UTIs Flashcards
what are the most common pathogens assoc. w/ cute bacterial prostatitis?
young adults: chlamydia trachomatis & neisseria gonorrhoeae
older adults: E. coli & pseudomonas
What UTI pathogen grows well on chocolate agar?
N. gonorrhoeae
MacConkey Agar is primarily for what class of bacteria?
Enteric Family
what enteric bacteria produce colorless colonies on MacConkey Agar?
Non-Lactose fermenters: Salmonella, Shigella, & Proteus
what enteric bacteria grow pink colonies on MacConkey Agar?
Lactose Fermenters: E. coli, Klebsiella, Enterobacter
what pathogen is the most common UTI?
E. coli
what allows E. coli to cause UTI?
minor trauma allows UPEC: P-pili is the key component for attachment & colonization
Describe the distinct characteristics of proteus mirabilis.
+ urease; highly motile; assoc. w/ struvite stones
list the distinct characteristics of staphylococcus saprophyticus.
Catalyze positive; coagulates negative; Novobioson resistant; non hemolytic
list the distinct characteristics of serratia marcescens.
Slow lactose fermenter (three to 4 days); red colonies; catalase positive; also causes effective endocarditis and ivy drug users
Describe the distinct characteristics of enterococci.
esculin hydrolysis in bile; Catalyze negative; optochin resistant; Causes soft tissue infections
What helps to distinguish pseudomonas aeruginosa from other enterobacteriaceae/
+ oxidase
What are distinguishing characteristics of N. gonorrhoeae?
ferments only glucose; iga protease is the virulent factor; often found in PMNs; oxidase positive; can also cause pelvic inflammatory disease
Why Can chlamydia not be seen on a gram stain?
it is an Obligate intracellular pathogen ; Must use Giemsa stain; iodine stain reacts with glycogen
describe The growth cycle of chlamydia
elementary body found in extracellular compartments; Elementary body transforms to the reticulate body once It enters the cell; cytoplasmic inclusions develop when the reticulate bodies grow inside the host cell and become mature
What unusual UTI forms caseating granulomas
TB usually latent phase
What are distinct characteristics of salmonella
Produces H2S; S flagellated
Describe the pyrogenic pathogenesis of strep A
impetigo, Cellulitis, pharyngitis, sepsis
Describe the toxagenic pathogenesis of strep a
Scarlet fever and toxic shock
describe the immune mediated Pathogenesis of strep a
rheumatic fever, acute glomerulonephritis which typically occurs a few weeks after an untreated sore throat
What kind of what pathogen is schisotosoma haematobium
trematode worm
How is schistosoma haematobium transmitted?
freshwater exposure through the skin; snails are the natural reservoir
What are the early stages of schistosoma haematobium.
Dermatitis, allergic reaction, fever, Malese, hematuria, dysuria, urinary frequency; egg deposition in the bladder wall leads to scarring; associated with squamous cell carcinoma of the bladder
In what regions is schistosoma haemoatobium most common?
North and Central African countries
What is the appropriate treatment for an uncomplicated case of acute cystitis
Trimethoprin-sulfamethoxazole for 3 days
What is the appropriate treatment for a complicated case of acute cystitis
TMP/SMX for 10-14 days
What are antibiotic alternatives for those that have a sulfa allergy
nitrofurantoin or flurorquinolones
What are appropriate antibiotics for UTI treatment in pregnant women
amoxicillin, cephalosporin, nitrofurantoin are usually 1st line
Should an asymptomatic UTI be treated during pregnancy
YES!!!!!!!!!!
