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ZA - Renal System > Pathology of UTIs > Flashcards

Pathology of UTIs Flashcards

1
Q

UTI presentation?

A

Dysuria
Frequency
Urine will smell

In elderly - incontinence, delirium

In very young - unwell, failure to thrive

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2
Q

How much of CO is renal blood flow?

A

20-25%

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3
Q

Do ureters store urine?

A

No - they have a continuous trickle of urine

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4
Q

Ureters enter the bladder at a BLANK this is significant because?

A

Angle

Significant as when bladder fills, the pressure inside closes off the ureter and stops reflux of urine

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5
Q

Normal urine pH, osmolality and ammonia contents ?

A

Low pH
High osmolality
High ammonia

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6
Q

Prostatic secretions are…which means…

A

Bacteriostatic - biological or chemical agent that stops bacteria from reproducing

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7
Q

Does urine contain anti-bacterial antibodies?

A

Yeah

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8
Q

Is the urinary tract ALL sterile?

A

No - most is except the terminal urethra

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9
Q

What significance does the terminal urethra not being sterile have on urine sample collection?

A

Sample must be collected mid-flow as the initial flow will be contaminated with the terminal urethra’s bacteria

The initial flow diminishes the urethras bacteria, doesn’t eliminate it

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10
Q

What is a MSSU?

A

mid stream specimen of urine

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11
Q

How do we tell if a MSSU is contaminated or if there is a real infection?

A

Sent to microbiology for culture under set conditions

Bacteria multiply in a log phase growth

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12
Q

What is a faster way to read a MSSU and to determine if it is contamination or infection?

A

A dip slide method - incubated for 24 hours at 37 degrees

A culture reading of 10^5 usually indicates infection

10^3 or ^4 suggests an infection probable if symptoms but if NO symptoms a 50% chance it isn’t an infection

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13
Q

If the culture shows less than 10^3?

A

Won’t be an infection

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14
Q

Issues with MSSU?

A

Hard to collect in young and elderly

Some bacteria are not normally preent in terminal urethra/rectal flora and may be pathogenic at low numbers BUT won’t be picked up on with a dip slide method

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15
Q

Microorganisms that cause UTIs?

A

Bacteria - usually gut flora - like E.coli

Viral infection rare

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16
Q

Route of infection?

A

Almost always ascending

An infection in the kidney’s would have spread from a bladder infection

17
Q

Is an upper or lower UTI more serious?

A

Upper

18
Q

Infection in urethra, bladder, ureter and kidney are called what respectively?

A

Urethra - urethritis
Bladder - cystitis
Ureter - ureteritis
Kidney - acute pyelo-nephritis BUT if prolonged - chronic pyelonephritis

19
Q

What are the predisposing factors for a UTI?

A
  1. Stasis of urine
  2. Pushing bacteria up from urethra below
  3. Generalised predisposition to infection
20
Q

What can cause stasis of urine?

A

Obstruction - congenital or acquired

Spinal cord/brain injury - losing the feeling of a full bladder

21
Q

Why does stasis of urine cause a UTI?

A

Bacteria that get higher up in the tract are not flushed out

22
Q

What does obstruction at the level of the ureter cause?

A

Upper urethral and bladder dilatation eventually leading to bilateral hydroureter

23
Q

What can bilateral hydroureter lead to?

A

Bilateral hydronephrosis (swelling of kidney) leading to chronic renal failure

24
Q

What happens if obstruction is at level of renal pelvis?

A

Unilateral hydroureter (lower ureter will be fine) and unilateral hydronephrosis

25
Q

Consequences of obstruction?

A

Proximal dilatation

Low urine flow means bacteria isn’t flushed out = infection

Low urine flow also means sediments form leading to calculous formation and further obstruction = further infections

26
Q

What should be done if a child presents with obstruction?

A

Always investigate asap and send to paediatric surgeons

27
Q

Most important obstruction cause in kids?

A

Vesicoureteric reflux - when angle of ureters into bladder is decreased and = a hydroureter

28
Q

Common causes of obstruction in men?

A

Benign prostatic hyperplasia (not a tumour)

Is a functional and anatomical obstruction

29
Q

Common causes of obstruction in women?

A

Uterine prolapse

30
Q

Common causes of obstruction not specific to 1 sex?

A

Tumours and calculi

31
Q

Why does a spinal injury that reduced sensation of when bladder is full cause stasis of urine

A

No sense of when to micturate and do not know how to empty bladder fully and leave urine in bladder = stasis of urine

32
Q

What can cause bacteria to be pushed up the urinary tract?

A

Sexual activity in women

Catheterisation

33
Q

Who would have a generalised predisposition to infection?

A

Diabetics due to glucose in urine and poor function of WBCs

34
Q

Acute complications of UTIs?

A

Sepsis and septic shock

35
Q

Chronic complications of UTIs?

A

Chronic damage to kidneys if repeated infections

Calculi = obstruction = hydronephrosis

All this leads to hypertension and chronic renal failure

ZA - Renal System (27 decks)

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