Brainscape's Knowledge GenomeTM

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


See full index

7. CP - Kidney and Urinary Tract Disease > (34) Urinary Tract Infection > Flashcards

(34) Urinary Tract Infection Flashcards

1
Q

Describe the flora of the urinary tract

A
  • kidneys + ureters = sterile
  • bladder = usually considered sterile
  • urethra = perineal flora (skin/lower GI flora)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The perineal flora is made up of skin flora and lower GI tract flora. What is skin flora made up of?

A

Predominantly coagulase-negative staphylococci

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

The perineal flora is made up of skin flora and lower GI tract flora. What is lower GI tract flora made up of?

A
  • anaerobic bacteria
  • aerobic bacteria eg. enterobacteriaceae (“enteric gram-negative bacilli”, “coliforms”)
  • gram-positive cocci eg. enterococcus spp.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is cystitis?

A

Lower urinary tract infection

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

Cystitis is a syndrome of what collection of symptoms/signs?

A
  • dysuria
  • urinary frequency
  • urgency
  • supra-pubic pain/tenderness
  • polyuria, nocturia, haematuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is dysuria?

A

Painful or difficult urination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is pyelonephritis?

A

Upper urinary tract infection (infection of kidney and/or renal pelvis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the symptoms of pyelonephritis?

A
  • same symptoms as lower UTI
  • loin/abdominal pain/tenderness
  • fever
  • other evidence of systemic infection eg. rigor, nausea, vomiting, diarrhoea, elevated CRP, WBC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is urethral syndrome also known as?

A
  • abacterial cystitis

- frequency-dysuria syndrome

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

Who does urethral syndrome mostly affect?

A

30-50 year old women

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

What are the symptoms of urethral syndrome?

A

Symptoms of lower UTI without demonstrable infection

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

What are the theorised causes of urethral syndrome?

A
  • hormonal imbalances
  • inflammation of Skene glands and paraurethral glands
  • reaction to certain foods
  • environmental chemicals
  • hypersensitivity following UTI
  • traumatic sexual intercourse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What criteria is used to diagnose urinary infection?

A

Kass criteria

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

How is significant bacteriuria diagnosed using Kass criteria?

A

10^5 cfu/mL = significant bacteria

10^4-10^5 cfu/mL = probable infection

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

What are the limitations of Kass criteria in diagnosis of UTI?

A
  • bacterial count is on a normal curve

- many symptomatic females have bacterial counts of

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

What is asymptomatic bacteriuria?

A
  • significant bacteriuria (with a single organism)

- no symptoms of UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is sterile pyuria?

A
  • pus in urine

- no organisms grown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the predisposing factors for UTI?

A
  • female sex
  • urinary stasis
  • instrumentation
  • sexual intercourse
  • fistulae
  • congenital abnormalities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the female:male ratio for UTIs?

A

10: 1
female: male

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Urinary stasis is a predisposing factor for UTI. What causes urinary stasis?

A
  • pregnancy
  • prostatic hypertrophy
  • stones
  • strictures
  • neoplasia
  • residual urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Is sexual intercourse a predisposing factor for UTI?

A

Yes

Associated with recent sexual intercourse and commoner in sexually active women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What kind of fistulae are predisposing factors for UTI?

A
  • recto-vesical

- vesico-vaginal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What kind of congenital abnormality is a predisposing factor for UTI ?

A

Vesico-ureteric reflux (VUR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Where are the potential sources of infection for UTI?

A
  • perineum (movement of bacteria along a lumen)
  • fistulae (movement of bacteria from genital/GI tract to urinary tract)
  • haematogenous (seeding of infection from blood - rare)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What organism causes 70-80% of UTIs in GP and 50% of UTIs in hospital?

A

E. coli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the 2nd commonest cause of UTI in GP? (after E. coli)

A

Staphylococcus saprophyticus (CNS) - 10-15% of UTI in GP but 0% in hospital

27
Q

What is the 2nd commonest cause of UTI in hospital? (after E. coli)

A

Enterococcus spp. - 10-20% of UTIs in hospital, 1-5% of UTIs in GP

28
Q

What are the potential organisms causing UTI?

A
  • E. coli
  • staphylococcus saprophyticus (CNS)
  • proteus mirabilis
  • enterococcus spp.
  • klebsiella spp.
  • other coliforms
  • pseudomonas aeruginosa
29
Q

What are the causes of sterile pyuria?

A
  • inhibition of bacterial growth
  • “fastidious” (hard to grow) organisms
  • urinary tract inflammation
30
Q

Inhibition of bacterial growth may cause sterile pyuria. Give examples

A
  • unprescribed antibiotics

- specimen contaminated with antiseptic

31
Q

“Fastidious” (hard to grow) organisms may be a cause of sterile pyuria. Give examples

A
  • mycobacterium tuberculosis
  • haemophilus spp.
  • neisseria gonorrhoeae
  • anaerobes
32
Q

Urinary tract inflammation may be a cause of sterile pyuria. Give examples

A
  • renal or bladder stones

- other renal disease

33
Q

How is catheter-related UTI caused?