What are the main physical exam findings of acute pylo nephritis
costa vertebral angle tenderness, fever, back pain
What are common complications associated with acute pylo nephritis and diabetic patients
Obstructive neuropathy associated with acute papillary necrosis and emphysematous pyelonephritis
Under what circumstances should a patient with symptoms of acute pylon nephritis be hospitalized
intractable vomiting, evidence of shock, severe dehydration; treatment should last 10 days with a follow up five days after treatment completion
Underwood circumstances should imaging for pylon nephritis be considered
On certain diagnosis, immunocompromised status, worsening renal function, suspected kidney stone or other urinary tract obstruction, relapsing pylon nephritis, failure to improve after 72 hours of antibiotics
What is the clinical criteria for acute bacterial prostitutes
White blood cell count greater than 10; + on voided specimen
what is the clinical criteria for chronic bacterial prostatitis
WBC count > 10; - Specimen; expressed prostatic secretions will be positive
What are common physical exam findings for acute bacterial prostatitis
Rectal pain, tents boggy prostate, purulent discharge on prostate massage, positive urine culture: most commonly gram negative organisms such as E coli or klebsiella
What our first line treatments for acute bacterial prostatitis
Quintalones are first line; TMP/SMX for Sensitive Organisms
What should be considered if there is pyurio without bacteria
order giemsa stain for chlamydia
And what circumstances would A UTI case indicate referral to a specialist
anatomical abnormalities; infections assoc. w/ nephrolithiasis; Persistent interstitial cystitis and painful water syndrome
Under what circumstances should you admit a non-pregnant patient to a specialist
Severe pain that requires parental medication; impaired ambulation For urination; dysuria associated with urinary retention or urinary obstruction; Polynephritis with ureole obstruction
What is the clinical criteria for uncomplicated uti
For the non pregnant patient’s: Acute cystitis or polynephritis without anatomic abnormalities or instrumentation of the urinary tract; for the male patient: urethritis
What are common symptoms of urethritis?
dysuria & urethral discharge
What are common Symptoms of cystitis
of the mucosal surface and the urethra and bladder; urinary frequency and urgency; Superpubic pain and Tenderness
What are common symptoms of poly nephritis
Flank pain and fever; cost over teabral tenderness; rigors, diarrhea, and tachycardia
What are common symptoms of prostatitis
Lower back pain, pererectal pain, testicular pain, and urinary retention
Describe the vesicoureteral reflux & complications
retrograde urine flow from the bladder back into the upper urinary tract; induces severe nephropathy; Voiding cystourethrogram is gold standard for diagnosis
Describe the normal physiologic process Of urine peristalsis
From kidneys to the bladder:
the ureteric pressure increases which subsequently opens the orifice to allow passage of urine into the bladder
The process of urine storage:
ureteric pressure drops while the intra vesicle pressure rises to close the Orifice
Under what circumstances will the uritic orifice remain open?
Will remain open if the ratio of intramural tunnel length to the ureteral diameter is less than 5
Describe VUR Grade 1
Reflex only into the non dilated ureter
Describe VUR grade 2
reflex into the ureter and the renal pelvis without Dilatation
Describe VUR grade 3
Reflux with mildly dilated ureter and pyelocalyceal system
Describe VUR grade 4
reflux with tortuous and moderately dilated ureter with blunting of renal fornixes
papillary impression preserved!!!!!!!!!
Describe VUR grade 5
Reflex with tortuous and severely dilated ureter, dilation of pylocalises with loss of fournixes and papillary impression
Describe the pathogenesis of a double ureter
ureteric bud from the mesonephric (wolffian) duct Either split or there are two buds present
Another mechanism is Incomplete fusion of kidney lobules:
the kidney is divided into 2 parts with an upper and lower lobe Due to intermingling of the collecting tubules
What is the most common cause of hydro nephrosis in infants and children?
ureteropelvic junction obstruction
Describe the pathogenesis of ureteropelvic junction obstruction
Abnormal organization of smooth muscle bundles
excess stromal deposition of Collagen
extrinsic compression of upj by abnormal renal Vasculature
What are histologic findings of ureteritis follicularis
accumulation of limbo sites and sub epithelial region; this causes slight elevation of the surrounding Mucosa
What are the histologic findings of ureteritis cystica
Nests of transitional epithelium growth downward into the lamina propria Which forms a central cystic space; Described as multiple small glistening bombs on the surface of a cut open ureter
What are a risk factors for ureteritis cystica
Diseases of chronic inflammation; however this condition is usually asymptomatic
How is sclerosing retroperitoneal fibrosis defined clinically
It is a fibrotic inflammatory process that encases retroperitoneal structures causing hydro nephrosis
what patient population is sclerosing retroperitoneal fibrosis most commonly found
Middle to late aged males
While most cases of SRF are idiopathic, what are secondary causes of SRF?
