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Clinical Med II Exam 3 (Annie and Lauren) > Cystitis, Pyelo, Interstitial Cystitis > Flashcards

Cystitis, Pyelo, Interstitial Cystitis Flashcards

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1
Q

Urine dipstick is most accurate in predicting UTI when positive for _________ and/or _________ in ______patients

A

Leukocyte esterase

Nitrite

Symptomatic

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2
Q

Does a negative dipstick rule out UTI in symptomatic pts

A

No

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3
Q

Does a positive dipstick support a UTI in asymptomatic pts

A

No

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4
Q

What can cause false negative nitrite on a dipstick

A

Non-nitrate reducing organisms

Frequent urination/urine in bladder <4hrs

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5
Q

What can cause a false positive leukocyte esterase on dipstick

A

Vaginal contamination

Trichomonas

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6
Q

Upper urinary tract infections are called

A

Pyelonephritis

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7
Q

Lower UTIs are called

A

Cystitis

Or prostatitis or urethritis but thats not what this lecture is about

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8
Q

In men aged 20-50 yo, most UTIs are _________

A

Urethritis or prostatitis

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9
Q

UTI’s are 50x more common in

A

Women

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10
Q

95% of UTIs occur from _____________

A

Ascending bacterial infection

The rest are hematogenous

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11
Q

What bacteria most commonly causes UTI

A

E. coli

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12
Q

Let’s see a list of other pathogens that cause UTIs in immunocompromised ppl

A

Let’s not because its prob not on test

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13
Q

What are the 3 broad categories of UTI risk factors

A
  1. Reduced urine flow- obstruction, dehydrated, neurogenic bladder
  2. Promote colonization- sex, spermicide use, recent abx use
  3. Facilitate ascent- catheterization, urinary/fecal incontincenc
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14
Q

What is the definition of Acute Simple Cystitis

A

UTI confined to the bladder

Non pregnant

No sx that suggest upper UTI/systemic infection

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15
Q

What is the definition of acute complicated UTI

A

S/s that suggest extension of infection beyond the bladder:

Fever, chills, rigor, fatigue/malaise, flank pain, CVA tenderness, pelvic/perineal pain in men

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16
Q

Who are “special populations” when they get UTIs

A

Pregnant women

Men

Pts with comordiities, immunocompromised, urologic abnormalities

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17
Q

What are irritative voiding sx

A

Dysuria

Urinary frequency

Urgency

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18
Q

What population may have an atypical presentation of UTI

A

Elderly

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19
Q

Can acute simple cystitis include hematuria or suprapubic discomfort

A

Yes, may or may not be present.

Irritative voiding sx ALWAYS present though

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20
Q

What will you find when you do your exam on someone with acute simple cystitis

A

NORMAL EXAM

Mightttt find suprapubic tenderness but thats it

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21
Q

What do you need to do with your patients urine sample if they have acute simple cystitis

A

Dipstick: +leukocyte esterase and nitrites

Microscopy: Pyuria and Bacteriura

+/- pregnancy test

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22
Q

Do you need to a urine culture for acute simple cystitis

A

No

Might do it to check for drug resistance bugs

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23
Q

When do you NEED to do a urine culture for acute simple cystitis

A

Atypical presentation/diagnostic uncertainty

Suspect complicated UTI

Sx do not resolve

Suspect antimicrobial resistance (recently took abx)

