UTI Flashcards

1
Q

What is UTI

A

Affects kidneys, ureters, bladder, urethra
Women at higher risk due to shorter urethra, more common in adults. UTIs in children more likely to be serious and should be investigated (may damage kidneys due to reflux)

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2
Q

What is upper UTI

A

Pyelonephritis

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3
Q

What is lower UTI

A

cystitis (inflammation of the bladder), urethritis, prostatitis

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4
Q

What are the organisms that cause UTI

A

Mainly Escherichia coli as it is in the gut, rarely fungi (candida) and viruses
Other:
Gram -: Klebseilla, Pseduomonas, Enterobacter, Proteus
Gram+: Staph, Strep, Enterococcus

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5
Q

What is the pathogenesis of UTI

A

Starts with contamination of the periurethral area with uropathogen from the gut. Bacteria can make biofilm to protect detection by neutrophils. Can cause epithelial damage by bacterial toxins and proteases. Can cause bacteraemia through colonisation of the kidneys

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6
Q

What are the symptoms of cystitis

A

dysuria, blood, discomfort in lower abdomen, pain in urination

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7
Q

What are the symptoms of urethritis

A

dysuria, urinary discharge

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8
Q

What are the symptoms of prostatitis

A

painful prostate on rectal examination

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9
Q

What are the symptoms of pyelonephritis

A

Fever, back pain, nausea or vomiting. In severe cases - sepsis

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10
Q

What is shown on urine dipstick

A

Dipstick: leucocytes, nitrite (gram negative bacteria), blood and protein
Microscopic examination to check for polymorphonuclear leucocytes (pus cells)
Urine culture to check for growth of pathogenic bacteria

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11
Q

What is required for bacterial culture to be confirmed

A

Confirmation: absence of prior abx therapy - 10^5 colony count
Contaminated specimens present with colony counts less than 10^4.

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12
Q

What is candiduria

A

Candiduria: frequently occurs in px with indwelling catheter. If grows in urine ,get rid of catheter. Treat only if symptomatic with fluconazole (amphotericin if resistant)

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13
Q

How to treat recurrent UTI

A

important to obtain urine culture and sensitivity to treat appropriately
Over 2 infections in 6 months. 3 UTIs in 12 months.
Reinfection: by different bacteria
Persistence: same organism from focus within the urinary tract
Causes: struvite stone (precipitates in alkaline urine), reflux (dysfunction of alves), ureteral stricture, obstruction

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14
Q

What are the causes of urethritis

A

Chlamydia trachomatis or Neisseria gonorrhoea
Chlamydia is frequently asymptomatic in female, but can present with dysuria, discharge or pelvic inflammatory disease
Send UA, urine culture (if pyuria seen, but no bacteria, suspect chlamydia)
Pelvic exam - send discharge from cervix or urethra for chlamydia PCR

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15
Q

What are the symptoms of prostatitis

A

Symptoms: pain in the perineum, lower abdomen, testicles, penis and with ejaculation, bladder irritation, bladder outlet obstruction and sometimes blood in the semen

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16
Q

How is prostatitis diagnosed

A

Typical clinical history (fevers, chills, dysuria, malaise pelvic/perineal pain, cloudy urine)
Finding of an oedematous and tender prostate on physical examination
Increased PSA
Urinalysis, urine culture

17
Q

How is pyelonephritis diagnosed

A

urinalysis, urine culture, blood test (raised white cells and CRP)

18
Q

What are culture negative UTIs

A

TB, gonococcal infections, chlamydia, anerobic bacteria