Urinary tract infections (UTI)

Question 1

What is inflammation of the kidney

Answer 1

Acute or chronic pyelonephritis

Question 2

What is inflammation of the bladder

Answer 2

cystitis

Question 3

what is inflammation of the urethra

Answer 3

urethritis

Question 4

What is inflammation of the prostate

Answer 4

prostatitis

Question 5

What is inflammation of the epididymis/testis

Answer 5

Epididymo-orchitis

Question 6

Which gender are UTIs more common in

Answer 6

Females 3:1 Males

Question 7

What general factors can make a person more susceptible to UTI and other infections

Answer 7

Immunosuppression
steroids
malnutrition
diabetes

Question 8

What are predisposing factors specific to UTI

Answer 8

Female gender - due to short urethra
Sexual intercourse
Congenital abnormalities like duplex kidney
Stasis of urine
Obstructions
Catheters
Estrogen deficiency in postmenopausal women which can cause the vagina to be more dry and can increase risk of uti

Question 9

What organisms most commonly cause UTI

Answer 9

E.coli is most common but staphylococcus and enterococcus are also common

Gram negatives are quite common

Question 10

What are the clinical features of a UTI in children

Answer 10

Diarrhoea
Excessive crying
Fever
nausea and vomiting
not eating

Question 11

Clinical features of UTI in adults

Answer 11

flank pain - cardinal symptom of pyelonephritis
Dysuria
Cloudy offensive urine
urgency
chills
strangury - voiding but feeling that the bladder is not empty
confusion in old people

Question 12

What are the clinical features of acute pyelonephritis

Answer 12

Pyrexia
Poor localisation
loin tenderness at the renal angle
Signs of dehydration due to increased frequency
Turbid urine (cloudy)

Question 13

What are the investigations done for UTI

Answer 13

MSSU
Urinalysis - looking for blood, leucocytes, protein and nitrites
Microbiology (culture)

Question 14

Why are nitrites checked in urinalysis

Answer 14

Bacteria produces nitrites so if nitrites are present, UTI is probable

Question 15

What investigations are done in children, men or when the UTIs are frequent

Answer 15

Ultrasound or intravenous urogram
Isotope studies for reflux

Question 16

describe isotope studies for reflux

Answer 16

Ask patient to drink a lot of water and insert a dye, take pictures during micturition

Question 17

How is a UTI managed

Answer 17

Identify the infecting organism and give the appropriate treatment

Identify any predisposing factor which caused the UTI and treat to prevent reoccurrence

Question 18

What is the treatment of UTI

Answer 18

Fluids
Amoxicillin (3-5 day course 2x 3g doses)
Cephalosporin
trimethoprim - first line treatment

In severe infections - IV antibiotics

Question 19

Why is trimethoprim sometimes avoided in treatment of UTI

Answer 19

It can sometimes cause acute pyelonephritis

Question 20

What is the most common cause of UTI in children and how does it work

Answer 20

Reflux nephropathy - the reflux results in stasis of urine in ureters which can predispose to infection

Question 21

What is the advice for people who have recurrent UTIs

Answer 21

Fluid intake of 2L
Void every 2-3 hours a day
Void before sleeping and after sexual intercourse
Avoid constipation

Question 22

What is Purple urine bag syndrome

Answer 22

Rare occurrence when patients are catheterised too long
it is caused by the breakdown of tryptophan which breaks down into a mix of a blue and red compound which makes purple

Question 23

When does UTI caused by catheter need treatment

Answer 23

When there are symptoms

Question 24

Why does pregnancy result in higher risk of infection

Answer 24

Porgestogens are increased which cause smooth muscle relaxation which causes ureters to relax which can cause urinary reflux

Question 25

Describe chronic pyelonephritis

Answer 25

It is caused usually by multiple UTIs which causes scarring which damages the nephrons which leads to kidney disease that can cause hypertension which worsens the kidney disease to chronic kidney disease