A

Long-term indwelling catheterisation resulting in bacteriuria - biofilm colonisation

34
Q

What do you need to distinguish between in catheter-related UTI?

A

Distinguish between colonisation and infection (clinical features)

35
Q

How may bacteraemia be caused in catheter-related UTI?

A

By manipulation or catheter removal

36
Q

When may antibiotic prophylaxis be used in catheter-related UTI?

A
  • history of symptomatic urinary catheter-associated infection with previous catheter changes
  • purulent urtheral/suprapubic catheter exit site discharge
  • catheter or meatal/suprapubic catheter exit site colonisation with staphylococcus aureus (inc. MRSA)
37
Q

What types of investigations are involved in urinary tract infection?

A
  • dipstick testing (analysis)
  • blood tests
  • microbiological
  • imaging
38
Q

What does dipstick testing look for?

A
  • blood
  • protein
  • nitrite
  • white blood cells (leucocyte esterase)
39
Q

Dipstick testing is of no diagnostic value in who?

A

Patients with indwelling urinary catheters unless these have been placed very recently

40
Q

What samples are needed to test in microbiological investigations for UTI?

A
  • urine

- blood

41
Q

What are the different types of urine sample?

A
  • mid-stream (MSU)
  • catheter urine (CSU)
  • “clean catch”
  • supra-pubic aspirate (SPA)
42
Q

What is supra pubic aspiration (SPA)?

A

Involves putting a needle into the bladder just above the pubic bone. It may be used as a method to collect urine in child who is not toilet trained in an effort to diagnose a urinary tract infection

43
Q

Why would you test the blood in suspected UTI?

A

In suspected pyelonephritis

44
Q

What kind of microbiological tests would you do in UTI?

A
  • microscopy
  • culture
  • sensitivity testing
45
Q

What is used in red cap containers to preserve urine in transportation to the lab?

A

Boric acid

46
Q

What are the stages in mid-stream urine testing?

A
  1. sample procurement (careful instructions)
  2. transport to lab (preservative)
  3. sample processing (semi-quantitative culture)
  4. interpretation of report
47
Q

What does EMU stand for?

A

Early morning urine

48
Q

Give an example of a special urine test and why you would use it

A

Early morning urine x3

  • whole contents of bladder
  • suspected urinary tuberculosis
49
Q

What might indicate further investigation into UTI?

A
  • recurrent UTI
  • any UTI in male patients
  • any UTI in childhood
  • pyelonephritis
50
Q

What further investigations might be necessary in UTI?

A
  • renal tract ultrasound scan
  • specialised tests:
  • isotope scans (DMSA, DTPA,MAG3)
  • micturating cystorethrogram
51
Q

What are the requirements for antibiotics for UTI?

A
  • present in urine
  • minimally toxic
  • effective against likely organisms
  • easily administered
  • cheap
52
Q

Give 4 examples of antibiotics used in UTI

A
  • nitrofurantoin
  • pivmecillinam
  • trimethoprim
  • fosfomycin
53
Q

What is treatment for cystitis in females?

A
  • treatment pre-empts microbiology results

- short course of antibiotics (3 days)

54
Q

What is the treatment for cystitis in males or in females with recurrence of symptoms?

A
  • longer course of antibiotics (7 days)
55
Q

What is the empiric treatment for pyelonephritis?

A
  • cefuroxime, ciprofloxacin

- piperacillin-tazobactam (if >65 years old)

56
Q

What is targeted therapy for pyelonephritis based on?

A

Sensitivity results

57
Q

What is the duration of treatment for pyelonephritis?

A

7-14 days depending on antibiotic used

58
Q

What specific groups would you treat for asymptomatic bacteriuria?

A
  • pregnant
  • infant
  • prior to urological procedures
59
Q

Why would you treat pregnant women for asymptomatic bacteriuria?

A
  • association with upper UTI
  • pre-term delivery
  • low birth weight babies
60
Q

Why would you treat infants for asymptomatic bacteriuria?

A

Prevention of pyelonephritis and renal damage

61
Q

Why would you treat asymptomatic bacteriuria prior to urological procedures?

A

Prevention of UTI/bacteraemia

62
Q

Who does not require antibiotics for asymptomatic bacteriuria?

A

Elderly, catheterised etc.

63
Q

What kind of things are included in a microscopy report?

A
  • sex
  • DoB
  • clinical details (symptoms and signs)
  • microscopy results
  • culture results
  • comment
  • type and date of urine sample

7. CP - Kidney and Urinary Tract Disease (5 decks)

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