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uti Flashcards

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USMLE® Step 1 flashcards Biology 101 flashcards
1
Q

What is a UTI?

A

Urinary tract infection (UTI) is a common type of infection in
the human urinary system. It can involve any part of the urinary
system, including the urethra, ureters, bladder and kidneys
Most UTIs can be treated with an antibiotic.
Introduction

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2
Q

What is the urinary tract?

A

The urinary tract includes two kidneys, two
ureters, a bladder, and a urethra.

The urinary tract is the body’s drainage
system for removing wastes and extra fluid.

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3
Q

How do we classify UTI’s?

A

A UTI is classified as “ simple/uncomplicated”
or “complicated”.

Uncomplicated UTIs will usually affect the
bladder.

Complicated UTIs describe resistant infections
that require stronger medications, or those
that affect the kidneys.

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4
Q

Types of Bacteria

A

UTIs are caused by Gram negative and Gram positive bacteria, as well
as fungi.

Uncomplicated UTIs typically affect women, children and elderly
patients.

Complicated UTIs are usually associated with indwelling catheters,
urinary tract abnormalities, immunosuppression or exposure to
antibiotics.

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5
Q

What causes UTI’s?

Specific viruses/bacterium

A

The most common causative agent is Escherichia coli

Other causative agents are Klebsiella pneumoniae , Staphylococcus
saprophyticus , Enterococcus faecalis , group B Streptococcus (GBS),
Proteus mirabilis , Pseudomonas aeruginosa , Staphylococcus aureus
and Candida spp .

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6
Q

What does dysuria mean?

A

Uncomfortable pee

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7
Q

What does polyuria mean?

A

Frequent urge to urinate

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8
Q

What does cystitis mean?

A

Inflammation of bladder

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9
Q

What is pyelonephritis

A

Inflammation of kidneys and ureters

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10
Q

Symptoms of UTI

A

Frequent need to urinate
Burning/painful urine
Cloudy looking urine
Pelvic pain
Blood in urine
Strong smelling

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11
Q

What is the bodies defence mechanisms?

A

The first lines of host defence to urinary pathogens are the
unidirectional flow of urine and the presence of antimicrobial
factors in the urine.

Human urine is frequently inhibitory and sometimes bactericidal.

The epithelial cells lining the urinary tract secrete pro
inflammatory cytokines and antibacterial agents that are
important for the phagocytosis.

The secretion of glycosaminoglycans by bladder transitional cells
forms a surface layer of mucin that acts as an anti adherence
factor.

Another mechanism used by the bladder to reduce bacterial load
is shedding of the superficial epithelial cell layer.

Exogenous regulation of hormones.

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12
Q

Facts about UTI’s

A

150 mil people affected each year

50% of all women in UK had one

20-30% reoccur

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13
Q

Pathogenesis of UTI

A
  1. Contamination of the periurethral area with a uropathogen from the gut
  2. Colonisation of the urethra and migration to the bladder
  3. Colonisation and invasion of bladder, mediated by pili and adhesions and/or inflammatory response in bladder and fibrinogen accumulation in the catheter
  4. Neutrophil infiltration
  5. Bacterial multiplication and immune system subversion
  6. Biofilm formations
  7. Epithelial damage by bacteria toxins and proteases
  8. Ascension to the kidneys
  9. Colonisation of the kidneys
  10. Host tissue damage by bacterial toxins
  11. Bactercaemia
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14
Q

Risk factors with UTI

A

Aging

A previous UTI

D iabetes mellitus

Impaired immune response

Females: short urethra, use of contraceptives that alter
normal bacteria flora of vagina and perineal tissues


Sexual activity

Pregnancy

Males: prostatic hypertrophy, bacterial prostatitis

Urinary tract obstruction: tumour or calculi

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15
Q

What is pyelonephritis

A

Kidney infection

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16
Q

What is cystitis

A

Bladder infection

17
Q

What is prostatitis

A

Prostate infection

18
Q

Summary of cystitis

A

Most common UTI

The common etiologic agents of cystitis are: Escherichia coli , Proteus ,
Klebsiella , and Enterobacter

Women are more likely to develop cystitis as a result of their shorter
urethra.

19
Q

Symptoms of cystitis

A

Symptoms:

Dysuria

Polyuria

Nocturia

Lower abdominal pain

Urine has foul odour, cloudy (pyuria), bloody (haematuria)

20
Q

How does cystitis progress?

A

Cystitis may precede pyelonephritis.

Cystitis is sometimes a secondary complication of some underlying
disorder such as prostatic enlargement, calculi, or tumours.

21
Q

What types of cystitis are there?

A
  1. Haemorrhagic cystitis
  2. Eosinophilic cystitis
  3. Chronic cystitis
  4. Interstitial cystits
22
Q

What is haemorrhage cystitis?

A

: When there is a haemorrhagic component,
This form of cystitis sometimes follows radiation injury or
chemotherapy such as Cyclophosphamide and Ifosfamide , which break
down into substances that irritate the bladder when they are excreted
from the body. Adenovirus infection also causes a haemorrhagic
cystitis.

23
Q

What is the grading of haemorrhage cystitis?

A

Grade I: This involves microscopic bleeding.

Grade II: The bleeding is visible.

Grade III: The bleeding contains small clots.

