GU- Adults

Question 1

lower UTI

Answer 1

involves bladder & urethra–> cystitis

Question 2

upper UTI

Answer 2

Ureters & Kidneys–> Pyelonephritis

Question 3

classification of UTI

Answer 3

o Uncomplicated
 refers to infections which occur in healthy, immunocompetent, non-pregnant women (but can occur in men too!) who do not have significant UTI history or any urological structural abnormalities
 Symptoms: Mild-moderate
o Complicated
 Existing structural or functional abnormality of urinary tract
 UTIs in pregnancy are “complicated” & require closer f/u
 UTI “complicated” if there are s/sx suggesting infection has spread beyond bladder (pyelo s/sx)
o Recurrent
 UTI that occurs after complete resolution of previous & recent UTI
o Asymptomatic bacteriuria (ABU)
 Urine has significant bacteria colony count (>100,000/mL) but no s/sx UTI

Question 4

most causative agent of UTI

Answer 4

E. coli

Question 5

risk factors for UTI in women

Answer 5

o Anatomy–> short urethra
o Fecal bacteria in the vaginal area
o Decreased fluid intake or irregular bladder emptying
o Sexual intercourse; ideally void within 10-15 mins after having sex
o Spermicide use
o Symptomatic partner
o Pregnancy
o Menopause
o Hyperuricemia, neurogenic bladder, kidney disease, immunosuppression; co-morbidities like DM: also risk in men
o Urological abnormalities/instrumentation: also risk in men

Question 6

risk factors for UTI in men

Answer 6

o BPH
o Anal intercourse (also a risk for women)

Question 7

risk factors for UTI in children

Answer 7

o Constipation, anatomical abnormalities, immunosuppression, dysfunctional voiding

Question 8

**Red flags (suggestive of pyelonephritis or urosepsis)

Answer 8

o Ill appearing
o Fever/chills
o Tachycardia
o Flank pain
o Nausea/vomiting
o Costovertebral (CVA) tenderness
o Urosepsis: severe infection of urinary tract which spreads into bloodstream
- More common in elders, cis-women. Precursor is often complicated UTI. Higher risk in those with urological structural abnormalities, persons with diabetes, immunocompromised persons

Question 9

1st line diagnostic for UTI

Answer 9

dipstick

Question 10

tx for uncomplicated UTI

Answer 10

o Nitrofurantoin (Macrobid)
o Trimethoprim-sulfamethoxazole (Bactrim)
o Fosfomycin

Question 11

UTI in pregnancy tx

Answer 11

amox-clavuante
doxy and fluoroquinolones contraindicated

Question 12

geriatric considerations with UTI

Answer 12

• before giving Nitrofuratoin, check renal clearance (creatinine clearance)
• only tx if there are symptoms

Question 13

older adult with UTI considerations

Answer 13

• diagnose based on symptoms and urine culture
• in LTC settings, do not tx right away for vague symptoms (ex lethargy, increased falls)
• assess for worsening symptions such as incontinence, suprapubic tenderness, then order urine C & S

Question 14

recurrent UTIs in younger women

Answer 14

• more than 2 UTIs in 6 months or more than 3 infections in 1 year
• risk factors: spermicide use or new partner in the past year, genetics, first UTI before age 15

Question 15

to decrease recurrence of UTI

Answer 15

• increase fluids 2-3 L/day
• avoid spermicides/diaphragms
• post sex voiding, ideally within 10-15 mins

Question 16

UTI prophylaxis

Answer 16

can be considered in women who have had more than 2 or more symptomatic UTIs in 6 months or 3 or more in 12 months

Question 17

pt education on UTIs

Answer 17

• encourage plenty of fluids
• drink fluids before sex to faciliate voiding after
• void within 10-15 mins after sex
• proper hygiene (front to back)
• empty bladder frequently
• educate on proper abx use

Question 18

UTI in men: risk factors

Answer 18

• uncircumcised,
• anal intercourse

Question 19

referral or hospitalization with UTIs

Answer 19

• presence of macroscopic hematuria, recurrent UTIs ofr infection
• hospitalization is recommended for pregnant pts with pyelonephritis
• hx of DM, sickle cell anemia, nephrolithiasis, or excessive analgesic use

Question 20

acute pyelonephritis

Answer 20

infection of kidney; considered to be complicated UTI

Question 21

risk factors of acute pyelonephritis

Answer 21

• female
• elderly
• anatomical abnormalities
• stress incontinence
• pregnancy
• pts with DM
• indwelling urinary caths
• recurrent kidney disease

Question 22

UA findings in pyelo

Answer 22

• dip or microscopic: positive leukocytes (pyuria), hematuria
• UA may show WBC casts

Question 23

referral to hospitalization with acute pyelonephritis

Answer 23

o Inability to maintain oral hydration/take meds
o Dehydration
o Vomiting
o Fever > 101.2 F (39.0 C)
o High WBC
o Hypotension
o Sepsis or s/sx suggestive of this
o Multiple co-morbidities
o Unsure diagnosis
o Pregnancy

Question 24

interstititial cystitis/bladder pain syndrome

Answer 24

• An unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than six weeks duration, in the absence of infection or other identifiable causes
• most common in women

Question 25

Interstitial Cystitis/Bladder Pain Syndrome: associated disorders

Answer 25

o Allergies
o IBS
o Sjogren Syndrome
o Fibromyalgia
o Chronic fatigue syndrome
o Crohn disease
o Ulcerative colitis
o Depression
o Anxiety

Question 26

Interstitial Cystitis/Bladder Pain Syndrome: s/s

Answer 26

o persistent unpleasant sensations attributable to the bladder, of which the most consistent feature is an increase in discomfort with bladder filling and a relief with voiding
o Bladder symptoms are usually described as painful but can include pressure, discomfort, or spasms
o Usually constant but may vary from one day to the next , range in severity from mild to severe.
o Location usually suprapubic or urethral, also can be unilateral lower abdominal pain or low back pain with bladder filling
o Usually gradual in onset and worsen over a period of months. However, some patients describe symptoms that are abrupt or severe from their onset.
o Some patients have developed symptoms after an uncomplicated urinary tract infection or surgical procedure, or after a trauma, such as a fall onto the coccyx.
o Exacerbation of IC/BPS symptoms may occur after intake of certain foods or drinks, during stress, after certain activities (eg, exercise, sexual intercourse, prolonged sitting), or during the luteal phase of the menstrual cycle

Question 27

diagnostics for Interstitial Cystitis/Bladder Pain Syndrome

Answer 27

o 1st line urine dip, culture and sensitivity to rule out UTI
o Would order urinalysis with microscopy (to exclude infection; evaluate for hematuria)
o If pt is sexually active would consider STI testing if they report dysuria

Question 28

tx of Interstitial Cystitis/Bladder Pain Syndrome

Answer 28

o Pelvic floor therapy
o First line – amitriptyline; check med list for contraindications: MAOIs, Cisapride, Cimetidine, many anticonvulsants
o Second line – pentosan polysulfate sodium or PPS; contraindication for persons with macular eye dz
o Antihistamines for persons with concomitant allergies; hydroxyzine first line
o Adjuvant/rescue analgesia – NSAIDs, acetaminophen, phenazopyridine, methenamine, intravesical lidocaine

Question 29

managment

Answer 29

o Evaluate for comorbid conditions
o Evaluate psychosocial needs
o Importance of self care and lifestyle modification
o Application of heat or cold to bladder or perineum
o Fluid management – A fluid and voiding diary
o Bladder training with urge suppression

Question 30

pt education bladder pain syndrome

Answer 30

o Certain foods can trigger flares Caffeine, alcohol, citrus, carbonated beverages, acidic foods
o Avoid prolonged sitting; be aware that sex may increase symptoms
o Avoid tight fitting clothes which may cause discomfort
o Diagnostic criteria
o Variability of symptoms
o Chronic nature of the condition
o Review normal bladder function
o Encourage pt to keep diary to identify activities, foods, behaviors that may exacerbate symptoms