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Urinary clinical conditions > UTI's > Flashcards

UTI's Flashcards

1
Q

what is the term for pus cells in the urine and what does this represent?

A

pyuria

neutrophil polymorphs in the urine - inflammatory process usually UTI

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2
Q

what is the term for inflammation / infection of the bladder?

A

cystitis

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3
Q

what are the symptoms of a UTI?

A 
dysuria 
polyruia
frequency of urination / strangury 
suprapubic tenderness
flank pain 
haematuria 
pyrexia / chills 
cloudy offensive urine 
confusion
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4
Q

what is dysuria?

A

painful or difficult urination

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5
Q

what are the guidelines wit regards to tretament/investigation women presenting with a suspected UTI?

A

women presenting with 3 or more symptoms should be started on antibiotic treatment (3 day course)
2 symptoms or fever = mid-stream urine sample

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6
Q

what 2 tests can be carried out to investigate a UTI?

A

urine dip stick

mid-stream urine samlple

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7
Q

what does can a dipstick test detect that can suggest a UTI?

A

nitrite (metabolic by product of some bacteria)
protein (sign of inflammation)
leucocyte (inflammatory marker)

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8
Q

in dipstick testing: if there is positive leucocyte but protein and nitrite are negative, does this indicate a UTI ?

A

it doesn’t exclude or diagnose UTI alone

a urine culture would be required for further investigation

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9
Q

on urine dip stick, if there is protein but negative leucocyte and nitrite, does this indicate UTI and why?

A

the protein can be due to other causes so should be further investigated with urine culture

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10
Q

what is the cause of increasing rates of men with UTI as they age?

A

secondary to obstruction caused by prostatic hypertrophy

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11
Q

what organisms may be responsible for UTI in younger men?

A

STI’s;

  • chlamydia
  • gonorrhoea
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12
Q

what may be recurrent UTI in older men the sign of?

A

prostatitis

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13
Q

at what percent does someone with a catheter have of a UTI?

A

5% per day

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14
Q

should asymptomatic bacteriuria patients be treated and why/

A

no as treatment shows no benefit
however there is exception with pregnancy, people undergoing urological surgery or surgery involving artificial prosthesis

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15
Q

what is acute pyelonephritis?

A

infection of the upper urinary tract

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16
Q

what are the presentations of acute pyelonephritis?

A

loin pain & fever (most common)
sterile pyuria
urinary symptoms i.e. frequency, dysuria
may be systemically unwell = signs of sepsis; rigors, nausea/vomiting,

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17
Q

in a patient with suspected pyelonephritis, what is the initial management?

A

urine culture
start antibiotic treatment immediately
(blood cultures if the patient is systemically unwell)

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18
Q

what is the difference in antibiotic treatment for cystitis vs acute pyelonephritis?

A 
cystitis = 3 days
pyelonephritis = 7 days
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19
Q

what is asymptomatic bacteriuria in pregnancy associated with and what is done to reduce this?

A

increased risk of pyelonephritis
premature delivery

screening pregnancy women by urine (MSU) culture

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20
Q

what are the causes of sterile pyuria?

A 
undeclared presence of antibiotics in the urine
treated UTI < 2 weeks prior
inadequately treated UTI
renal TB
chlamydia 
pyelonephritis 
bladder tumour 
appendicitis 
calculi: prostatitis 
polycystic kidneys
papillary necrosis (i.e. BM)
chemical cystitis i.e. cyclophosphamide
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21
Q

why is it extremely important to follow up and treat UTI in children?

A

there is an association between UTI in children and chronic pyelonephritis (renal damage/scarrin) in adulthood

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22
Q

what is the most common presentation of chronic pyelonephritis?

A

vague abdominal discomfort
hypertension
impaired renal function only in a minority of patients

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23
Q

what factors predispose someone to a UTI?

A

pregnancy - stasis of urine
sexual intercourse - damage to urethra, STI’s
female - short urethra & proximity to the colon
obstruction i.e. BPE - stasis of urine
foreign bodies i.e. catheterisation
pre existing renal parenchymal damage i.e. from recurrent pyelonephritis
renal cysts
congenital abnormalities i.e. vesico-ureteric reflux

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24
Q

what organisms are responsible for uncomplicated UTI in women?

A

e. coli

staph. saprophyticus

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25
Q

what investigations should be carried out if its a complicated UTI?

A 
for lower tract;
- flow studies
- residual bladder scan
- cystoscopy 
upper tract;
- USS kidneys
- CT-KUB
- IV Pyelogram /urogram
26
Q

when should urine cultures be undertaken for a UTI?

A 
women with mild symptoms or dipstick test is inconclusive 
suspected UTI in men
suspected acute pyelonephritis
pregnant women with symptoms
after failed antibiotic treatment 
persistant symptoms
recurrent UTI
children
27
Q

how is a urine sample collected from a patient who has a catheter?

A

urine collected from catheter sampling port and not the collection bag

28
Q

why are urine samples more likely to be positive in the morning ?

A

over night growth of bacteria

29
Q

what are the common species that cause UTI’s in the hospital?

A

e. coli
enterococcus faecalis
klebsiella pneumonia

30
Q

what are the common species that cause community acquired UTI?

A

e.coli
proteus mirabilis
enterococcus faecalis

31
Q

what organism that causes UTI’s promotes the formation of stones and why?

