NR 507 Advanced
Pathophysiology Week 4
Urinary Tract study
Guide
Urgency is a common symptom of a lower urinary tract
infection (UTI). It is characterized by a strong and sudden need
to urinate. The other options (decreased urination, fever, and
flank pain) are not typical symptoms of a lower UTI
Urinary Tract Infections
Bacteria from the gut can invade the urinary epithelium to
cause inflammation and infection anywhere along the urinary
tract such as the urethra, bladder, ureter, or kidney.
More common for women to develop a UTI especially when
pregnant, sexually active, during post-menopause with
estrogen-deficiency and when being treated with antibiotics.
Men may develop a lower UTI. An upper UTI is less common in
men due to the longer urethra and ureter structures that make it
more difficult for bacteria to reach the kidney. A foley can also cz
UTI. Finally, ppl who experience urinary obstruction, diabetes or
neurogenic bladder are also at risk for UTI.
Complicated or uncomplicated, upper vs. lower tract disorders.
The pathophysiology of a UTI is simple. First, bacteria enter
and contaminate the lower urinary tract. This causes the
colonization of bacteria in the urethra and the bladder which
triggers an inflammatory response in the lower urinary tract.
Neutrophils are recruited to the area where the bacteria are
present. The bacteria multiply which allows them to evade the
immune system due to virulent factors. For example,
Escherichia coli can bind to cells in the lower urinary tract and
hide from the immune cells. The bacteria can form biofilms. A
biofilm is any group of microorganisms that allow them to stick
to one another and adhere to surfaces that help them survive. If
the UTI progresses or is not treated, or if the patient is
immunocompromised, the bacteria can ascend to the kidneys
and colonize there. At this point, the infection becomes an
upper UTI. If left untreated, the bacteria can spread into the
circulation via the renal veins causing bacteremia or septic
,shock.
,UTI Risk Factors
Pregnancy: During pregnancy, progesterone relaxes smooth
muscle that causes stasis of urine, allowing the bacteria to
colonize. Also, the female ureter is shorter and allows for the
entrance of bacteria into the urethra.
Post-menopausal: The lack of estrogen results in vaginal and
urethral dryness that promotes an environment for bacteria to
grow.
Sex: bacteria can be easily introduced into the urethra. If
spermicides are used during sexual intercourse, this also puts
the woman at risk for a UTI.
Catheterization: especially in females. The catheter itself can
introduce infections directly into the bladder. The neutrophils
enter the area to further promote inflammation. Fibrinogen
accumulates on the catheter which provides an ideal
environment for the attachment of uropathogens that express
fibrinogen-binding proteins. After the initial attachment to the
fibrinogen-binding proteins on the catheter, the bacteria multiply
to form biofils. This results in epithelial damage to the urinary
tract that leads to a kidney infection.
Lower vs. Upper Tract Disorders
A UTI can occur anywhere along the urinary tract and can be
associated with another issue in the area. For ex, if the infection
occurs at the opening of the urethra, then the condition is
termed urethritis. Cystitis (bladder) is a condition of the
lower urinary tract that denotes a bladder infection. Cystitis can
occur in both females and males. In males, the cystitis may be
a/w prostatitis.
, Lower urinary tract disorder: urgency a/w burning on urination,
frequency, dysuria, suprapubic pain, and cloudy, odor urine.
Pyelonephritis: can cause ARF. The S/S of pyelonephritis
include all the symptoms associated with cystitis plus fever,
flank pain, costovertebral angle (CVA) tenderness, nausea, and
vomiting, Malaise. Sgns of shock if the infection has entered the
circulation via the renal vein. S/S a classic triad: vomiting, flank
pain and fever.
Diagnosing:
A urine dipstick can be observed for the presence of
leukocyte esterase and nitrites. Leukocyte esterase is an
enzyme that is released by the WBCs (leukocytes). It is a
qualitative measure of WBCs in the urinary tract. On the
actual dipstick test, you may just note leukocytes. But note that
the dipstick does not measure the number of leukocytes.
