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Urogenital Y2 > L8 - Urinary Infections > Flashcards

L8 - Urinary Infections Flashcards

1
Q

Acute Urinary Retention

A

Complete, painful inability to empty bladder.

Where bladder is catheterised <800mls drained

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2
Q

Chronic Urinary Retention

A

Patient can void but not completely consistently.

> 500ml drained

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3
Q

Diuresis

A

Increased / excessive production of urine, of loading of retained salt and water which have been retained for a week

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4
Q

Osmotic diruesis may be caused by a

A

Increased urea level.

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5
Q

What may cause the excessive retention of salt and water?

A
  1. Dissipation of corticomedulary concentration gradient
  2. caused by reduced urinary flow through LoH
  3. with maintenance of BF through chronically obstructed kidney.
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6
Q

What caused ureteric colic?

A
  • Passage of a stone

- Occasionally by a clot

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7
Q

What may cause the classic loin pain associated with ureteric colic?

A

Local inflammation + stretching of collecting systems.

Ureter contracting to try and eject the stone.

Causes loin pain

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8
Q

What is septic shock?

A

Combination of septicaemia with hypotension.

Organ damaged in response to infection - potentially fatal.

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9
Q

Anuria

A

Passing no urine at all

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10
Q

Patient presenting with a history of recurrent haematuria preceding their anuria by some months may have…

A

Bladder cancer.

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11
Q

Describe Transurethral Resection Prostate

A

Transurethral resection of prostate.

  • performed by visualising prostate through urethra and removing tissue via dissection.
  • considered most effective treatment for benign prostatic hyperplasia
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12
Q

What may be given if a patient has a uteric stone?

A

Analgesia - nsaids e.e.g diclofenac can provide very effective relief of pain.

However… persistent pain can indicate obstruction

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13
Q

How may obstruction be managed?

A

May be relieved by insertion of a precutaneous nephrostomy into the kidney.

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14
Q

What may be the treatment for obstructed infected kidney?

A

Resusciation with IV fluid, analgesia, IV broadspectrum antibiotics

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15
Q

Give an example of an IV broad spectrum antibiotic?

A

Gentamicin, combined with ampicillin.

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16
Q

Describe some characteristics of septic shock?

A 
Tachycardia 
Tachypnoea 
Hyperthermia 
Inadequate tissue perfusion (hypoxia) 
Oliguria 
Elevated plasma lactic acid level
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17
Q

Tachypnoea

A

Abnormally rapid breathing

> 20 resps.

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18
Q

Oliguria

A

Small urine output

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19
Q

Criteria for hypotension

A

Systolic BP <90mmHg

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20
Q

Which class of bacteria traditionally cause septic shock?

A

Gram negative.

May be due to gram positive bacteria or fungi.

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21
Q

State common gram negative bacteria?

A 
E.Coli 
Klebsiella 
Enterobacter Serratia 
Proteus 
Psuedomonas
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22
Q

Describe the pathophysiology of septic shock?

A

Gram negative lipopolysaccharide (Endotoxin)

Activates humoral pathway.

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23
Q

What does the humoral pathway consist of?

A 
Compliment 
Bradykinin 
Coagulation 
Macrophages 
MEDIATE INFLAMMATION
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24
Q

Patients with anuria and bilateral hydronephrosis on USS usually have?

A
  • Usually have bilateral uteric obstruction

Could be due to BOO, locally invasive prostate cancer or bladder tumor

25
Q

Describe torsion of testes

A
  • Fetal development.
  • Testes enveloped by visceral layer of peritoneum in its descent into scrotum.
  • Known as bell-clapper testis
  • Can easily rotate on its pedicle and so occlude blood supply.
26
Q

Two categories of renal trauma

A

Blunt or Penetrating

27
Q

Why are children’s kidneys more vulnerable?

A
  1. Proportionatly larger kidneys relative to body size.
  2. Less surrounding perineal fat
  3. Less protective muscle bulk
28
Q

In terms of pain what questions should we be asking?

A 
Site
Severity 
Duration 
Constancy 
Radiation 
Aggravating factors 
Relieving factors
29
Q

Pain in kidneys typically found…

A

Loin

30
Q

Pain in ureter commonly found…

A

Loin, iliac fossa, groin or scrotum

31
Q

Pain in bladder commonly found…

A

Suprapubically

32
Q

Give an example of an Upper UTI?

