Urinary Tract Infection (UTI) Flashcards Preview

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Flashcards in Urinary Tract Infection (UTI) Deck (41):
1

What is dysuria?

Pain on micturition

2

How does a UTI present?

Dysuria
Frequency
Smelly urine

Very young: unwell, failure to thrive

Very old: incontinence, off their feet

3

Why do the ureters enter the bladder at an angle?

Enter bottom of bladder at angle so that increasing pressure from bladder as it fills -> closes off ureter and stops reflux of urine

4

What are the bacteriostatic properties of the normal urinary tract?

Free flow of urine through normal anatomy- assumes drinking enough fluids

Low pH, high osmolarity, and high ammonia (NH3) content of normal urine

Prostatic secretions are bacteriostatic

Anti-bacterial antibodies

5

How much of the urinary tract is normally sterile?

All urinary tract except for terminal urethra

6

How can you bypass the terminal urethra to take a clean sample of urine?

Suprapubic aspirate of urine
-Needle straight into bladder

7

Why do we take a midstream sample (or suprapubic aspirate) for urine MC&S?

Urinated sample will always be contaminated by terminal urethral flora

Initial void will wash terminal urethra -> sample taken after will be more sterile avoiding false positives

8

Explain how you carry out a mid stream sample

Patient voids and stops mid-stream, discarding urine, then collects next volume of urine = MSSU (midstream specimen of urine

9

Can you ever get rid of all terminal urethral flora by a MSSU?

No

Urethral flora will be diminished by always present

Will always grow in culture so never a negative result

10

What does MSSU stand for?

Mid Stream Specimen Urine

11

How do you tell contamination from real infection in MSSU?

Microbiology for culture under set conditions

Bacteria multiply in log phase growth

10^5 per ml

12

A MSSU culture result of 10^3 would indicate what?

10^3 and 10^4 need to be interperated clinically:

-If symptomatic probably infection

-If asymptomatic 50% infection

13

In which populations is an MSSU difficult to collect?

Young children and elderly

14

What are the problems with interpretation of urine culture?

Some bacterial species are not normally present in terminal urethra/rectal flora and may be pathogenic at low colony numbers

15

What micro-organisms cause UTI?

Bacteria mostly = gut flora, especially E. coli

Viral infection rare

16

What is the route of infection in UTI?

Almost always ascending from terminal urethra

Infection in kidneys has usually spread up from bladder infection

17

Which is more serious:
Upper UTI or Lower UTI?

Upper UTI more serious

18

What is urethritis?

INFECTION of urethra

Usually itis = inflammation but here almost always infection

19

What is cystitis?

Inflammation/infection of bladder

20

What is ureteritis?

Infection of the ureter

21

What is acute pyelonephritis?

Kidney infection/ inflammation

If recurrent/ prolongued infection -> chronic pyelonephritis

22

What are the predisposing factors for a UTI?

1. Stasis of urine

2. Pushing bacteria up urethra from below

3. generalised predisposition to infection

23

How can stasis of urine come about?

1. Obstruction, whether congenital (presents in childhood) or acquired (adults).

2. Loss of "feeling" of full bladder - spinal cord/ brain injury

24

How can pushing bacteria up urethra from below come about?

Sexual activity in females

Catheterisation (and other urological procedures)

25

What may cause a generalised predisposition to infection?

e.g. Diabetes

26

How does obstruction of the urethra effect the urinary tract?

Upper urethral and bladder dilatation

If this continues -> bilateral hydroureter -> bilateral hydronephrosis -> chronic renal failure

27

What does unilateral hydroureter indicate as opposed to bilateral hydroureter?

Unilateral = obstruction above bladder

Bilateral = obstruction below bladder

28

What are the consequences of obstruction?

Proximal dilatation

Slowed urine flow -> cannot flush out bacteria -> infection

Slowed urine flow -> sediments form -> calculous formation -> obstruction -> repeat cycle

29

What is the obstruction triad?

Infection -> calculi -> obstruction -> infection etc

30

What is obstruction in children usually caused by?

There are numerous renal tract abnormalities
-Usually one of these

Always investigate at first presentation and send to paediatric surgeons

31

What is the most important renal tract abnormality for obstruction in children?

Vesicoureteric reflux

32

What is vesicoureteric reflux?

Normally ureters insert into bladder at angle

Decreased angulation in vesicoureteric reflux -> ureter isnt closed off by increasing bladder pressure -> reflux -> hydroureter -> hydronephritis

33

What are common causes of obstruction in adults?

Males - Benign Prostatic Hyperplasia (NOT a tumour) -> functional and anatomical obstruction

Females - Uterine prolapse

Both sexes - Tumours and calculi

34

What is the residual bladder volume?

Volume of fluid left in bladder after urination

You want this to be as small as possible to prevent static urine

35

How does spinal cord/ brain injury predispose to UTI?

Decreased sensation -> no sense of when to micturate and do not know how to empty bladder completely -> leave urine in bladder -> high residual volume -> stasis of urine

36

How does female sexual activity tend to lead to UTI?

Move lower urethral flora up the tract (back wall of urethra is just in front of vagina)

37

Why are females more predisposed to UTI?

Short urethra

Lack of prostatic bacteriostatic secretion

Closeness of urethral orifice to rectum

Sexual activity (helps if void after intercourse)

Pregnancy - pressure on ureters and bladder

38

How does catheterisation predispose to UTI?

Any instrumentation of urinary tract tends to move lower urethral flora up the tract

39

How does diabetes predispose to UTI?

Glucose in urine

Poor function of WBC

40

What are the acute complications of UTI?

Severe sepsis and septic shock

41

What are the chronic complications of UTI?

Chronic damage to kidneys if repeated infections (chronic pyelonephritis) -> hypertension, chronic renal failure

Calculi -> obstruction -> hydronephrosis -> hypertension, chronic renal failure