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Urology > UTI > Flashcards

UTI Flashcards

1
Q

what bacteria are causes of UTI?

A

E. coli, proteus mirabilis, klebsiella pneumoniae, staphylococci’s saprophyticus

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2
Q

what is the most common bacterial cause of UTI?

A

E.oli

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3
Q

what are the bacterial causes of pyelonephriits?

A

o E. coli, pseudomonas, step faecalis, Proetus, Enterobacter

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4
Q

what are the haematogenous causes of pyelonephritis?

A

staphylococcus, E. coli (infective endocarditis, post-surgery, septicaemia

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5
Q

what are the risk factors to UTIs?

A

female, sexual intercourse, indwelling catheters, diabetes, obstruction, vesicoureteral reflux (due to failure of vesicoureteral orifice), pregnancy, constipation

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6
Q

what are the different types of UTI?

A

cystitis
prostatitis
pyelonephritis

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7
Q

what kind of symptoms does cystitis present with?

A

LUTS

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8
Q

what kind of symptoms does prostatitis present with?

A

LUTS

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9
Q

what kind of symptoms does pyelonephritis present with?

A

systemic symptoms

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10
Q

what are the virulence factors for bacteria in UTI?

A

o Flagella, aero bacterium , adhesions
o Urine pH and osmolarity – greater lower osmolarity and normal pH promote bacterial survival
o Commensals organisms prevent bacteria overgrowth
o Urine flow/micturition washes away bacteria – stasis promotes UTI

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11
Q

what is the pathway of infection in UTI?

A
  • Enter through urethra – also blood, lymphatics or a fistula
  • Ascending infection
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12
Q

what is the pathophysiology of pyelonephritis?

A

unilateral, bacteria adhere to renal epithelium of tubules, chemokines attract neutrophils to interstitial (normally glomeruli + vessels spread)

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13
Q

what are the clinical features of acute pyelonephritits?

A

high fever, rigors, vomiting, loin pain and tenderness, oliguria (if AKI)

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14
Q

what are the clinical features of cystitis?

A

frequency, dysuria, urgency, haematuria, suprapubic pain

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15
Q

what are the symptoms of prostatitis?

A

flu-like symptoms, low backache, few urinary symptoms, swollen or tender prostate on PR

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16
Q

what are the signs of UTI?

A

fever, abdominal or loin tenderness, foul smelling urine, occasionally distended bladder, enlarged prostate, pyuria

17
Q

what investigations are done for UTI?

A

MSU
Urine Culture
Blood tests: FBC, U&E, CRP, culture
Imaging: USS, CTKUB, cystoscopy and urodynamics

18
Q

when are MSUs done in UTI?

A

if symptomatic

Always send if male, child, pregnant, immunosuppressed or ill

19
Q

how do MSU results guide management?

A

o +ve nitrites or leukocytes – treat empirically

o If -ve but symptomatic – MSU lab

20
Q

what criteria of MSU results allow for diagnosis?

A

 Bacteria of greater than 105

 Bacteria of greater than 102 in the presence of pyuria

21
Q

what is the management of UTI in catheterised patients?

A

o Do not use urinalysis. Do not treat unless clinical signs/symptoms of infection.
o If definite infection treat as per complicated uti.

22
Q

what is the management of UTI in older patients?

A

o do not use urinalysis. Do not treat unless clinical signs/symptoms of infection.
o If definite infection treat as per guidance

23
Q

what is the management of complicated uti/ pyelonephritis/ urosepsis ?

A

o iv amoxicillin + gentamicin (if penicillin allergic: iv co-trimoxazole + gentamicin)
o step down: po co-trimoxazole or as per sensitivities total iv/po 7 days

24
Q

what is the management of uncomplicated female lower uti?

A

nitrofurantoin 100mg mr bd or 50mg qds or trimethoprim 200mg bd (3 days)

25
Q

what is the management of uncatheterised male uti?

A

nitrofurantoin 100mg mr bd or 50mg qds or trimethoprim 200mg bd (7 days)

26
Q

what is the management of acute bacterial prostatitits?

A

o Ofloxacin 400mg od or Ciprofloxacin 500mg bd (28 days).
o Trimethoprim 200mg bd if high CDI risk (28 days)
o If IV required: Amoxicillin IV 1g tds + Gentamicin IV then step down as per oral options above to complete 28 day course.

27
Q

what is the cause of a perinephric abscess?

A

o E.coli, pretus species, staphylococcus aureus

o Rupture of an acute cortical abscess or from haematogenous seeding

28
Q

what is a perinephric abscess?

A

abscess located between the capsule of kidney and gerota fascia

29
Q

what are the clinical features of perinephric abscess?

A 
o	Insidious onset
o	Approx. 33% not pyrexial
o	Flank mass 50%
o	High WCC, high serum creatinine
o	Pyuria
30
Q

how are perinephric abscess diagnosed?

A

CT

31
Q

how are perinephric abscess managed?

A

antibiotics + percutaneous or surgical drainage

Urology (10 decks)

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