UTI

Question 1

What result of what test would strongly (99/100) suggest a UTI

Answer 1

MSSU (mid stream specimen urine) of 10^5 CFU’s/ml

And symptoms present

Question 2

What result of what test would suggest a POSSIBLE UTI (50/50)

Answer 2

MSSU 10^3-10^4 CFU’s/ml

No symptoms

Question 3

What result of what test would suggest a PROBABLE UTI

Answer 3

MSSU 10^3-10^4 CFU’s/ml

Symptoms present

Question 4

What result of what test would suggest no UTI

Answer 4

MSSU <10^3 CFU’s/ml

Question 5

Problems with interpretation of MSSU

Answer 5

Some bacterial species are not normally present in terminal urethra/rectal flora and may be pathogenic at low colony numbers

Question 6

Micro-organisms that cause UTI’s

Answer 6

Bacteria mainly gut flora especially E. Coli

Rarely viral cause

Question 7

Route of UTI

Answer 7

Almost always Ascending

Question 8

What kind of UTI is more serious

Answer 8

Upper UTI’s

Question 9

Inflamation of;
Urethra 
Bladder
Ureters
Kidneys

Answer 9

Urethritis
Cystitis
Ureteritis
Acute pyelonephritis

Question 10

Result of recurrent/prolonged Acute pyelonephritis

Answer 10

Chronic pyelonephritis

Question 11

Predisposing factors to UTI’s

Answer 11

Stasis of urine
Pushing bacteria up urethra (catheters/sex)
Generalised predisposition to infections

Question 12

What can cause stasis of urine

Answer 12

Obstruction (congenital or acquired)

Loss of feeling of full bladder (spinal cord/brain injury)

Question 13

What can push bacteria up urethra

Answer 13

Sexual activity

Catheters and other urological procedures

Question 14

What would obstruction at the level of the urethra cause

Answer 14

Upper urethra and bladder dilation => bilateral hydroureter => bilateral hydronephrois => chronic renal failure

Question 15

What would obstruction at the level of the renal pelvis cause

Answer 15

Unilateral hydroureter => unilateral hydronephrosis

Question 16

Basic consequences of obstruction

Answer 16

Proximal dilatation
Slowed urine flow => Cannot flush out bacteria => infection
Slowed urine flow => sediments form =>calculous (stone) formation => obstruction (worsens problem)

Question 17

What problem can bacterial infections cause unique to the kidneys

Answer 17

Some bacteria predispose one to calculous formation

Question 18

Cycle of obstruction

Answer 18

Infection => calculi => obstruction => infection

Question 19

What is seen in vesicouteric reflux in regards to bladder and ureters

Answer 19

Decreased angulation (enters bladder more horizontally)

Question 20

Common causes of obstruction in men, women and both sexes

Answer 20

Benign prostatic hyperplasia
Uterine prolapse
Calculi and tumours

Question 21

UTI’s more common in men or women and why

Answer 21

Women
Short urethra
Lack of prostatic bacteriostatic secretion
Closeness of urethral orifice to rectum
Sexual activity – (helps if void after intercourse)
Pregnancy – pressure on ureters and bladder

Question 22

Why do UTI’s become more common ~>60

Answer 22

Prostate problems in males; uterine prolapse in females; tumours in both sexes

Question 23

Why do UTI’s become more in females in late teens early twenties

Answer 23

Sexual activity

Question 24

Acute complication of UTI

Answer 24

Severe sepsis and septic shock

Question 25

Chronic complications of UTI

Answer 25

Chronic damage to kidneys if repeated infections (chronic pyelonephritis) => hypertension, chronic renal failure
Calculi => obstruction => Hydronephrosis => hypertension, chronic renal failure