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Urology/Renal > UTIs > Flashcards

UTIs Flashcards

1
Q

what is a UTI?

A

the presence and multiplication of microorganisms in the urinary tract

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2
Q

give examples of clinical syndromes caused by UTIs

A 
cystitis
prostatitis 
Epididymitis/orchitis
Urethritis
Pyelonephritis
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3
Q

what a re the classifications of UTIs?

A

Asymptomatic bacteriuria
Uncomplicated
Complicated

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4
Q

what is the difference between bacteriuria and pyuria?

A

bacteriuria is the presence of bacteria in the urine and pyuria is the presence of leucocytes in the urine

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5
Q

what is sterile pyuria?

A

presence of white cells in the urine but a pathogen cannot be cultured

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6
Q

what is the most common age group to get asymptomatic bacteriuria?

A

over 65s

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7
Q

what percentage of people with a catheter will have asymptomatic bacteriuria?

A

100%

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8
Q

describe the prevalence of asymptomatic bacteriuria

A

increases with age in both genders
higher in women at all ages
rapid and marked increase with pregnancy

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9
Q

what is the popln that comes under uncomplicated bacteriuria

A

non pregnant women

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10
Q

what is the popln that comes under complicated bacteriuria

A 
Pregnant
Men
Catheterised
Children
Recurrent/persistent infection
Immuncompromised
Noscomial infection
Structural abnormality
Urosepsis
Associated urinary tract disease
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11
Q

in children who are girls or boys more likely to get UTIs?

A

girls

if it happens in boys, it is a sign of structural abnormality which needs to be reviewed

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12
Q

what percentage of women experience a UTI in their life?

A

10-20%

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13
Q

what is the complication of asymptomatic bacteriuria in renal transplant pts?

A

pyelonephritis

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14
Q

what are some of the causative organisms for UTI?

A 
E. coli - most common causative organism
Proteus 
Klebsiella
Enterococci
Staph. saprophyticus 
S. aureus 
Pseudomonas aeruginosa
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15
Q

which of the bacterial causes is associated with renal stones?

A

proteus - as it produces ureas which causes an increase in the pH of the urine and this is the pH that stones form at

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16
Q

where does Klebsiella come from?

A

the gut - it is an Enterobacteriaceae

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17
Q

who does Staph saprophyticus most commonly affect?

A

young women

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18
Q

what needs to be checked for when we have a pt with Staph aureus bacteriuria?

A

endocarditis, abscesses, prosthetic joint infections, likes to seed places, can be in the kidneys - so the pt needs to be investigated for a deep infections

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19
Q

What are the G+ cocci that cause UTIs?

A

Enterococcus
Staph. saprophyticus
Staph aureus

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20
Q

What are the G- bacteria that can cause UTIs?

A

Neisseria
Enterobacteriaciae ie E.coli and Kelbsiella, Proteus
Bacteroides

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21
Q

what are the culture negative causes of UTI?

A 
mycobacteria 
Chlamydia 
Fungi eg Candida albicans 
Mycoplasma 
Ureaplasma urealyticum
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22
Q

explain the pathogenesis of UTIs

A

colonic flora colonises the vagina, then the urethral meatus and then the bacteria ascend further till they cause a UTI

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23
Q

What factors predispose to UTI?

A 
obstruction from prostatic hypertrophy
bladder stones or tumour 
low urinary volume 
ureteric stones 
stasis during pregnancy 
ureteric reflux
female short urethra 
catheterisation 
low urinary volume eg due to dehydration
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24
Q

what factors make uropathogenic E.coli virulent?

A

adherence molecules ie fimbriae

toxins that cause extensive tissue damage

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25
Q

What happens post-menopause for the risk of UTI to increase?

A

after menopause, the pH rises and there is increased colonisation by colonic flora
reduction in vaginal mucus secretion means there is increased vaginal mucosal receptivity to uropathogenic E. coli

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26
Q

How is the normal acidic vaginal pH maintianed?

A

the normal vagina is heavily colonised with lactobacilli, which metabolise glycogen to lactate which is acidic

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27
Q

What are the symptoms of a UTI?

A

frequency
dysuria
fever
haematuria

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28
Q

What are the investigations that are done to diagnose a UTI?

A

collect a urine sample
urinalysis
microscopy
culture and sensitivity

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29
Q

What may be found on urinalysis in a UTI?