Special populations- men, pregnant, immunocompromised

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24
Q

What values on your urine culture will represent positive cultures

Study These Flashcards
A

10^3 CFUs

But….. 10^2 CFUs is considered positive if the patient has typical UTI symptoms

25
How do you treat the sx of acute simple cystitis
OTC Phenazopyridine (Pyridium) 200mg TID prn NO MORE THAN 2 DAYS TURNS PEE ORANGE (Dont know if dosages are important )
26
What is the antibiotic treatment for Acute Simple Cystitis for a NON-pregnant person
Nitrofurantoin (Macrobid) 100mg BID x 5 days Bactrim 160/800 BID x 3 days Fosfomycin (monaural) 3gm PO single dose
27
When should you not use bactrim for acute simple cystitis
20% of the local E. coli are resistant
28
Can you use nitrofurantoin (macrobid) or Fosfomycin (Monurol) for early pyelonephritis
No, they do not penetrate the kidney enough
29
What are some alternative abx for acute simple cystitis in a non pregnant person if you’re concerned about allergies or cost or whatever (probably not on test)
Beta lactams- augmentin, cefdinir Fluoroquinolones- Ciprofloxacin, Levaquin etc
30
What are your antibiotic options for acute simple cystitis in a PREGNANT woman
Augmentin, cephalexin, cefpodoxime, fosfomycin Nitrofurantoin/Bactrim- ask their OB if its ok **AVOID FLUOROQUINOLONES ****!!
31
How do you treat acute simple cystitis in MEN
Primary therapies for a longer duration (7 days) **must rule out prostatitis - dribbling, enlarged prostate, etc
32
How do you treat acute simple cystitis in patients who are immunicompromised or have underlying urologic abnormalities
Primary therapies for longer (1-2 weeks) -low threshold to manage as complicated UTI
33
What are the things you need to educate your pt about for acute simple cystitis
Drink more water Void when you need to Wash your snatch Pee after sex? Finish abx- expect relief within 48hrs go to ER if sx of pyelonephritis
34
Do you need to do follow up urine cultures for acute simple cystitis ?
only pregnant women
35
What are some sx that suggest pyelonephritis instead of cuystsits
Flank pain Constitutional sx (fever,chills, maialise) GI sx (N/V abdominal pain) CVA tenderness
36
What do you need to do with the urine sample if you suspect pyelonephritis
Dipstick: leukocyte esterase, nitrites Microscopy: Pyuria (>10 leukocytes/mL), bacteriuria, WBC casts*** Culture: positive if >10^5 CFU
37
Do you need to do a CBC or BMP for pyelonephritis
No, but if you did: CBC: leukocytosis w left shift BMP: assess renal function, hydration, electrolytes (due to nausea/vomiting)
38
Do you need to do imaging for pyelonephritis?
No. Only if you suspect an obstruction. You’d do a CT with and without contrast
39
What is the antibiotic treatment for mild-moderate pyelonephritis?
Cipro 500mg BID x 5-7 days Cipro-ER 1000mg once/day x 5-7 days Levofloxacin- 750mg once/day x 5-7 days If local resistance to Fluoroquinolones, provide an initial IV/IM dose of ceftriaxone 1g in addition to Fluoroquinolones
40
If you treat your pt for mild-mod pyelonephritis as an outpatient, when do they NEED to follow up? Do you need to get follow up cultures?
24-48hrs!!! F/u cultures only if pregnant
41
When do you need to hospitalize your pt for pyelonephritis
Suspected obstruction*** Critically ill/hemodynamically unstable Persistently high fever >103 F Marked pain Metabolic derangements Unable to take liquids PO Concerns about compliance with f/u
42
What kind of IV antibiotics can you give during inpatient treatment for complicated/severe pyelonephritis?
Fluoroquinolones Broad spectrum cephalosporin Broad spectrum PCN Carbapenem Aminoglycoside
43
What complications are you looking for at the 24-48 hr follow up
Sepsis Renal failure Scarring/chronic pyelo Renal abscess formation
44
What are the other 2 names for interstitial cystitis
Bladder pain syndrome Painful bladder syndrome
45
What is the definition of IC
Unpleasant sensation perceived to be related to the bladder, associated with UTIO sx of more than 6 weeks duration in the *absence* of infection or other identifiable causes
46
Who usually gets IC?
Women 4th decade or older Other chronic pain: fibromyalgia, IBS
47
Interstitial Cystitis is: Chronic debilitating condition characterized by bladder pain
No question just read it becasue she put it in red and I didn’t know how to make a card
48
How can IC impact your life
Psychosocial functioning Quality of life Sexual dysfucntion Sleep dysfunction Depression
49
What is the pathophysiology of IC?
**ALTERED UROTHELIUM**🐝 Caused by some combination of these things that probably wont be on the test: Disruption of GAG layer Bladder urothelilal injury Secretion of proinflammatory substances, mast cell activation, fibrosis Neural hypersensitivity Neuropathic pain and voiding dysfunction
50
What are the presenting symptoms of IC
Suprapubic/bladder pain that is often WORSE with bladder filling and RELIEVED with voiding******* +/- urgency, frequency, nocturia +/- pain in other areas, vaginal burning
51
How long must sx last for a diagnosis of IC
6 weeks ***************
52
Yes yes we all know that IC is a ~diagnosis of exclusion~ but what are the most important things to rule out
Cancer Infection
53
What will you see on cystoscopy if the patient has IC?
ALTERED UROTHELIUM
54
What is the 1st line tx for IC
Self care Diet mods- avoid citrus, acid, spicy, caffeine, etoh, soda Bladder retraining (⬆️voiding intervals) exercise psychotherapy/support gourps Pyridium (short term 2 day use for flares)
55
What is the 2nd line to for IC?
Tricyclics antidepressant (Amitriptyline) Pentosan Polysulfate (Elmiron) - FDA approved for IC. Takes 3-6 months to work Antihistamines (Hydroxyzine) Lidocaine in the bladder Pelvic physical therapy
56
What is the 3rd line tx for IC
Cystoscopy with short duration bladder hydro distention (under anesthesia) Intravesical instillation of GAGs Intravesical Dimethyl sulfoxide
57
What are the 4-6th line tx of IC
4th: Botox, sacral neuromodulation 5th: cyclosporine 6th: surgery
58
Do you NEED to do cystoscopy to diagnose IC?
No, but it will support you dx when you see that ALTERED UROTHELIUM

Clinical Med II Exam 3 (Annie and Lauren) (5 decks)

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