A

proteus sp. because it produces the enzyme urease which splits urea to release ammonia thus making urine alkaline encouraging stone formation
- also associated with klebsiella

32
Q

what antibiotics are given to treat UTI in women?

A

nitrofurantoin

trimethoprim

33
Q

what is the treatment for UTI in males?

A

14 day course of a quinolone e.g. ciprofloxacin

if uncomplicated = 7 day course of nitrofurantoin or trimethoprim

34
Q

what measures can be taken to reduce recurrent UTI in women?

A

urinate after sexual intercourse
single dose of antibiotic prophylactally after intercourse
maintain good hygiene
take 1 tablet of nitrofurantoin or trimethoprim for a year

35
Q

what is a common symptom of UTI’s in the elderly?

A

incontinence

36
Q

what are the causes of stasis urine which can predispose someone to a UTI?

A

obstruction:

  • tumours and calculi
  • benign prostatic hyperplasia
  • uterine prolapse
  • vesicoureteric reflux
37
Q

describe how an obstruction can lead to renal impairment.

A

obstruction = stasis of urine
stasis urine back up into the ureters = hydroureter
if this is prolonged then it can increase and lead to dilatation of the kidneys = hydronephrosis which can lead to chronic renal impairment

38
Q

what is the most common cause of UTI in women over child bearing age?

A

uterine prolapse

39
Q

what is the most common cause of UTI in children?

A

vesticoureteric reflux

40
Q

what is the most common cause of UTI in older and younger males?

A 
younger = chlamydia &amp;  gonorrhoea
older = benign prostate hyperplasia
41
Q

what is required for the diagnosis of a UTI?

A 
microbial evidence plus symptoms/signs;
Bacterial count of 104 cfu/ml from MSSU with no more than 2 species of bacteria
At least one of the following;
- fever >38
- loin/frank pain 
- suprapubic pain or tenderness
- urinary frequency
- urinary urgency 
- dysuria
42
Q

what is the treatment for acute pyelonephritis?

A

7 day ciprofloxacin

43
Q

what could be the underlying causes of pyelonephritis in men and recurrent pyelonephritis in women?

A

renal calculi

44
Q

if you suspect vesico-ureteric reflux, what investigation would you carry out to confirm?

A

micturating cystogram

45
Q

what is chronic interstitial nephritis?

A

the histopathological appearance common to chronic pyelonephritis due to non-infective causes

46
Q

What is the most common causative organism of acute pyelonephritis?

A

E.coli

47
Q

What are 3 first-line investigations for suspected acute pyelonephritis?

A

Urinalysis
Urine culture
Gram stain

48
Q

What is the treatment for acute pyelonephritis?

A

Ciproflaxacin (flouroquinolone)

49
Q

What is the most common cause of chronic pyelonpehritis?

A

Chronic vesico-ureteral reflux

50
Q

What are the risk factors for chronic pyelonephritis?

A 
Acute pyelonephritis
Vesicoureteral reflux
Obstruction (calculi, tumour, BPD)
Diabetes mellitus
Neurogenic bladder
51
Q

What are 3 first-line investigations for suspected chronic pyelonephritis?

A

Urinalysis
Urine culture
Renal function
CT-KUB

52
Q

What is the treatment for chronic pyelonpehritis?

A

There isn’t specific treatment for chronic pyelonephritis

You have to treat the underlying cause

53
Q

List three common causative organisms of UTI.

A 
E.coli
Enterococcus faecalis
Proteus mirabilis 
klebsiella sp. 
pseudomonas aeruginosa
54
Q

List 4 general systemic factors that might predispose an individual to a UTI.

A

Immunosuppression
Steroids
Malnutrition
Diabetes

55
Q

What specific urological problems might lead to an increased risk of UTI?

A

Vesico-ureteric reflux
Catheterisation
Kidney / bladder stones
Female sex (short urethra)
Sexual intercourse and poor voiding habits
Stasis of urine e.g. poor bladder emptying, pregnancy
Oestrogen deficiency in post menapausal women
Vesico-colonic fistula
Congenital abnormalities e.g. duplex kidney

56
Q

What are the symptoms and signs of a UTI?

A 
Pyrexia, pyrexia 
Flank pain / suprapubic tenderness 
Dysuria / polyuria 
haematuria 
Cloudy offensive urine
Strangury / frequency 
Confusion
57
Q

How are UTIs managed?

A

Trimethoprim, nitrofurantoin

Amoxicillin if kidney disease

58
Q

What advice would you give for recurrent UTI in young women?

A 
Void before and after intercourse
1 tablet of trimethoprim for a year 
Antibiotic prophylaxis after intercourse 
Maintain good hygiene 
Fluid intake 2l day
Void every 2-3 hours by day 
Void before bedtime
59
Q

What antibiotic is not suitable for treatment of complicated UTI and why?

A

Vancomycin

It is only active against gram positive organisms but UTI’s are mostly caused by gram negative

60
Q

if a male has persistent UTI or fails to respond to treatment, what are the differential diagnoses?

A

prostatitis
epididymitis
chlamydia infection

61
Q

what is the treatment for UTI in men?

A

14 day course of ciproflaxacin (quinolone)

Urinary clinical conditions (17 decks)

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