Grade IV: There is bleeding with large clots that may obstruct the flow
of urine

24
Q

What is Eosinophilic cystitis?

A

: This type of cystitis is rare but thought to be
more common in people with allergies. It’s caused by a build up of a
type of white blood cell = eosinophils in the bladder.


Manifested by infiltration of the submucosa by eosinophils together
with fibrosis and occasionally giant cells. Most cases of eosinophilic
cystitis represent nonspecific subacute inflammation, although,
rarely, these lesions are manifestations of a systemic allergic disorder.

25
Q

What is chronic cystitis?

A

: Due to persistent infection. The mucosa appears
red, friable, granular, sometimes with ulcerated surface. Chronicity of
the infection gives rise to fibrous thickening in the muscularis propria
and consequent thickening and inelasticity of the bladder wall.

Follicular cystitis is a chronic cystitis where lymphoid follicles form in
the bladder. If you have follicular cystitis, you may have to take
antibiotics as well as steroid treatments to reduce inflammation.

26
Q

what is interstitial cystitis?

A

Persistent, painful form of chronic cystitis occurring most
frequently in women and associated with inflammation of all layers
of the bladder wall.

Also diagnosed as painful bladder syndrome.

I t isn’t caused by a bacterial infection. The condition is of unknown
aetiology but is thought to be of autoimmune origin, particularly
because it is sometimes associated autoimmune disorders.

27
Q

Prognosis of interstitial cystitis

A

Scientists have not yet found a cure
for IC nor can they predict who will
respond best to which treatment.

Medications are prescribed for
inflammation and pain.

Only half of IC patients are full
recovery from this disease.

Much more research needs to be
done in order to find a cure.

28
Q

Pathophysiology of interstitial cystitis - theories

A

Mast cell activiation
neurogenic inflammation
uti
decreased tight junction protein
Signalling disturbance

29
Q

Summary of pyelonephritis

A

Acute pyelonephritis is a bacterial infection causing inflammation of the kidneys and
parenchyma (functional kidney tissue).

Occurs as a complication of an ascending urinary tract infection that spreads from the
bladder to the kidneys.

The main cause is gram negative bacteria, Escherichia coli . Proteus , Klebsiella , and
Enterobacter.

Bacteria can reach the kidneys in 2 ways: hematogenous spread and through
ascending infection from the lower urinary tract

30
Q

Pathogenesis of pyelonephritis

A

E. coli is the most common bacteria causing acute pyelonephritis
due to its unique ability to adhere and colonise the urinary tract and
kidneys.
*
E.coli has adhesive molecules called P fimbriae.
*
The adhesion of bacteria to the renal cells disrupts the protective
barriers, which leads to localised infection.
*
E. coli can lead to an acute inflammatory response which can cause
scarring of the renal parenchyma.

31
Q

What are the risk factors of pyelonephritis?

A

Risk factors
1. Pregnancy
2. Urinary tract obstruction and congenital malformation
3. Urinary tract trauma, scarring
4. Renal calculi
5. Polycystic or hypertensive renal disease
6. Chronic diseases, i.e. diabetes mellitus
7. Vesicourethral reflux

32
Q

What are the symptoms of pyelonephritis?

A

Rapid onset with chills and fever
*
Malaise
*
Vomiting
*
Flank pain
*
Costovertebral tenderness
*
Urinary frequency, dysuria
Treatment:
Levofloxacin, ciprofloxacin, co trimoxazole, ampicillin

33
Q

How do we diagnose UTIs?

A

If UTI symptoms: obtain a urinalysis (UA) and culture

UTI affected urine can be visibly cloudy due to an increase of
suspended particles that scatter light.

The urine is examined under a microscope for bacteria or white blood
cells.

A positive UA shows evidence of inflammation (e.g., elevated white
blood cells).

A positive urine culture is defined as ≥100,000 cfu /mL of a urinary
pathogen.

Blood cultures when suspecting pyelonephritis or urosepsis.

34
Q

Other clinical ways to diagnose UTIs

A

If infection does not respond to treatment.
T he following tests can be made :

Ultrasound : In this test, sound waves create an image of the internal organs.
This test is done on top of your skin, is painless and doesn’t typically need
any preparation.

Cystoscopy : This test uses a special instrument fitted with a lens and a light
source (cystoscope) to see inside the bladder from the urethra.

CT scan : Another imaging test, a CT scan is a type of X ray that takes cross
sections of the body (like slices). This test is much more precise than typical
X rays.

35
Q

Treatment for Uncomplicated acute cystitis

A

Nitrofurantoin or cephalosporin: 5 days7
Trimethoprim/sulfamethoxazole (TMP/SMX): 3 days14

36
Q

Treatment for Uncomplicated pyelonephritis

A

Fluoroquinolone: Levofloxacin: 5 days; Ciprofloxacin 7 days14
TMP/SMX or IV/oral cephalosporin: 10–14 days (10 days if early response)15,16

37
Q

Treatment for complex UTI

A

3 days if lower tract CAUTI in women ≤65 years if catheter is removed/not replaced
Other residents: 7 days if prompt resolution of symptoms or 10–14 days if delayed
response, obstruction, or other urologic abnormality3

38
Q

How to prevent UTI’s?

A

Birth control (increases risk)
Good hygiene
Probiotics
Hydration

39
Q
A

Medical Microbiology (10 decks)

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