three days
56
In which two circumstances do we send a urine culture in non-pregnant women with a suspected UTI?
Women > 65 years old Visible or microscopic haematuria
57
What are the two side effects of trimethoprim?
Hyperkalaemia Increased Creatinine Levels
58
What drug does trimethoprim interact with? What is the effect?
Methotrexate Bone marrow suppression or fatal pancytopenia
59
What is the first line management option for UTIs in symptomatic pregnant patients?
A course of nitrofurantoin for seven days
60
In which trimester should nitrofurantoin be avoided in? Why?
Third trimester This is due to associated complications of haemolytic anaemia in the newborn
61
What is the second line management option for UTIs in symptomatic pregnant patients - typically administered in the third trimester?
A course of amoxicillin or cefalexin for seven days
62
What is the first line antibiotic of urinary tract infections in women who are breastfeeding?
Trimethoprim This is due to the fact that nitrofurantoin can cause haemolysis in GP6D infants
63
When should a urine culture be sent off in pregnant patients with a suspected UTI?
All cases
64
What is the management option of UTIs in asymptomatic pregnant patients?
An immediate seven day course of either nitrofurantoin, amoxicillin or cefalexin
65
Why do we administer antibiotics to manage UTIs asymptomatic pregnant patients?
There is a significant risk of acute pyelonephritis
66
What is the next management step once asymptomatic pregnant patients have completed their UTI antibiotic course? Why?
A further urine culture This is to test of cure
67
Which UTI antibiotic is avoided during pregnancy? Why?
Trimethoprim It has teratogenic effects in the first trimester
68
What is the management option of UTIs in male patients?
An immediate course of trimethoprim or nitrofurantoin for seven days
69
When should a urine culture be sent off in male patients with a suspected UTI?
All cases
70
Do male patients need a referral to urology following one uncomplicated urinary tract infection?
No
71
What are the two management options of UTIs in symptomatic catheterised patients?
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
Do we treat asymptomatic UTIs in catheterised patients?
No
73
What are the two management options of recurrent UTIs?
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
What is the management option of acute pyelonephritis?
We administer a course of broad spectrum cephalosporins or quinolones for a period of ten to fourteen days
75
What are the four complications of UTIs?
Sepsis Chronic Pyelonephritis Acute Kidney Injury Renal Abscess

Year Two - Urinary System (15 decks)

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