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Mariam Renal System > Urinary Tract Infections > Flashcards

Urinary Tract Infections Flashcards

1
Q

Define Pyuria

A

Pus cells present in the urine Sterile pyuria = pus cells but -ve on urine cultures

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2
Q

What can cause chronic pyelonephritis?

A

Recurrent UTI

Vesio-ureteric reflux (obstruction)

Diabetes

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3
Q

Define uncomplicated UTI

A

Young Sexual active women

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4
Q

Define complicated UTI

A

kids

men

abnormal tracts

immunosuppression

tumours

chronic retention

Bladder outlet obstruction

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5
Q

Management of men with UTI

A

14 days ciprofloxacin

7 days nitrofurantoin (if uncomplicated)

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6
Q

Management of women with UTI

A

3 days trimethoprim

nitrofurantoin if preganant

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7
Q

Common cause of UTI in men

A

STI (Younger men)

Prosthetitis (Older men)

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8
Q

How do you approach pregnant women re UTIs?

A

Screen with an MSSU culture at first antenatal appointment. Treat even if asymptomatic

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9
Q

Presentation of Lower UTI

A

Suprapubic Pain -

Dysuria -

Frequency -

Urgency -

Polyuria -

Haematuria

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10
Q

Presentation of Acute Pyelonephritis

A

Loin Pain

Fever - ~systemic unwellness -

Severe cases have bacteraemia (rigors, N&V etc)

Signs of dehydration

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11
Q

Management of Acute Pyelonephritis

A

7 days ciprofloxacin

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12
Q

Invesigation for suspected UTI in kids

A

Urine dipstick/MSSU

Screen for congenital vesicoureteric reflux

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13
Q

UTI presentation in kids

A

Often unspecific

Not eating

Crying

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14
Q

What extra investigation would you do for a patient with a proteus or Klebsiella UTI?

A

Non-contrast CT for stones. They’re produce a lot of stones

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15
Q

What are the important parts of the dipstick test for a UTI?

A

Nitrites (produced by bacteria)

Protein (inflammation or renal pathology)

Leucocytes

If all 3 are present its an indication for empirical Abx Also blood

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16
Q

What are the indications for a MSSU?

A

1) Women in which the dipstick is inconclusive
2) Men
3) Acute pyelonephritis
4) Pregnant (screening & Symptomatic)
5) Failed Abx or persistant symptoms
6) Recurrent UTIs
7) Children

17
Q

How do you take a urine sample from a child?

A

Most kids can’t give a decent MSSU. So a clean catch urine sample is preferable. IF that fails: - Urine collection Pad - Catheter Sample - Suprapubic Aspiration

18
Q

How do we tell if its contamination or infection on a urine culture?

A

10^4 organisms/ml indicates infection > contamination

(10^5 in asymptomatic bacteriuria)

Mixed organisms usually means contamination

19
Q

Aetiology of UTI

A
  1. Urine stasis:
  • Obstructuon (congenital/aquired)
  • CNS problems = lack of voiding
  1. Bacteria entering urethra from anus
  • Sexual activity
  • Catheter
  1. General predispition
  • Sexual active women
  • Post menoposal women (due to low oestrogen)
  • Diabetic (bacteria feed of GLC in urine)
  • Pregnancy due to compression of urethra & progestrone dilating ureters
20
Q

Investigations for UTI

A

MSSU:

  • 10^5 colony= typically infection
  • 10^3-10^4 = 50% infection- especially if they are symptomatic
  • <10^3 usually no infection

Children & Elderly may have issues with complying to an MSSU

US

CT-KUB

WBC

Cystoscopy

Post-void bladder scan - Urinary Flow study

21
Q

Common causative organisms of UTI

A
  • E. Coli - most common
  • Proteus Spp.
  • Klebsiella Spp.
  • Pseudomonas Aeruginosa
  • Enterococci
22
Q

What are the complications of a UTI?

A
  • Sepsis and septic shock
  • Chronic pyelonephritis
  • Calculi –> Obstruction –> Hydronephrosis –> Hypertension & chronic renal failure
23
Q

Whats the main cause of obstruction in children?

A

Vesicouretic reflux Its a loss of the angle of entry of ureter to bladder

24
Q

What are the main causes of obstruction in adults?

A
  • Benign Prostatic Hyperplasia (men) - Uterine Prolapse (Women) - Tumours & Calculi (both)
25
Q

Why are women more at risk of UTIs?

A
  • Short urethra
  • No prostatic bacteriostatic secretion
  • Close urethral orifice to rectum
  • Sexual activity (vagina just behind urethra so pushes bacteria up)
  • Pregnancy pressures the ureter & bladder
26
Q

What other tests would we do in kids with UTIs?

A

A micturating Cystogram to check for vesico-ureteric reflux

27
Q

How would we advise women with recurrent UTIs?

A

Drink plenty of fluids Urinate frequently, particularly bbed and before/after sex.

28
Q

How do we handle UTIs due to indwelling catheters.

A

Only treat if the patients symptomatic.

29
Q

What radiological signs (CT) may indicate pyelonephritis?

A
  • Scarring
  • Clubbing of Calyces
  • Abscess
  • Emphysematous (gaseous) pyelonephritis.

Lots of gas pockets within the kidney due to gas-forming bacteria.

Mariam Renal System (23 decks)

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