Pathophysiology Week 4
Urinary Tract study
Guide
Urgency is a common symptom of a lower urinary tract
infection (UTI). It is characterized by a strong and sudden need
to urinate. The other options (decreased urination, fever, and
flank pain) are not typical symptoms of a lower UTI
Urinary Tract Infections
Bacteria from the gut can invade the urinary epithelium to
cause inflammation and infection anywhere along the urinary
tract such as the urethra, bladder, ureter, or kidney.
More common for women to develop a UTI especially when
pregnant, sexually active, during post-menopause with
estrogen-deficiency and when being treated with antibiotics.
Men may develop a lower UTI. An upper UTI is less common in
men due to the longer urethra and ureter structures that make it
more difficult for bacteria to reach the kidney. A foley can also cz
UTI. Finally, ppl who experience urinary obstruction, diabetes or
neurogenic bladder are also at risk for UTI.
Complicated or uncomplicated, upper vs. lower tract disorders.
The pathophysiology of a UTI is simple. First, bacteria enter
and contaminate the lower urinary tract. This causes the
colonization of bacteria in the urethra and the bladder which
triggers an inflammatory response in the lower urinary tract.
Neutrophils are recruited to the area where the bacteria are
present. The bacteria multiply which allows them to evade the
immune system due to virulent factors. For example,
Escherichia coli can bind to cells in the lower urinary tract and
hide from the immune cells. The bacteria can form biofilms. A
biofilm is any group of microorganisms that allow them to stick
to one another and adhere to surfaces that help them survive. If
the UTI progresses or is not treated, or if the patient is
immunocompromised, the bacteria can ascend to the kidneys
and colonize there. At this point, the infection becomes an
upper UTI. If left untreated, the bacteria can spread into the
circulation via the renal veins causing bacteremia or septic
,shock.
,UTI Risk Factors
Pregnancy: During pregnancy, progesterone relaxes smooth
muscle that causes stasis of urine, allowing the bacteria to
colonize. Also, the female ureter is shorter and allows for the
entrance of bacteria into the urethra.
Post-menopausal: The lack of estrogen results in vaginal and
urethral dryness that promotes an environment for bacteria to
grow.
Sex: bacteria can be easily introduced into the urethra. If
spermicides are used during sexual intercourse, this also puts
the woman at risk for a UTI.
Catheterization: especially in females. The catheter itself can
introduce infections directly into the bladder. The neutrophils
enter the area to further promote inflammation. Fibrinogen
accumulates on the catheter which provides an ideal
environment for the attachment of uropathogens that express
fibrinogen-binding proteins. After the initial attachment to the
fibrinogen-binding proteins on the catheter, the bacteria multiply
to form biofils. This results in epithelial damage to the urinary
tract that leads to a kidney infection.
Lower vs. Upper Tract Disorders
A UTI can occur anywhere along the urinary tract and can be
associated with another issue in the area. For ex, if the infection
occurs at the opening of the urethra, then the condition is
termed urethritis. Cystitis (bladder) is a condition of the
lower urinary tract that denotes a bladder infection. Cystitis can
occur in both females and males. In males, the cystitis may be
a/w prostatitis.
, Lower urinary tract disorder: urgency a/w burning on urination,
frequency, dysuria, suprapubic pain, and cloudy, odor urine.
Pyelonephritis: can cause ARF. The S/S of pyelonephritis
include all the symptoms associated with cystitis plus fever,
flank pain, costovertebral angle (CVA) tenderness, nausea, and
vomiting, Malaise. Sgns of shock if the infection has entered the
circulation via the renal vein. S/S a classic triad: vomiting, flank
pain and fever.
Diagnosing:
A urine dipstick can be observed for the presence of
leukocyte esterase and nitrites. Leukocyte esterase is an
enzyme that is released by the WBCs (leukocytes). It is a
qualitative measure of WBCs in the urinary tract. On the
actual dipstick test, you may just note leukocytes. But note that
the dipstick does not measure the number of leukocytes.
