Cystitis, Pyelonephritis Maclary

Question 1

Define acute cystitis

Answer 1

• Symptomatic bacterial infection of bladder

- Commonly called UTI

Question 2

How does acute cystitis occur?

Answer 2

Bacteria establishes infection by ascending from urethra to the bladder

Question 3

Risk factors for acute cystitis

Answer 3

• Female
• Hx of UTI
• Recent sexual intercourse (use of diaphragm w/spermicide)
• Diabetes
• Incontinence/indwelling catheter
• Anatomic abnormality

Question 4

Pathogens of acute cystitis

Answer 4

• E coli (70-90%)
• Staph saprophyticus (5-15%)
• Klebsiella, proteus, enterococcus, citrobacter (5-10%)

Question 5

Clinical features of acute cystitis

Answer 5

• Frequency, urgency, dysuria
• Suprapubic discomfort
• Gross hematuria

Question 6

In acute cystitis, what does fever indicate?

Answer 6

Invasive infection

Question 7

In acute cystitis, what does unilateral back pain indicate?

Answer 7

Upper urinary tract involvement

Question 8

What is the MC cause of confusion in elderly?

Answer 8

UTI

Question 9

What does urine dipstick show in acute cystitis?

Answer 9

Positive nitrites or leukocyte esterase

Question 10

What does urinalysis show in acute cystitis?

Answer 10

• Pyuria
• Bacteriuria
• Possible hematuria

Question 11

What is the gold standard for diagnosis of acute cystitis?

Answer 11

Urine culture (but can take 24-48 hrs)

Question 12

What is diagnostic for UTI?

Answer 12

100K colonies on urine culture

Question 13

Treatment of UTI

Answer 13

• Short term abx
• Sitz bath
• Urinary analgesics (pyridium)

Question 14

Who qualifies for prophylactic abx to UTI?

Answer 14

Women with 3 or more episodes per year

Question 15

Define interstitial cystitis

Answer 15

• Painful bladder syndrome

- Pain when bladder fills and relieved by emptying

Question 16

Who is most affected by interstitial cystitis?

Answer 16

Females
Age of onset 40 yo
Childhood bladder problems

Question 17

Diseases a/w interstitial cystitis

Answer 17

• Severe allergies
• IBS
• IBD

Question 18

Treatment of interstitial cystitis

Answer 18

• No cure, up to 50% may have spontaneous symptom remission
• Hydrodistention
• Amitriptyline, nifedipine
• TENS unit, acupuncture

Question 19

What is the surgical treatment of interstitial cystitis?

Answer 19

Ureter diversion (last resort)

Question 20

Define pyelonephritis

Answer 20

• Acute infectious inflammatory disease affecting kidney parenchyma and renal pelvis
• Complication of a UTI

Question 21

How does pyelonephritis occur?

Answer 21

Bacteria ascend from bladder to ureter to kidney

Question 22

Pathogens of pyelonephritis

Answer 22

• E coli, proteus, klebsiella, enterobacter, pseudomonas

- S aureus (usually spread by a hematogenous route)

Question 23

Clinical features of pyelonephritis

Answer 23

• Fever, flank pain, chills
• Urgency, frequency, dysuria
• N/V, diarrhea
• Tachycardia
• CVA tenderness

Question 24

What do diagnostic studies of pyelonephritis show?

Answer 24

• CBC: increased WBCs
• UA: pyuria, bacteriuria, hematuria
• Urine culture: heavy growth of offending organism

Question 25

Treatment of pyelonephritis

Answer 25

- Choose tx based on organism - Fluoroquinolones 1st line for acute uncomplicated pyelo - May need IV therapy initially and switch to oral once response is observed - FU urine culture once tx is complete

Question 26

If IV tx is needed for pyelonephritis, how should it be given?

Answer 26

- Combo of drugs | - Ampicillin w/an aminoglycoside, quinolone, or broad spectrum cephalosporin

Question 27

Who is most affected by urinary stone disease?

Answer 27

- Males | - 3rd and 4th decades of life

Question 28

5 major types of urinary stonres

Answer 28

1. Ca oxalate 2. Ca phosphate 3. Struvite 4. Uric acid 5. Cystine

Question 29

Risk factors for urinary stone disease

Answer 29

- Hot humid climate - Sedentary - High protein, high salt diet - Genetic

Question 30

Urinary stone disease may be precursor to what disease?

Answer 30

CV disease

Question 31

Clinical features of urinary stone disease

Answer 31

- Acute and severe pain to flank - N/V - Pain may radiate to groin, testes, vulva

Question 32

What will diagnose most urinary stones?

Answer 32

Abdominal x-ray and renal US

Question 33

What does UA show for urinary stone disease?

Answer 33

Microscopic or gross hematuria

Question 34

Treatment of urinary stone disease

Answer 34

- Increase fluid intake - Decrease Na, animal protein, oxalate, purine intake - Medical expulsive therapy - Ureteroscopic stone extraction - Shockwave lithotripsy - Percutaneous nephrolithotomy

Question 35

High oxalate foods?

Answer 35

Blueberries Strawberries Spinach Eggplant

Question 36

High purine foods?

Answer 36

Mussels Sardines Yeast products (beer)

Question 37

What are med treatments of urinary stone disease?

Answer 37

Alpha blocker Ibuprofen Oral steroid (appropriate for first weeks, may need additional pain med)