UTI

Question 1

General predisposing factors of UTI or other infection (make someone more susceptible)

Answer 1

Immunosuppression
Steroids
Malnutrition
Diabetes

Question 2

Specific predisposing factors of UTI

Answer 2

Female sex (short urethra)

Sexual intercourse and poor voiding habits

Congenital abnormalities e.g. duplex kidney

Stasis of urine e.g. due to poor bladder emptying

Foreign bodies eg catheters, stones

Oestrogen deficiency in postmenopausal women

Fistula between bladder & bowel

Question 3

Most common gram -ve bacteria causing an uncomplicated UTI

Answer 3

E.coli

Question 4

Most common gram +ve bacteria causing an uncomplicated UTI

Answer 4

Enterococci

Question 5

Transurethral route

Answer 5

Perurethral area contaminated - Recurrent UTIs, diaphragms, ? bubble baths

Urethra to bladder - Intercourse, catheterisation

Bladder (and up ureters)

Question 6

Clinical features of UTI in children

Answer 6

Diarrhoea	
Excessive crying
Fever
Nausea and vomiting
Not eating

Question 7

Clinical features of UTI in adults

Answer 7

Flank pain
Dysuria (“like passing broken glass”)
Cloudy offensive urine
Urgency
Chills
Strangury - painful, frequent urination of small volumes
Confusion (very old people)

Question 8

Clinical features of acute pyelonephritis

Answer 8

Pyrexia
Poor localisation
Loin tenderness (renal angle)
Signs of dehydration
Turbid urine (milky or cloudy)

Question 9

What is Acute pyelonephritis?

Answer 9

A sudden and severe kidney infection

Question 10

Investigations for UTI

Answer 10

Mid-stream sample of urine.

Urinalysis In ward -
Blood, leucocytes,
protein and nitrites

Microbiology In laboratory - Microscopy and Gram staining
Bacteruria >105 CFU /ml. Culture and sensitivity

Question 11

In children, men or when UTI’s are frequent what should be done?

Answer 11

USS or IVU ( intravenous urogram) may be helpful

Isotope studies to rule out reflux and scarring

Question 12

2 main principles of management of UTIs

Answer 12

Identify the infecting organism & institute appropriate treatment

Identify predisposing factors and treat if possible

Question 13

Treatment of UTIs

Answer 13

Fluids

Antibiotics - amoxicillin, cephalosporin, trimethoprim

Severe infections - IV antibiotics

Question 14

In what cases might a patient have an abnormal urinary tract

Answer 14

Anatomical / neurological abnormalities
Stones
Diabetes

Question 15

What is reflux nephropathy?

Answer 15

Kidney damage due to urine reflux from the bladder toward the kidneys.

Common in children

May require surgery in severe reflux cases

Question 16

Investigation done in reflux nephropathy?

Answer 16

Micturating cystogram (radionuclide 99Tc techniques)

A scan that shows how well your child’s bladder works. It is used to diagnose why your child may have urinary tract infections.

Question 17

How do you assess progression of reflux nephropathy

Answer 17

USS and biochemistry

Question 18

Best way to deal with recurrent infections?

Answer 18

Fluid intake of 2L a day

Pee every 2-3 hours a day

Pee before bedtime and before and after sexual intercourse

Question 19

Indwelling urinary catheters

Answer 19

Stay in your bladder

Question 20

What should you do if patient’s indwelling catheter becomes infected

Answer 20

Antibiotics if symptomatic

replace catheter

Question 21

Definition of bacteriuria

Answer 21

> 10^5

depends on clinical symptoms

Can be asymptomatic

Question 22

Chronic Pyelonephritis

Answer 22

Continuing pyogenic infection of the kidney that occurs almost exclusively in patients with major anatomic abnormalities

Causes scarring and clubbing of calyces

Hypertension /

15% progress to renal failure