Urinary > UTIs > Flashcards

UTIs Flashcards

(44 cards)

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1
Q

Risk factors for UTIs + why

A
  • female: short urethra + closer proximity to anus
  • pregnancy: enlarged uterus + hormonal effects of relaxation of musculature
  • MS/stroke: affect bladder emptying > stagnant urine
  • stones, enlarged prostate, retroperitoneal fibrosis: obstructive > stagnant urine
  • abnormal renal tract
  • diabetes mellitus/immunosuppression impaired host defence
  • catheterised patients
  • poor hygiene
  • vesico-ureteric reflux: urine reflux from bladder to ureters
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2
Q

What are coliforms?

A

Gram negative
Non sporeforming
Bacilli

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3
Q

What is the most causative organism of UTIs?

A

Escherichia coli

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4
Q

Types of UTI

A
  • Cystis: bladder | lower UTI
  • Pyelonephritis: kidneys |upper UTI

(Then complicated + uncomplicated)

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5
Q

Virulence factors of E. coli

A
  • flagellar: movement
  • pili: attachment
  • capsular polysaccharide: colonisation
  • toxins: damages host membrane > renal damage
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6
Q

What are the majority of UTIs caused by?

A

Coliforms
Mainly E. coli

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7
Q

Presentation of cystitis | lower UTI

A
  • Dysuria
  • cloudy urine
  • nocturia
  • frequency
  • urgency
  • suprapubic tenderness
  • haematuria
  • mild pyrexia
  • confusion in older patients
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8
Q

Presentation of pylonephritis |upper UTI

A
  • high fever +/- rigours
  • loin pain + tenderness
  • renal angle tenderness
  • nausea + vomiting
  • +/- symptoms of cystitis
  • haematuria
  • loss of appetite
  • sysmetic illness
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9
Q

Pathophysiology of UTI

A
  • bacteria travels up the urethra
  • into bladder (cystitis)
  • can travel up ureters into kindey (pyelonephritis)
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10
Q

Features of urinary system which prevent UTIs

A
  • one way direction of urine flow
  • emptying of bladder during micturition
  • vesicouteral valves
  • immunological factors
  • mucosal barriers
  • urine acidity
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11
Q

Investigations of UTI

A
  • Urine dipstick
  • MSU > microscopy, culture + sensitivities
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12
Q

Prevalence of UTIs

A
  • more common in women
  • peak in women at:
    • preschool age
    • sexually active age
    • pregnancy age
  • peak in men >60 years old
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13
Q

When are urine dipsticks not useful for investigations of UTIs?

A

> 65 years old
Catheterised patients

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14
Q

What is an uncomplicated UTI?

A

Infection by a usual organism (E. coli) in a patient with a normal urinary tract + normal urinary function

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15
Q

What is a complicated UTI?

A

Patient has >1 factors that predispose to persistent infection, recurrent infection, or treatment failure
- abnormal urinary tract
- virulent organism Staph aureus
- immunosuppressed
- poorly controlled diabetes
- impaired renal function
- suspected pyelonephritis

UTIs in men are always complicated

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16
Q

Key symptoms of UTI

A
  • dysuria
  • new nocturia
  • cloudy urine
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17
Q

Urine dipstick results in UTI patient

A

Nitrite +
Leukocyte esterase +++
Possible haematuria

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18
Q

Describe urine culture process
When is it used for investigation?

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A
  • mid stream urine in adults
  • clean catch in children
  • culture urine within 4 hours of collection
  • refrigerate or use boric acid preservative
  • sent for microscopy, cultures + sensitivity
    .
  • used for pregnancy pts, recurrent UTIs, atypical symptoms, not improving with abx
19
Q

General treatment of UTIs

Study These Flashcards
A
  • increase fluid intake
  • regular analgesia
  • address underlying disorder
  • antibiotics (3 days for uncomplicated | 7 day for complicated)
20
Q

Antibiotic treatment of cystitis

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A
  • nitrofurantoin: 100mg twice a day (avoid if eGFR <45)
  • trimethoprim: 200mg twice a day

3 days for uncomplicated
7 days for complicated (+men)

21
Q

When is imaging for used for UTIs?

Study These Flashcards
A
  • children
  • septic patient to identify renal involvement
22
Q

Treatment of pyelonephritis

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A
  • 7-10 days oral antibiotics: cefalexin, co-amoxiclav
  • use agent with systemic activity (not nitrofurantoin)
  • IV antibiotics: ceftriaxone, gentamicin
23
Q

Antibiotics for treatment of pyelonephritis

Study These Flashcards
A

Oral: cefalexin, co-amoxiclav
IV: ceftriaxone, gentamicin

24
Q

Complication of chronic pyelonephritis

Study These Flashcards
A

recurrent infections > scarring of parenchyma > CKD > ESRD

25
What can be used to assess for renal damage in recurrent pyelonephritis?
**dimercaptosuccinic acid scan** injecting radiolabeled DMSA which builds up in healthy kidney tissue
26
Treatment of UTIs in pregnancy
7 days abx - *nitrofurantoin* first line but avoid in 3rd trimester - *amoxicillin* only after sensitives are known - *cefalexin*
27
Why should trimethoprim be avoided in preganncy?
it is a folate antagonists folate is essential in early pregnancy especially in development of the CNs + neural tube defects
28
Why should nitrofurantoin be avoided in 3rd trimester of pregnancy
risk of neonatal haemolysis
29
Mechanism of action of trimethoprim
- folate antagonist - inhibits dihydrofolate reductase > inhibits tertahydrofolate production - which is needed for RNA, DNA + protein synthesis
30
What drug should not be used at the same time as trimethoprim?
methotrexate also inhibits dihydrofolate reductase
31
Adverse affects of trimethoprim
- myelosuppresion - rise in creatinine - tetratogenic
32
Mechanism of action of nitrofurantoin
affects bacterial protein synthesis, DNA + RAN
33
Prevention of UTIs
- hydration - promote good hygiene practice - encourage post coital voiding - avoid unnecessary catheterisation
34
What is the most likely causative organism of a UTI if urine dipstick shows negative nitrites + positive leukocyte esterase?
Staphylococcus saprophyticus
35
Why does a UTI caused by E. coli show a positive nitrite in urine dipsticks?
E. coli converts nitrates to nitrites
36
Why can a patient with a UTI have negative nitrites on dipstick? What is the most common demographic affected by this?
- Patient is infected in staph saprophyticus which doesn’t convert nitrates to nitrites - Girls who engage in sexual activity young
37
What is interstitial cystitis?
chronic condition causing bladder inflammation > lower UTI symptoms + suprapubic pain
38
other names for Interstitial cystitis
bladder pain syndrome hypersensitive bladder syndrome
39
Presentation of interstitial cystitis
- similar to lower UTI but more persistent >6 weeks - more common in women - suprapubic pain - worse with full bladder, relieved by emptying bladder - frequency - urgency
40
Investigations +why of interstitial cystitis
- **urine dipstick** - UTIs - **swabs** - STIs - **cystoscopy** - bladder cancer - **DRE**: prostatitis, BPH, cancer
41
findings of cystoscopy in interstitial cystitis
- **hunner lesions**: red inflamed patches on mucosa associated with small vessels - **granulations**: tiny haemorrhages on bladder wall
42
conservative + medical management of interstitial cystitis
- lifestyle changes: smoking cessation, avoid caffeine and alcohol - bladder training - pelvic floor exercises - CBT - analgesia - antihistamines - anticholinergics *e.g. oxybutynin* - B3 receptor agonst *e.g. mirebegron* - intravesical medications *e.g. lidocaine, hyaluronic acid*
43
Surgical management of interstitial cystitis
- cauterisation of hunner lesions during cystoscopy - botulinum toxin injection during cystoscopy - neuromodulation with implanted electrical nerve stimulator - ileocystoplasty - cystectomy
44
what is ileocystoplasty?
augmentation of bladder, using section of ileum to increase capacity
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