Urinary Tract Infections Flashcards Preview

Systems - Urinary > Urinary Tract Infections > Flashcards

Flashcards in Urinary Tract Infections Deck (34):
1

What is the presentation of UTI?

Dysuria (pain on micturition)

Frequency

Smelly urine

Very young - failure to thrive

Very old - incontinnce, off their feet

 

2

What percentage of cardiac output is renal blood flow?

20 - 25%

3

How does urine change with oral intake of fluids?

Resorption of fluid is diminished if increase fluid intake therefore increased urine output

4

How do ureters function?

They have continuous trickle of urine - they do not store urine

5

How do the ureters interact with the bladder wall?

Ureters enter the bladder at an angle

 

Increasing pressure from the bladder as it fills closes off the ureter and stops the reflux of urine

6

What is the content of normal urine?

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

7

What is a useful property of prostatic secretions?

They are bacteriostatic

8

What portions of the normal renal tract are sterile?

All except the terminal urethra

 

Suprapubic aspirate of urine is sterile

9

What part of the stream do we use for urine specimen?

Mid stream

Initial voiding will flush out many terminal urethral floral bacteria

Mid stream specimen - urethral flora is diminished but always present - will always grow on culture - never a negative result

10

•MSSU – how to tell contamination from real infection?

Send to microbiology for culture under set conditions - bacterial multiply in log phase growth

 

10is usually an infection - unless contamination (chances of which are less than 1 in 100)

Contamination more likely if they are asymptomatic

11

What values are associated with infection 'sometimes'?

10or 104

Probably an infection if there is symptoms

 

50% chance if there is no symptoms

12

When is there usually no infection?

When the culture shows less than 103

13

What is a problem associated with MSSU culture interpretation?

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

14

What are the micro-organisms that cause UTI?

•Bacteria mostly = gut flora, especially E.coli

•Viral infection rare

15

What is the route of infection in UTI?

Almost always ascending 

If kidneys are infected this is usually because infection in the kidneys has usually spread up from the bladder infection

Upper UTI's are more serious

16

What is the neame given to inflammation of the urethra, bladder ureter and the kidney?

  • Urethra – urethritis
  • Bladder – cystitis
  • Ureter – ureteritis
  • Kidney – acute pyelonephritis / chronic pyelonephritis

17

What are the predisposing factors to UTI?

Stasis of urine

Pushing bacteria up the urethra from below

Generalised predisposition

18

What are the causes of stasis of urine?

Obstruction

Loss of feeling of a full bladder - spinal cord / brain injury

19

What are the causes of pushing bacteria up from the urethra below?

Sexual activity

Catheterisation (and other urological procedures)

20

What is a generalised predisposition to infection?

Diabetes

21

Why does stasis of urine cause UTI?

•Bacteria that do get higher up do not get flushed out

22

What happens when there is obstruction at the level of the urethra?

Upper urethral and bladder dilation

Bilateral hydroureter

Bilateral hydronephrosis - chronic renal failure

23

What happens when there is obstruction of the renal pelvis on one side only?

Causes unilateral hydroureter and unilateral hydronephrosis

24

What are consequences of obstruction?

Proximal dilateion

Slowed urine flow - cannot flush out bacterial - infection

Slowed urine flow - sediments form - calculous (stone) formation - obstruction

 

Calculous - more dilation, increased calculous formation, more infections

25

What is a common cause of obstruction in children?

Vesicoureteric reflux -  decreased angulation at angle into the bladder 

26

What are common causes of obstruction in adults?

•Men – Benign Prostatic Hyperplasia (not a tumour) of prostate – functional and anatomical obstruction

Women - uterine prolapse

Both sexes - tumours and calculi

27

How does spinal cord/brain injury predispose to UTI?

•Decreased sensation therefore no sense of when to micturate and do not know to empty bladder completely - leave urine in bladder (high residual volume) - stasis of urine

28

How does sexual activity in females predispose to UTI?

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

29

What are the predisposing factors that increase chances of getting a UTI in female sexual activity?

•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

30

What is the effect of catheterisation on the urethral flora?

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

31

What parts of diabetes cause you to be more predisposed to infection?

Glucose in urine

Poor function of WBC

32

Summary of when people get UTI's

33

What is an acute complication of UTI?

Severe sepsis and septic shock

34

What are chronic complications of UTI?

•Chronic damage to kidneys if repeated infections (chronic pyelonephritis) therefore hypertension, chronic renal failure

 

•Calculi - obstruction- Hydronephrosis - hypertension, chronic renal failure