Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Stage 2: Inflammation > UTIs > Flashcards

UTIs Flashcards

1
Q

What is a UTI?

A

An inflammatory response of the urothelium (all transitional cell epithelium) to bacterial invasion, usually associated with bacteriuria and pyuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do you define a UTI depending on the amount of bacteria?

A
  • Bacterial infection of urine with >10^5 colony forming units/ml of urine
  • In symptomatic patients allow lower counts - > 10^2 cfu/ml
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is bacteriuria?

A

Describes the presence of bacteria in the urine, which may be asymptomatic or symptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is a CSU?

A

Catheter urine sample

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is pyuria?

A

The presence of white blood cells ( >10 per HPF x 400) in the urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Simple/uncomplicated UTIs are UTIs in which patients?

A
  • Female
  • First presentation
  • Not pregnant
  • No signs of pyelonephritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are signs of pyelonephritis?

A
  • Fever
  • Sepsis signs - high WBCs, lactate, fever
  • Loin pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Complicated UTIs are UTIs in which patients?

A
  • Male
  • Recurrent UTIs
  • Pregnancy
  • Elderly
  • Catheter related
  • Children
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the definition of recurrent UTIs?

A

> 2 in 6 months or > 3 in 1 year (different from persistent UTI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the types of lower UTIs (bladder and lower)?

A

1) Urethritis
2) Cystitis
3) Prostatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the types of upper UTIs (higher than bladder)?

A

1) Pyelonephritis

2) Intrarenal/perinephric abscess (complication of pyelonephritis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the risks factors for UTIs in anyone?

A

1) Previous UTI
2) Instrumentation or surgery
3) Catheterisation
4) Upper tract obstruction e.g. stones
5) Neurogenic bladder e.g. due to stroke
6) Renal transplantation (immunosuppressed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the risks factors for UTIs in adults?

A

1) Sex
2) Spermicides
3) Diaphragm
4) Pregnancy
5) Diabetes mellitus
6) Benign prostate enlargement (BPE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the risk factors for UTIs in women of older age?

A

1) Oestrogen deficiency - vaginal dryness and atrophy

2) Prolapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are UTI complicating factors?

A

1) Catheters
2) Bladder outlet obstruction (BOO), PVR > 100ml
3) Diabetes, CKD
4) Males, elderly
5) Vesico ureteric reflux
6) Pregnancy
7) Previous upper tract surgery
8) Bladder or renal stones
9) Chemo or radiotherapy to bladder
10) Upper tract reconstruction with bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the PVR?

A

Post-void residual - the amount of urine left in the bladder after urination

17
Q

What is the vesico ureteric reflex?

A

When urine goes back into the kidneys

18
Q

What uropathogens cause UTIs?

A

1) Streptococci
2) Proteus - makes kidney stones, recurrent proteus infections leads to infection stones
3) Klebsiella
4) E.coli
5) Staphylococci

19
Q

What are the gram positive bacteria?

A

1) Staphylococcus
2) Streptococcus
3) Enterococcus

20
Q

What are the gram negative bacteria?

A

1) Neisseria gonorrhoea
2) Escherichia (coli)
3) Klebsiella
4) Proteus
5) Pseudomonas (long term stents)
6) Chlamydia trachomatis

21
Q

How does chlamydia typically present in females?

A

Typically asymptomatic in females but can present with dysuria, discharge or PID

22
Q

How do you investigate an STD (chlamydia)?

A
  • Send urinalysis, urine culture (if pyuria seen, but no bacteria, suspect chlamydia)
  • Pelvic exam - send discharge from cervix/urethra for chlamydia PCR
  • Low oestrogen in post menopausal women
23
Q

What are the host defence mechanisms against UTIs?

A

1) Commensal flora
2) Integrity of skin/mucus membrane
3) Secretions - lysosomes, IgA
4) Long male urethra
5) Urine flow
6) Bladder surface mucin/GAG layer
7) Tamm - Horsfall protein (uromucoid) → secreted by cells of ascending loop of Henle, bind to E.coli expressing type 1 mannose sensitive fimbriae
8) Mucosal shedding
9) Local immune response

24
Q

What are the clinical features of a UTI?

A

Dysuria, frequency, urgency, pain

25
Q

What should be features of a focussed history for UTI?

A

1) Classify the UTI
2) Triggers e.g. sex, STI, poor oral intake of fluid
3) Microbiology history - E coli could be resistant to abx that took before
4) PMH - diabetes, stones, neurology, childhood UTI
5) Drug history - if on pill will need alternative contraception with abx

26
Q

What are red flag symptoms in a UTI and why?

A

1) Visible haematuria - 16% chance of having bladder cancer (ask about cancer symptoms)
2) Persistent microscopic dipstick haematuria 4% chance

27
Q

What are the parts of a focused examination in UTI presentation?

A
  • Vaginal examination

- Post void residual to check if they are emptying the bladder

28
Q

What should you do with a MSU - urine dipstick ± microscopy (culture)?

A
  • Ensure accurate collection of MSU
  • Process specimen promptly, or refrigerate to prevent overgrowth of contaminants before being sent
  • pH, blood, leucocytes, nitrites, protein, glucose
29
Q

What are indications for further investigation of a UTI?

A

1) Visible haematuria
2) Persistant non-visible haematuria
3) Pyelonephritis
4) Atypical UTI
5) Obstructive lower urinary tract symptoms
6) Urea-splitting organisms
7) Suspicion of stones
8) Persistent UTI - failure to respond to abx could be cancer

30
Q

What are further investigations in a UTI?

A

1) Imaging - USS (renal if flank pain and tenderness), PVR, kidney ureter bladder x ray (± CT if classic renal colic, proteinuria, haematuria)
2) Cystoscopy

31
Q

Describe how you use antibiotics in a UTI?

A
  • Self-start - make sure to collect urine sample before starting it so can be tested for resistance
  • Continuous prophylaxis - change in 3 month cycles
32
Q

What antibiotics are used to treat a UTI?

A

1) Nitrofurantoin
2) Trimethoprim
3) Penicillin e.g. amoxicillin
4) Cephalosporin e.g. cefalexin
5) Aminoglycosides
6) Erythromycin - usually IV
7) Tetracyclines
8) Fluroquinolones (ciprofloxacin) - usually in males

33
Q

What are the two first line antibiotics for uncomplicated lower UTI?

A

Nitrofurantoin or trimethoprim

34
Q

When do you treat asymptomatic bacteriuria?

A

1) Pregnancy
2) Patients prior to undergoing a surgical procedure - give abx before induction
3) Post renal transplant early post-op

35
Q

Explain treatment of UTI in catheterised patients

A

1) Bacteriuria with no symptoms = no treatment
2) Bacteriuria with symptoms e.g. fever, urgency, frequency, dysuria or suprapubic tenderness = treat, abx may be unable to penetrate biofilm to removal of the catheter may be necessary if catheter is in place for > 1 week (IV abx?)
3) Routine use of prophylactic abx in catheterised patients is not recommended

36
Q

What are behavioural treatments/prevention for UTI?

A

1) Increased fluid intake
2) Post-coital voiding
3) Perineal hygiene - washing
- Cranberry only good for prevention or tablets, sugar good for bacteria not patient

37
Q

What else can be used to treat UTIs in post-menopausal women?

A

Oestrogens

  • Topical, gradually reduce
  • Ensure no contra-indications e.g. DVTs, breast cancer
38
Q

What type of bacteria are chlamydia and gonorrhoea?

A

Gram negative diplococci

Stage 2: Inflammation (39 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions