UTI

Question 1

Acute pyelonephritis

Answer 1

can be spread by
HAEMATOGENOUS INFECTION
- primary site in the tonsils, carious teeth or from cutaneous infections, particularly boild or a carbuncle
-renal tuberculosis
ASCENDING INFECTION
- UT is the most common route, most likely when there is vesico-ureteric reflux
- urinary stasis and the stones are common

Question 2

Risk Factors

Answer 2

FEMALES
CHILDHOOD, AFTER SEX, PREGNANCY
E.COLI INFECTION
Proteus and staphylococci split urea to form ammonia, which makes the urine alkaline and promotes the formation of calculi

Question 3

Clinical features

Answer 3

FEVER, RIGORS
FLANK PAIN
COSTOVERTEBRAL TENDERNESS
-sudden onset
-severe
-occasionally feels anteriorly
INCREASE FREQUENCY OF URINATION
DYSURIA
SUPRAPUBIC PAIN
BURNING SENSATION ALONG THE URETHRA
CLOUDY OR BLOOD STAINED URINE
NAUSEA, VOMITING
HEADACHE, MALAISE
CYSTITIS SYMPTOMS

Question 4

Physical findings

Answer 4

General

• LOOKS ILL
• FLUSHED
• SWEATING
• FEVERISH
• TACHYCARDIA
• TONGUE IS DRY AND FURRED

Abdomen

• KIDNEY TENDERNESS
• RENAL ANGLE VERY TENDER
• MILD SUPRAPUBIC TENDERNESS

Question 5

Complications

Answer 5

SEPTIC SHOCK

RENAL FAILURE

Question 6

Investigations

Answer 6

FBC
-pyuria (leucocytosis)
URINALYSIS
IMAGING
-TRO pyonephrosis, perirenal abscess, obstruction of collecting system by stones

Question 7

UTI in childhood/ VESICO-URETERIC REFLUX

Answer 7

Causes:

• VUR
• DETRUSPR-SPHINCTER DYSSYNERGIA
• POOR BLADDER EMPTYING HABITS
• STONES
• CONSTIPATION

Question 8

VUR GRADING

Answer 8

Grade I: reflux into the ureter.
●● Grade II: reflux into the ureter and renal pelvis.
●● Grade III: reflux is associated with mild/moderate dilatation
on an IVU.
●● Grade IV: additional blunting of fornices.
●● Grade V: absent papillary impressions

Question 9

VUR DIAGNOSIS

Answer 9

SCARRING dt renal parenchymal inflammation DETECTED BY IVU
DMSA SCAN (dimercaptusuccinic acid) - to assess the degree of renal scarring

Question 10

MANAGEMENT OF VUR

Answer 10

Surgery (ureteric
re-implantation, periureteric injections of Teflon or
collagen) should be considered if episodes of acute PN recur
despite antibiotic therapy or if severe reflux is accompanied
by a surgically correctable malformation.

Question 11

How to prepare KUB Xray

Answer 11

Bowel prep

Give contrast