Drug-Induced: Ergot derivatives and beta blockers
inflammatory conditions: vasculitis, diverticulitis, and Crohn’s disease
malignant sees: lymphoma and urinary tract carcinomas
What are the histologic characteristics of SRF?
Infiltrate of lymphocytes within a germinal center that contains also plasma cells and eosinophils
Fibro epithelial polyps are most commonly seen in what patient population?
Pediatric patients
Describe the histologic characteristics of fibro epithelial polyps
Loose vascularized connective tissue overlay by urothelium
What are the most common type of primary malignant tumors in the bladder
uraithelial carcinomas
Cancers of the bladder commonly occur during which decades of life?
6th and 7th decades of life
Describe the pathogenesis of congenital diverticulitis
development of bladder musculature Or can be secondary to a primary urinary tract obstruction
describe the physiology of acquired diverticular
Secondary urinary outflow obstruction increases intravascular pressure which causes outpouching of the bladder wall and formation of a diverticular
What is the most common cause of acquired diverticula?
prostatic hyperplasia
What is exstrophy of the bladder
Direct communication between bladder and the abdominal surface
What are complications of exstrophy of the bladder?
granular metaplasia; chronic infection
What happens if the uracus remains fully patent
formation of a bladder umbilicus fistula
What forms when only a central region of the patent uncus persists
formation of a uracos cyst lined by either urethere or metaplastic granular epithelium
Patients with uracal cysts are at increased risk for what?
adenocarcinoma
What are predisposing factors to cystitis?
bladder calculi, The urinary obstruction, diabetes mellitus, immune deficiency, instrumentation
Why are women more susceptible to UTIS than men?
women have shorter ureters
What are common atypical UTI pathogens?
adenovirus, mycoplasma, schistosomiasis, and tuberculosis cystitis after renal tuberculosis
What are gross characteristics of acute Cystitis?
hyperemia with small hemorrhagic areas
What are histologic characteristics of acute cystitis?
uthelial ulceration with inflammatory infiltrate above sub urethelial lymphoid follicles
What are histologic characteristics of chronic cystitis?
Friable, mucosa with some congestion and ulcerations; extensive fibrosis
What are epidemiological factors of malakoplakia?
Acquire defects of phagocyte function; chronic inflammatory reaction and infection by E coli or Proteus species for renal transplant recipients
Describe the histologic characteristics of malakoplakia.
Large foamy macrophages with abundant granular cytoplasm; laminated deposition of calcium in enlarged lysosomes referred to as michaelis-gutmann bodies; raised mucosal plaques
What are the most common causes of secondary bladder outlet obstruction in men and women respectively?
men: BPH
women: cystocele of the bladder
What are histologic characteristics of bladder outlet obstruction?
early stages: thickening of bladder wall Due to smooth muscle hypertrophy
later stages: muscle bundles are greatly enlarged and produce trabeculation of the bladder wall
What are common risk factors 4 Urothelial neoplasms?
Cigarette smoking; industrial exposure to aryl amines; Schistosoma haematobium infections; Long term use of analgesics; Long term exposure to cyclophosphamide; irrradiation
Describe the pathogenesis of noninvasive papillary cancers
gain of function alterations in grwoth factor receptor pathways:
Amplifications of FGFR3 tyrosine Kinase receptor genes
Activating mutations in genes encoding RAS & PI 3-kinase
Describe the pathogenesis of progression of late stage non-invasive papillary cancer to muscle invasive bladder cancers
p53 & RB mutations
Muscle invasive bladder cancers Arise from early manifestation of what cancer
flat non-invasive carcinoma
what aryl amines increased risk of urothelial neoplasms?
