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39 Cards in this Set
- Front
- Back
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1. Community acquired UTI are due to ?? 2. Nosocomail UTIS are due to ?? - patients with catheters are infected by? - patiets without catherters are infected by? |
1. faecal flora Ecoli. klebsiella, proteus, enterococcus 2. mutliple drug resistant bacteria - Psudomonas aeruginosa - E.coli |
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what are the three routes of infection for urinary system? |
1. ascending infection faeces --> perineum --> urethra --> bladder (multiply if pH > 5.5) --> renal pelvis --> kidney 2. haematogenous staphylooccus, streptococcus, mycobacterium and fungi --> renal/perirenal abscess 3. direct extension colon --> colovesical fistula --> bladder |
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when is colonisation of anterior urethral mucosa commonin males? |
in anatomic abnormality (urethral stricutre) |
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when is there high prevalance of UTIs |
1. women (close proximity between anal and urethral orifice) 2. newborns (toielet habits) 3. elderly (poor sphincter control) |
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what are the infections of the kidney? |
1. pyelopnephritis 2. pyonephrosis 3. renal TB 4. renal abscess |
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define pyelonephritis |
infection of kidney pelvis and parenchyma either acute or chronic |
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what is the cause of acute pyelonephritis? |
ascending UTI (e.coli) |
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what is the cause of chronic pyelonephritis |
1. infection above unrelieved obstruction 2. urinary stasis in bladder. ureter of kidney pelvis |
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what are the prediposing factors for pyelonephritis |
1. age >40 2. analgesic abuse (phenactin) 3. congenital (horseshor or double kidney) 4. cystitis 5. DM 6. gout 7. instrumentation 8. neurogenic bladder 9. prostitis 10. obstruction to flow (stone, bladder diverticulum, prostate) 11. pregancy (pressure of uterus --> obstruction) 12. renal disease 13. being female 14. vesico-ureteric reflux |
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what is the pathology of acute pyelonephritis |
1. kidney and calycces and pelvis shows features of acute inflammation inflammation - infiltration with polymorphs - hyperaemia 2. enlarged kindney 3. small scattered abscesses 4. areas of necrosis later |
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what is the pathology of chronic pyelonephritis |
1. may be uni or bilater 2. gross scarring 3. decreaaws kidney isizw 4. fibrosis 5. calcificaion |
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what are the clinical features of acute pyelonephritis |
1. rapid onset of symptoms 2. loin pain (aching) 3. acute fever and rigors 4. Dysuria 5. frequency 6. vomting, nausea, diarrhoea, constipation 7. may palpate lower pole of kidney 8. cloudy, bloodstain urine |
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what are the clinical features of chronic pyelonephritis |
1. symptomless 2. chronic renal failure --> uraemia and HT 3. vague symptoms - lassitude - tiredness - dysuria - aching lumbar pain |
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define pyonephrosis |
collection of ps in renal pelvis |
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what is the cause of pyonephrosis |
kidney ninfection with hydronephrosis (pelvis and calyces distension by urine that cant be cleared |
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what are he lclincial features of pyonephrosis |
1. pyuria (unless ureter is obstructed) 2. palpatable tender kindneys |
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define renal TB |
TB involving kidney |
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what is the cause of renal TB |
secondary to TB elsewhere which infects kidney ia blood |
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what is the pathology of renal TB |
lesion begins in renal cortex --> ulcerate into pelvus --> bladder, epidydimis, seminal vesival and prostate |
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what are the clincal feature of renal TB? |
1. 'sterile' pyuria (pus in urine where organsim causeing it cant be cultures) 2. haematuria and dysuria (secondary involvedment of bladder) 3. general signs of TB -maliase - fever -lassitude - weight loss |
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define carbuncle/cortical abscess of the kidney |
collection of pus in kidney parenchyma |
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what is the cause of carbuncle/cortical abscess of the kidney |
haematogenous spread of staph aureus from a cutaneous boil |
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what are the clincal features of carbuncle/cortical abscess of the kidney |
1. loin pain 2. fever, toxaemia |
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inflammation of the bladder is known as |
cystitis |
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what is the cause of cystitis |
infective - e. coli - proteus - klebsiella - pseudomonas - enterococcus - staphyloccocus non infective - drugs - toxins - radiation |
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what are the predisposing factors for cystitis |
1. females 2. constipation 3. (D) bacterialcidal acitivity of urine and prostate secretions 4. high frequency of sex 5. immobility --> poor bladder emptying 6. immunosupression 7. instrumentation 8. UT obstruction (pregnancy and prostate enlargement) 9. senile vagintisi (dried vagina) urinary reflex 10. urinary stais (neurogenic = not emptying whole bladder) |
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is cystitis common? what age is it going to effect most what gender? |
yes after one females |
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what is the pathology of cystisis |
1. signs of inflammatory response - hyperaemia - swelling of mucosa |
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what are the clinical features of cystitis |
1. dysuria 2. urinary frequency 3. urinary urgency 4. suprepubic pain 5. cloudy, smelly, bloody urine 6. enuresis (bed wetting) in children |
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what is urethral syndrome? |
it is an inflammatory proccess of the urethra (not infection) have clinical fetures of cystitis but MSU indicate <100,000 bacteria/ml |
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what causes urethritis |
STD = chlamydia it may involve Reiter's syndrome (urethritis + conjunctivitis + arthritis) |
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define glomerulonephrtis |
Disease resulting as aconsequence of inflammation NOT INFECTION (that pyelonephritis) |
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how can glomerulonephritis be classified? |
1. acute (AGN) Group A B heamolytic strep throat + antobodies --> immune-commplex --> blodstream --> deposition in glomerular basement membrane --> inflammation 2. subacture rapidly progrssive for of glomerulonephritis. Intense cellular proliferative changes --> destruction of glomeruli --> uraemia --> death 3. chronic slow progressive glomerulonephritis --> sclerosing and obliterative changes in glomeruli --> small, contracted kidneys --> uramia --> death (2 to 40 yrs) |
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what are the two mechanisms of glomerulonephritis |
1. immune complex Ab + Ag --> circulating Ag-Ab complexes --> passive trapping in glomerular BM --> complement fixation --> release of immunologic mediatores --> glomerular injury 2. nephrotoxic (anti-glomerular basement membrane) indivividuals own glomerular basement membrane is seen as an antigen and body makes Ab against it (AI) |
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what are the clinical features of glumerulonephritis |
1. persitent urine abnormalities 2. acute nephritic syndrome 3. acute nephrotic syndrome 4. uraemic syndrome |
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what do patient with persistent urine abnormalites present like? |
A latent stage in chronic GN = minimal proteinuria/haematruria BUT no symtpoms (stable glomerular function) |
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what do patient with acute nephritic syndrome present like? |
1. sudden onset usually associated with poststreop GN (may occur as acute exacerbation of chronic GN) 2. haematuria 2. high BP (HT) 4. oliguria 5. odema . uraemia |
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what do patients with acute ephrotic syndrome present like |
1. lOw prOtein - proteinura, hypoalbunaemia, odema, 3. hyperlipidiaemia usually in: 1. primary renla and systemic disease 2. chronic GN 3. others - DM - hypersensitivyt - reations and drugs |
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what do patients with uraemic syndrome present like |
symtomatic end stage renal failure |
