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Flashcards in Urinary: UTIs Deck (17)
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1
Q

What is the prevalence of UTIs by age?

A

Spike in infancy: early presentation often indicates abnormality of the urinary tract

Spike in late teens - 30’s: called honeymoon cystitis and related to sexual activity

Increase in old age: cause in men is mostly obstruction via an enlarged prostate

2
Q

What are the defence mechanisms of the urinary tract against UTIs and how can they go wrong?

A
Long urethra (more UTIs in females)
The ability to pass urine to clear bacteria - goes wrong when there is:
- obstruction eg prostate, pregnancy, stones
- neurological problems which mean there is incomplete emptying and residual urine

The ureteric reflex which prevents back flow of urine back up the ureters - this can be faulty, presents especially in children

3
Q

What are some bacterial factors that make them more likely to colonise host:

A
  • Haemolysins which damage host membranes
  • Fimbriae allow attachment to host epithelium
  • Urease which breaks down urea and creates a favourable environment for growth
  • Polysaccharide capsule which resists host defence
4
Q

What are the most common bacteria that cause UTIs?

A

Coliforms such as E. Coli

They are aerobic gram negative rods which are part of the normal bowel flora

5
Q

What is cystitis and what are the symptoms?

A

A lower UTI

Symptoms are frequency, urgency, dysuria and sometimes a low grade fever

6
Q

What is pyelonephritis?

What are the symptoms?

A

An upper UTI - Can be acute or chronic

Symptoms are febrile, loin pain which is usually unilateral, dysuria and frequency

7
Q

What is the difference between an uncomplicated and complicated UTI?

A

Uncomplicated UTI: Infection by a usual organism in a pt with a normal urinary tract and normal urinary function.
(but in reality is women on child bearing age that isnt pregnant)

Complicated UTI: factors present that predispose a pt to persistent, recurrent and hard to treat infection.
(but in reality males, children, elderly and PREGNANT)

8
Q

How are UTIs diagnosed?

A

In uncomplicated UTIs the diagnosis is made purely on presentation and near pt testing eg turbidity and dipstick testing

In complicated UTIs the urine is cultured

9
Q

How do you assess the turbidity of urine?

A

Look at the urine, if it is cloudy then there is white cells and most likely an infection

10
Q

What does dipstick testing measure?

A

Leukocyte esterase: a marker of leukocytes
Nitrite: break down of nitrate by bacteria
Haematuria
Proteinuria: marker of abnormality of urinary tract rather than UTI

11
Q

What is urethral syndrome?

A

Irritation and inflammation of the urethra that presents similarly to UTIs.
It is treated the same as UTIs and the majority of pts recover

12
Q

When is imaging of the urinary tract considered?

A

Considered in all children with a UTI.
Valuable in septic pts to identify renal involevement
Females with vesico-ureteric reflux

13
Q

What are some causes of sterile pyuria? (pus in the urine but no bacteria present)

A
  • antibiotics have suppressed bacterial growth
  • urethritis
  • vaginal inflammation
  • TB (bacilli wont grown on the medium)
  • appendicitis which pushes on the bladder
14
Q

In what situations does asymptomatic bacteriuria need treatment?

A

Only requires action in pregnancy and urological surgery

15
Q

How are UTIs treated?

A

Increase fluid intake to naturally flush out bacteria
Address underlying cause eg DM, enlarged prostate

Uncomplicated: 3 day course of trimethoprim or nitrofurantoin
Complicated: 5-6 day course of trimethoprim, nitrofurantoin or cephalexin

16
Q

How is pyelonephritis treated?

A

A 14 day course of antibiotics (one with systemic activity)
eg Co-amoxiclav, ciprofloxacin

Gentamicin should only be used IV as it is nephrotoxic

17
Q

When is prophylaxis considered?

A

If there are 3 or more episodes in one year with no treatable underlying condition.

Use a singly nightly dose (risk period is at night because there is no urine flow) of trimethoprim or nitrofurantoin

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