Pathology of UTIs

Question 1

What are the 3 most common presenting symptoms of a UTI?

Answer 1

Pain (dysuria)
Increased frequency (polyuria)
Smell of urine

Question 2

How much of the CO do the kidneys receive?§

Answer 2

20-25%

Question 3

Do the ureters store urine?

Answer 3

NO

Question 4

When there is an increase pressure in the bladder what happens to the vesicoureteric openings? Why?

Answer 4

Close

To prevent reflux of urine

Question 5

What is the composition of normal urine?

Answer 5

Low pH
High osmolarity
High ammonia

Question 6

Is normal urine sterile or non-sterile?

Answer 6

Sterile (bacterostatic)

Question 7

All of the urinary tract is sterile apart from which area?

Answer 7

Urethra

Question 8

What type of bacterial flora are present at the urethra?

Answer 8

Skin (perineal)

Gut (rectal)

Question 9

When collecting a urine specimen, what type do you want? Why?

Answer 9

Mid-stream specimen of urine (MSSU)

Initial voiding with flush out terminal urethral bacteria

Question 10

In a MSSU will bacteria be present?

Answer 10

Yes, urethral flora will be detected but to lesser extent

Question 11

What do you use MSSU for?

Answer 11

Microbiology culture

Question 12

In a MSSU culture if there is 10^5 bacteria /ml what would this suggest?

Answer 12

Infection (even if asymptomatic)

Question 13

In a MSSU culture if there is 10^3/4 bacteria /ml what would this suggest?

Answer 13

Infection sometimes (if there are symptoms - treat)

Question 14

In a MSSU culture if there is < 10^3 bacteria /ml what would this suggest?

Answer 14

No infection

Question 15

In what cases can it be difficult to collect MSSU?

Answer 15

Young & elderly

Question 16

What micr-organisms are responsible for caring UTIs?

Answer 16

E.coli (gut)

Question 17

Which direction do bacteria move through urinary tract?

Answer 17

Ascend

Question 18

Inflammation of the urethra is called?

Answer 18

Urethritis

Question 19

Inflammation of the bladder is called?

Answer 19

Cystitis

Question 20

Inflammation of the ureters?

Answer 20

Ureteritis

Question 21

Inflammation of the kidneys is called?

Answer 21

Acute pyelonephritis

Question 22

In recurrent/ prolonged infection, what can occur at kidney?

Answer 22

Chronic pyelonephritis

Question 23

What are the 3 general predisposing factors to UTI?

Answer 23

Stasis of urine
Pushing bacteria back up urethra
General predisposition ot infection

Question 24

What are some of the causes of stasis of urine?

Answer 24

Obstruction (acquired or congenital)

Loss of feeling of bladder - spinal cord injury

Question 25

What are some of the causes of pushing bacteria back up urethra?

Answer 25

Sexual activity in females | Catheterisation

Question 26

What are some cause which predispose people to infection?

Answer 26

Diabetes Chemotherapy Immunosuppression

Question 27

If the urethra becomes obstructed, what occurs initially in the urinary tract?

Answer 27

Upper urethral & bladder dilation

Question 28

If the urethra becomes obstructed, what can it lead to in the upper urinary tract?

Answer 28

Bilateral hydronephrosis

Question 29

If one of the ureters becomes blocked, what will be observed?

Answer 29

Unilateral hydroureter leading unilateral hydronephrosis

Question 30

What are the triad of consequences which occur in obstruction?

Answer 30

Dilation Bacteria accumulation Calculous formation

Question 31

What renal tract abnormality is often seen in children leading to obstruction?

Answer 31

Vesicoureteric reflux

Question 32

Why does vesicoureteic reflex occur?

Answer 32

Reduced angulation of ureters results in retrograde flux of urine from bladder

Question 33

What can vesicoureteric reflux result in?

Answer 33

Hydroureter

Question 34

What is a common cause of urethral obstruction in males?

Answer 34

Benign prostatic hypertrophy

Question 35

What is a common cause of urethral obstruction in females?

Answer 35

Uterine prolapse

Question 36

What is a common cause of urethral obstruction in both sexes?

Answer 36

Calculi & tumours

Question 37

In those with spinal cord injuries, why can stasis of urine occur?

Answer 37

No sensation of micturition therefore bladder doesn't fully empty (high residual volume)

Question 38

What age range are UTIs most common in females?

Answer 38

Sexually active (20s)

Question 39

What can predispose a woman to UTIs?

Answer 39

``` Short urethra Close relation of urethral orifice to rectum Sexual activity Pregnancy Lack of prostatic secretions ```

Question 40

What are the properties of prostatic secretions?

Answer 40

Bacteriostatic

Question 41

Why is it important to clean urethral orifice before inserting catheter?

Answer 41

Can push terminal urethral flora back up urinary tract

Question 42

Why are those with diabetes predisposed to UTIs?

Answer 42

Glucose in urine | Poor function of WBC

Question 43

What is an acute complication of a UTI?

Answer 43

Sepsis & septic shock

Question 44

What is a chronic complication of UTI?

Answer 44

Chronic damage to kidneys (chronic pyelonephritis) > hypertension & chronic renal failure