A 
blood 
protein 
pH change 
glucose and ketones as diabetics are more prone to UTIs
leukocytes 
nitrates
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30
Q

What are the different types of urine sample?

A 
MSU
CSU - catheter specimen of urine 
early morning urine - for TB 
SPA - suprapubic aspirate
clean catch - clean down below before giving the sample
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31
Q

What may be seen on microscopy with a UTI?

A 
WBCs
RBCs
casts 
bacteria 
epithelial cells
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32
Q

What doe epithelial cells in the sample indicate?

A

poorly taken specimen ie not MSU

33
Q

how is asymptomatic bacteriuria treated in over 65s?

A

do not treat, as not likely to get pyelonephritis and more likely to get problems with bacterial resistance

34
Q

how are uncomplicated UTIs treated

A 
give 3 days antibiotics 
give advice:
- increase fluid intake 
- void pre and post intercourse 
- hygiene
35
Q

what is a complicated UTI?

A

Any UTI in the presence of a structurally or functionally abnormal urinary tract, with or without host compromise

36
Q

how are complicated UTIs treated?

A

always send sample for culture

give antibiotics for 7 DAYS

37
Q

How are recurrent/complicated UTIs investigated?

A 
MSU
DRE or PV (vaginal exam) 
post void bladder scan (incomplete bladder emptying)
USS of renal tract/pelvis
X-ray KUB, NCCT KUB to rule out stones 
flexible cystoscopy to look at bladder
38
Q

what are the first line antibiotics used for UTI?

A

Nitrofurantoin

Trimethoprim

39
Q

when should nitrofurantoin not be given and why?

A

final trimester of pregnancy as it causes neonatal haemolysis
Renal function eGFR <45
end of the RANT = final trimester

40
Q

when should trimethoprim not be given

A

first trimester of pregnancy

41
Q

what are the new antibiotics that can be given for UTI?

A

fosfomycin

pivmecillinam

42
Q

should you dipstick a catheter sample?

A

No

43
Q

what structure do bacteria form on catheters?

A

biofilms - difficult for antibiotics to penetrate this

44
Q

what are the complications of a long term catheter?

A

UTI/Pyelonephritis
Stones
Obstruction
Chronic inflammation

45
Q

how do we prevent community a community acquired uti?

A

do not catheterise or if you must use intermittnet catheterisation or suprapubic
keep catheter closed and reove as soon as possible
replace the catheter and do not treat if asymptomatic as can produce resistance

46
Q

what should women be screened for in pregnancy in terms of UTIs?

A

asymptomatic bacteriuria

47
Q

what are the risk factors for UTIs in pregnancy?

A 
increasing age 
parity 
sexual activity 
diabetes 
previous UTI
48
Q

how are UTIs in pregnancy investigated?

A
  • culture rather than use a dipstick
  • Positive cultures should be confirmed with a second sample before recommending treatment
  • Asymptomatic bacteriuria should be treated(unlike elderly) to prevent pyelonephritis
  • Test of cure should be sent 1 week after treatment
49
Q

what is prostatitis?

A

Inflammation/swelling of the prostate gland

50
Q

what are the symptoms of chronic bacterial prostatitis?

A

pain in the urogenital regions eg perineum, suprapubic, testicles, penis, lower back, abdomen, rectum, groin etc
urinary symptoms -
LUTS and urethral burning
sexual dysfunction - ejaculatory dysfunction and loss of libido
psychosocial symptoms - depression, anxiety

51
Q

how does acute bacterial prostatitis present?

A

Systemically unwell, fever, rigors, significant voiding LUTS, pelvic pain, comes on v. quickly

52
Q

how does chronic bacterial prostatitis present?

A

Symptoms >3 months, recurrent UTI’s
Pelvic pain, voiding LUTS
Uropathogens in urine +/- blood

53
Q

how does chronic pelvic pain syndrome present?

A

Chronic pelvic pain +/- LUTS +/- UTI’s

54
Q

what are the causative organisms for prostatitis?

A

E. coli
Proteus
Klebsiella

55
Q

what is the pathogenesis of prostatitis?

A

Ascending infection from the urinary tract

or Haematogenous spread

56
Q

how is prostatitis diagnosed?

A 
Urinalysis and MSU
Bloods (FBC< U+E, CRP) including cultures
STI screen
Urodynamic tests
TRUSS +/- CT abdo and pelvis
57
Q

when do you need to admit a pt with acute prostatitis?

