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Flashcards in UTIs Deck (52):
0

What are the normal UTI tract defence mechanisms?

Regular flushing during voiding to remove organisms from distal urethra
Antibacterial secretions into urine and urethra
Urine osmolality (high)
High urine pH

1

What host factors are there which allow for infection?

Shorter urethra in females
Obstruction due to stones, enlarged prostate, pregnancy or tumours
Neurological - incomplete emptying
Ureteric reflex

2

Why does incomplete emptying increase chance of infection?

Residual urine is left in the b,added and some can be forced back up the ureters

3

What bacterial factors allow for infection?

Ability to adhere to epithelial cells - determines degree of virulence

4

How do E. coli get into and adhere to the urinary tract?

Have flagellae for motility
Aerobactin for iron acquisition in an iron-poor environment
Haemolysin - pore forming
Adhesins on fimbrae and on cell surface

5

What are the more cellular urinary tract defence mechanisms?

Neutrophils which are activated by adhesions. Found on mucosal surfaces
Complement activation with IgA production by urothelium
Commensal organisms
Urothelium has proteins in the mucus which interfere with bacterial binding

6

What predisposes people to a UTI?

Trauma - due to catheterisation, sex because it affects the urothelium

7

Define dysuria

Painful/difficult urination

8

Define pyuria

Pus in urine

9

What is pyelonephritis?

Infection of the kidneys

10

What are the symptoms of pyelonephritis?

Fever
Loin pain
Tenderness
Significant bacteriuria

11

What can be seen with imaging in pyelonephritis?

CT scan shows wedge shaped areas of inflammation
Small renal cortical abscesses and streaks of pus in the renal medulla
Focal infiltration of polymorphonuclear leukocytes and polymorphs in tubular lamina

12

Complications of acute pyelonephritis if left untreated?

Significant permanent kidney damage (rare)
Inflammation in renal cortex

13

How does reflux nephropathy occur?

Combination of vesicoureteric reflux and infection acquired in infancy and early childhood
Vesicoureteric valve normally prevents reflux of urine when bladder empties but in some children, the mechanism can be void
Secondary consequence is incomplete emptying as urine returns to bladder - predisposes to infection and kidney damage

14

How is reflux nephropathy diagnosed?

CT scan showing irregular renal outlines and a reduction in renal size
Can be unilateral or bilateral
Affect all or part of the kidney

15

When does urine reflux normally stop?

Around puberty

16

What can occur if damage persists from reflux nephropathy?

Progressive renal fibrosis
Further loss of function in severe cases
Predisposed to hypertension in later life

17

Who does reflux nephropathy normally affect?

Children
Suspect it if they 'fail to thrive'

18

What is chronic interstitial nephritis?

Renal impairment following chronic inflammation
Can be caused by infection or an adverse reaction to drugs

19

What is bacterial cystitis?

Inflammation of the bladder caused by bacteria
Common in women as a result of sexual intercourse

20

Symptoms of bacterial cystitis?

Frequency and dysuria
Smelly urine
Pyuria
Haematuria

21

What is prostatitis?

Inflammation of the prostate gland

22

Symptoms of prostatitis?

Fever
Dysuria
Frequency
Perineal and lower back pain

23

Symptoms of an upper UTI?

Loin pain
Fever
Oliguria
Systemic symptoms

24

Symptoms of a lower UTI?

Frequency and dysuria
Smelly urine
Polyuria
Haematuria

25

Define oliguria

Production of abnormally small amounts of urine

26

What are possible complications of UTIs?

Long term renal damage
Common source of life threatening Gram negative bacteraemia

27

What is covert bacteriuria?

Asymptomatic bacteria in the urine

28

When is covert bacteriuria important to detect and how is it detected?

Children and pregnancy
Culture

29

Common organisms responsible for UTIs?

Gram negative rods
Particularly coliforms - E. coli

In young women and hospitalised patients can also be caused by coagulase negative staphylococci

30

Risk factors for a UTI?

Female
Sexual intercourse
Spermicide in females
Pregnancy
Menopause
Immunosuppression
Urinary tract obstruction
Catheterisation
Constipation

31

What is an uncomplicated UTI?

A UTI where the anatomy of the urinary react is normal and renal imaging will be normal.
There is no underlying condition contributing to the infection
Unlikely to result in serious kidney damage

32

Who would have an uncomplicated UTI?

Women of child-bearing age and healthy

33

What is a complicated UTI?

Infection of the lower urinary tract with an associated condition such as structural or functional abnormalities of the urinary tract or the presence of an underlying disease, which increases the risk of acquiring an infection or failing therapy

34

What can complicated UTIs lead to?

Severe and rapid kidney damage
Risk of Gram negative septicaemia

35

How to diagnose a UTI?

Midstream specimen of urine
Dipstick - Gram negative bacteria will reduce nitrates to nitrites however many false positives -> low sensitivity
Leuokocyte esterase may be present -> pyuria

Test for haematuria and proteinuria

36

When is dipstick testing not useful to diagnose UTIs?

Acute uncomplicated UTI
Men with typical/severe symptoms
Catheterised patients
Older patients with asymptomatic bacteriuria

37

How do you collect a sample in small children?

Adhesive bag
(Unreliable)

38

Now do you collect a sample from a catheterised patient?

Needle up a special tube in the catheter

39

What is a suprapubic aspiration?

Put a needle through the abdominal wall to take a urine sample

40

How is a urine sample transported?

4*C
Boric acid

41

When is microscopy done with UTIs?

Suspected kidney disease
Suspected endocarditis
Children under 6
Schistosomiasis
Suprapubic aspirates

42

What is sterile pyuria?

When a UTI is present but unable to be cultured

43

Why might you get sterile pyuria?

Patient has already been treated with antibiotics
Infected with difficult bacteria to isolate or culture eg chlamydia, TB
Appendicitis

44

What is urethral syndrome?

When women present with symptoms of a UTI but not due to a bacetrial cause

45

What can cause urethral syndrome?

Vaginal infection
STI
Mechanical, physical or chemical causes

46

Treatment of uncomplicated UTIs? (Cystitis)

3 day course of trimethoprim

47

Treatment of complicated UTI?

Trimethoprim, nitrofurantoin or cephalexin for 7 days

48

Treatment of pyelonephritis and septicaemia?

14 day course of co-amoxiclav or ciprofloxacin
IV

49

How does ciprofloxacin work?

It is a quinolone
Inhibits bacterial DNA gyrase, preventing bacterial supercoiling

50

How do you treat prostatitis?

Ciprofloxacin

51

When would you give a patient prophylaxis for UTIs and what would you give?

If they have had 3 or more episode in one year and there is no treatable underlying condition
Trimethoprim/nitrofurantoin - 1 at night