2-naphthylamine
How long after the initial exposure of aryl amines will a neoplasm develop?
15 to 40 years
schistosoma haematobium Is endemic to what countries?
Egypt and Sudan
schistosoma haematobium infections Cause chronic inflammation. This promotes the development of what?
progressive mucosal dysplasia leading to neoplasia; 70% of cancers are squamous
What urothelial pathologies create flat lesions?
urothelial proliferation; urothelial dysplasia; urethelial carcinoma in situ
What urothelial pathologies create exophytic papillary lesions?
Papilloma; Urothelial proliferation of papillary hyperplasia; papillary urothelial Neoplasms of low malignant potential; Low and high grade pepillary urethelial carcinoma
Describe the histologic characteristics of Papillomas.
Loose fibrovascular tissue Covered by epithelium that is histologically identical to normal urothelium
Papillary uothelial neoplasms of low malignant potential are very similar to papillomas. what are key distinctions?
Thicker urothelium with greater density of cells; generally larger than papillomas
Describe the histologic characteristics of low grade papillary urethelial carcinomas
Normal tissue structure; Scattered hypochromatic nuclei
The histologic characteristics of high gray papillary uothelial carcinoma Would be the same as low grade papillary carcinoma. What is different?
disarray of tissue structure w/ marked cytologic atypia: hyperchromasia and prominent nucleoli
Unlike many of the urothelial carcinomas, high grade papillary urothelial carcinoma has a significant potential for metastasis. To which regions does it typically metastasize to?
Lymph nodes To liver and lungs
How would you describe carcinoma in situ of the uroepithelium in a histologic context?
multi-focal (distinctive layers of distribution); enlarged pleomorphic nuclei; mucosal reddening, granularity & thickening
How are stages of invasive urethelial carcinoma measured?
Depth of invasion in the bladder wall at the initial time of diagnosis
What is an indication for radical treatment of invasive urethelial carcinoma
Invasion of the muscularis propria layer
What cancers commonly metastasize to the bladder?
Cervix, uterus, prostate, rectum, lymphoma
What are pathogens associated with nongonococcal urethritis?
Chlamydia trachomatis
What is a common pathogen associated with gynecological urethritis?
N. gonorrhoeae
Microscopy of a suspected N. gonorrhoeae would reveal what?
PMNs containing diplococci
urethritis is Often accompanied by what and women and what and men
cystitis and women and prostitutes and men
If a patient with urethritis Also complaints of arthritis and presents with conjunctivitis,, What is the most likely diagnosis
non infectious urethritis: AKA reactive arthritis/Reiter syndrome
urethral caruncles Presents as what and is commonly associated with what Population?
Small, red, painful-inflammatory mass; typically occurs in older females
Describe the histologic features of urethral caruncle.
inflamed granulation tissue covered by friable mucosa with ulcerations and bleeds
What are common benign epithelial tumors of the urethra?
Urothelial papilloma, inverted Urothelial papillomas, condylomas
where are urethral caruncles located anatomically?
external urethral meatus
What is the Definition of inverted urothelial papilloma
Urothelial Invagination into the lamina propria
condyloma Consists of what??
hyper plastic papillary fronds of squamous epithelium and koilocytosis caused by hpv
What carcinomas are associated With the Proximal urethra?
Urothelial carcinomas
What are carcinomas associated with the distal urethra?
Squamous cell carcinomas and HPV related Cancers
Adino carcinomas are infrequent in the urethra but what population is this most common in/
women
Describe the histologic characteristics of Swamis cell carcinomas of the urethra
Hyperchromatosis of nuclei and nucleoli below the basement membrane with atypical mitosis