A

Unable to take oral antibiotics. - vomiting
Severely ill.
In acute urinary retention

58
Q

how is acute prostatitis treated?

A
  • start antibiotics immediately: quinolone ie ciprofloxacin or ofloxacin for 28 DAYS (give triomethoprin if unable to take quinolones)
  • treat the pain
59
Q

how do you treat chronic prostatitis?

A 
Pain relief
Paracetamol/ibuprofen
Stool softener
Antibiotics
4-6 weeks, quinolone
\+/- α blocker
60
Q

what is the symptom of urethritis?

A

dysuria = Painful/difficult urination

61
Q

what are the causative organisms of urethritis?

A 
It is sexually transmitted: 
Gonococcal vs non gonococcal
Chlamydia trachomatis
Ureaplamsa urealyticum
Trichomonas vaginalis
Mycoplasma genitalium
HSV
62
Q

How do you manage urethritis?

A 
Requires sexual health referral =GUM
antibiotics depending on the cause 
Ceftriaxone
Azithromycin
Oflaxacin
Doxycycline
63
Q

How does epidiymo-orchitis present?

A

Presents with acute onset of pain and swelling

64
Q

What is the pathophysiology of Epididymo-orchitis?

A

Sexually transmitted pathogens ascending from the urethra or non-sexually transmitted uropathogens spreading from the urinary tract
this depends on age, if <35 then more likely to be an STI than a UTI and vice versa if over 35 so take a sexual history

65
Q

what are the sexually transmitted causes of Epididymo-orchitis?

A

Chlamydia trachomatis
Neisseria gonorrhoeae
Gram negative enteric organisms – anal intercourse

66
Q

what are the non-

sexually transmitted causes of Epididymo-orchitis

A

Gram negative enteric organisms (urinary tract surgery/instrumentation)
Mumps
Tuberculosis – can be associated with renal TB
Brucellosis
Candida

67
Q

what are the non-

infectious causes of Epididymo-orchitis

A

Amiodarone

Behcets disease

68
Q

What are the symptoms of Epididymo-orchitis?

A

Acute onset –usually unilateral scrotal pain +/- swelling
Urethritis symptoms
UTI Symptoms

69
Q

What are the signs of Epididymo-orchitis?

A

unilateral swelling and tenderness of epididymis +/- testes, urethral discharge, hydrocoele, erythema +/- oedema of scrotum, pyrexia

70
Q

what must be ruled out before making a diagnosis of epididymo-orchitis?

A

TESTICULAR TORSION

71
Q

what are the features suggestive of testicular torsion?

A

Short duration of pain
Associated nausea/abdo pain
Previous short duration orchalgia (pain in the tesitis)

72
Q

How do we investigate epididymo-orchitis?

A

Urethral smear looking for STI - eg gonorrhoea and NAAT
dipstick
MSU - culture and sensitivity
CRP and ESR to monitor infection and response to treatment

73
Q

what is the treatment of epididymo-orchitis?

A

• Analgesia
• Antibiotics - if sexually transmitted Ceftriaxone and Doxycycline for 14 days and refer to GUM
if non-sexually transmitted - Ofloxacin or Ciprofloxacin - quinilone for 14 days
• Sexual abstinence
• Supportive underwear
• Contact tracing

74
Q

what is the classical triad of symptoms for pyelonephritis?

A

loin pain
fever
pyuria

75
Q

what are the modes of infection of pyelonephritis?

A

• Ascending
Urethra colonised with bacteria and this enters urethra in intercourse
• Haematogenous - S.aureus/Candida
• lymphatic spread

76
Q

what are the investigations done for pyelonephritis?

A

• Abdominal examination
- Tender loin
- Renal angle tenderness
- PV: rule out tubal/ovarian/appendix pathology
• Bloods (FBC, U+E, CSR) including cultures
•U/S scan - Rule out obstruction in upper tract
•MSU

77
Q

how is pyelonephritis treated?

A

Fluid replacement – increased losses
IV Abx – Broad spectrum eg. Co-amoxiclav/Ciprofloxacin +/- Gentamicin
Drain obstructed kidney
Catheter – to monitor fluid balance, part of sepsis 6 Analgesia
Complete 7-14 days (depending on choice of antibiotic)

78
Q

what are the complications of pyelonephritis?

A

renal abscess

Emphysematous pyelonephritis- gas accumulation in the tissues of the kidney which is life-threatening

Urology/Renal (14 decks)

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