Session 9

Question 1

Major barriers against a UTI?

Name of bladder colonisation?

Kidney colonisation

Why more venous distension in pregnancy?

Answer 1

Urine acidity, emptying of bladder, vesicle-ureteral valves.

Cystitis (lower UTI)

Pyelonephritis (upper UTI)

Uterus compresses IVC so less venous return

Question 2

Risk factors for UTI?

Answer 2

Immunosuppressive, catheters, pregnancy as hormones relax smooth muscle, MS effecting bladder emptying, kidney stones and enlarged prostate obstructing.

Question 3

Common bacteria?

Virulence?

Answer 3

E.coli

Flagella,pilli (attachment), polysaccharide capsule, Haemolysin

Question 4

Symptoms of cystitis?

Pyelonephritis?

What else could dysuria be from?

Answer 4

Dysuria, Cloudy urine, Nocturia, urgency, haematuria, suprapubic tenderness

High fever,rigors, loin-tenderness, nausea, vomiting

STI, post intercourse, menopause,contact with irritants

Question 5

Define uncomplicated UTI?

Complicated?

When will you culture urine?

Answer 5

Infection by a usual organism in a patient with a normal urinary tract with normal urinary function.

1 or more factors predisposing persistent/reoccurring infections. (Abnormal tract/poor kidney function/immunosuppressive/pregnancy)

In complicated UTI’s, (mid stream)

Question 6

What does urine dipstick test?

When used?

Answer 6

PH,nitrites,blood,protein,leukocyte esterase

<65, not in elderly as up to 50% have asymptomatic infection and if catheter it will be positive so no point.

Question 7

When might sterile pyuria be present? (Raised wbc but no bacteria growth)

When are asymptomatic bacteriurea treated?

Treatment of UTI?

Answer 7

Urethritis(clap)
Vaginal infection
TB

Only in pregnancy as risk for premature labour

Antibiotics,fluid intake,analgesics

Question 8

How does antiobiotic course for UTI change?

What about upper UTI/Pyelonephritis?

Answer 8

Uncomplicated-3 days Trimethoprim
Complicated- 5/7 Trimethoprim

7-10 days, ciprofloxacin

Question 9

What are urinary caniculi made from?

Staghorn kidney stone?

When do stones require intervention?

With kidney stones when do you get renal colic flank pain?

Answer 9

Calcium deposits

Filling numerous major and minor calices

Above 7mm

When it starts to move down the urinary tract

Question 10

How do you get large kidney stones out?

Type of kidney stone shows?

Answer 10

Ureteroscopy, percutaneous nephrolithotomy (skin puncture),shock wave lithotripsy

Supersaturation in kidney