A

Pyelonephritis
- Severe infectious inflammatory disease of renal parenchyma, calices and pelvis.

Can be acute, recurrent or chronic

33
Q

Give an example lower UTI?

A

Cystitis

- inflammation of bladder.

34
Q

Describe an uncomplicated UTI?

A

Urinary tract infection occurring due to appropriate susceptible bacteria, usually in non pregnant immune competent females.

35
Q

Describe a complicated UTI?

A

Underlying condition that increases the risk of failing therapy.

36
Q

Describe how a patient may come to get a complicated UTI?

A
  1. Hospital acquired infection
  2. Urinary tract obstruction
  3. Long term urinary catheter
  4. Stent, nephrostomy
37
Q

What are the certain risk factors for complicated UTIs?

A 
Gender: being male 
Diabetic 
Pregnant 
Prolonged symptoms before treatment. 
Renal failure. 
Renal transplantation. 
Immunosupression. 
History of UTIs in childhood.
38
Q

Asymptomatic bacteriuria

A

Presence of bacteria in urine, without urinary symptoms.
Increased incidence with age >20% over 80 y/o
No benefit treating unless patient is pregnant or before a urological procedure.

39
Q

Sterile pyuria

A

Presence of leucocytes in urine in the absence of bacteria.

40
Q

Causes of sterile pyuria

A 
Prior antibiotics 
Contamination with vaginal leucocytes / sterilising solution 
Stones 
Tumour 
TB, chlamydia 
Interstitial nephritis
41
Q

What microbes are associated with uncomplicated UTI?

A 
E-Coli 
Staphylococcus 
Saprophyticus (5-15%) 
Proteus 
Klebsiella Pneumoniae 
Enterococci
42
Q

What microbes are associated with complicated UTI?

A 
Serratia 
Providencia 
Morganella 
Citrobacter 
Enterobacter
Psuedomonas 
Fungi e.g. candida
43
Q

What are some clinical manifestations of acute uncomplicated cystitis?

A 
Dysuria 
Urinary frequency 
Urgency 
Suprapubic pain 
Haematuria 
(esp in absence of vaginal symptoms)
44
Q

What are some clinical manifestations of acute uncomplicated pyelonephritis?

A 
Fever 
Chills / rigors 
Flank pain 
Costovertebral angle tenderness 
Nausea and vomiting
45
Q

Where would you find the costovertebral angle?

A

Acute angle formed on either side of the human back between the 12th rib and vertebral column.

46
Q

What organisms may cause urethritis?

A 
Chlamydia 
Gonorrhoea 
Trichomonas 
Candida 
Herpes simplex virus 
Non-infectious irritants
47
Q

Describe a sign of urethritis?

A

Sterile Pyuria

48
Q

Describe a sign of vaginitis?

A

Discharge, itch, dyspareunia

Absence of urinary frequency.

49
Q

Give examples of structural urethral abnormalities?

A

Stricture - narrowing of urethra, results in difficulty for urine to pass through.
Diverticulum - small bulges/ pockets that can develop in lining of intestine as you get older.

50
Q

What may nitrates in urine indicate?

A

Urinary nitrates - Nitrites (Enterobacteriaceae)

51
Q

How might the presence of WBCs in urine be confirmed?

A
  • Urine test detects leukocyte esterase.
  • This indicates presence of WBCs in urine.
  • Absence of pyruria strongly suggest alternative diagnosis.
52
Q

White blood cell casts in urine sample may indicate …

A

Upper renal tract infection

53
Q

State two antibiotics commonly used for treating UTI?

A

Nitrofurantoin

Trimethoprim

54
Q

Nitrofurantoin

A

Only for uncomplicated lower UTIs

- doesn’t penetrate renal tissue or reach therapeutic concentrations in blood

55
Q

Trimethoprim

A

Uncomplicated UTI, widely distributed in tissues.

56
Q

Why are Beta-Lactams used?

A

Generally good excretion in urine.
Safety in pregnancy.
Favourable safety profile.

57
Q

State examples of commonly used beta-lactams?

A

Cefalexin: C difficile
Amoxicillin
Augmentin
Pivmecillinam

58
Q

What is the disadvantage of amoxicillin?

A

> 70% of enterobacteriaeceae are resistant.

59
Q

Whats a very valuable antibiotic

A

Ciprofloxacin

Urogenital Y2 (16 decks)

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