Dysuria and UTI Flashcards
Dysuria what further questions do you ask?
Check for bladder dysfunction
frequency, urgency, cramping or pain
How will you diagnose cystitis?
Urine dipstick - WBC / leukocyte esterase
Midstream urine - microscopy, culture, susceptibility
A common demographic for cystitis?
post menopausal women, lack of oestrogen to promote growth of good flora
Male and female factors that can contribute to a UTI?
Females - Past UTI - Sexual intercourse - diaphragm use - pregnancy - diabetes - instrumentation males - lack of circumcision - AIDS - MSM
A common sense cost saving approach to diagnosis and treatment
Typical symptoms? dipstick shows pyuria? = TREAT
Further problems? = reassess and send MSU to lab
Other features in older people that cause UTIs
Females: - Post menopause - UT abnormalities - neurological disease - incomplete bladder emptying Male - strictures - stones - prostatic disease - neurological disease
The bacteria that cause cystitis
E. coli = 80%
Staphylococcus saprophyticus - quite common in young women
other enterobacteriaceae
e.g. candid albicans
Features of uropathogenic E.coli that help it evade out immune system
Sequesters iron to help it evade our immune system
Fimbriae to anchor bladder to wall
Alpha haemolysin damages epithelial cells
Commonly used antibiotics to treat said infections
trimethoprim - antidote drug, bacteria do folate synthesis to produce nucleotides, BUT avoid in pregnancy, and in patients recovering form chemo treatment for leukaemia
ALLERGY: rash, can be severe, sevens-Johnson syndrome
co-trimoxazole
Human defences against uropathogenic E.coli
Microbial flora
Urine - inhospitable to bacterial growth
Urination - important to fully empty bladder
Tamm- horsfall protein - formed in loop of Henle binds to bacteria
Prostatic fluid
Innate and adaptive immunity
treatment regimes?
although most cases will resolve after a few months they’re very discomforting, so treat with antibiotics
Treatment of pyelonephritis
IV then rapid change to oral treatment when responds
gentamicin 5mg/kg
Possible reasons for recurring cystitis?
intercourse
form of contraception
abnormal urinary tract or urodynamics
