GU Flashcards
Bacteria of UTI
90 % e.coli gram -
UTI - Eval
UA = WBC, Nitrates, RBC
CVAT abdominal exam
Acute UTI
Acute simple cystitis
Relapsed UTI
Same pathogen occurs within 2 weeks of completion of UTI TX
Recurrent UTI
Arises more than two weeks after TX may or may not be caused by same pathogen
> 2 infections in 6 months or > 3 infections in one year
Complicated UTI
co morbidity - DM, immunospression, reduced renal function indwelling catheter , nuerogenic bladder
Intermediate susceptibility
May be effective but will have to five a higher dose that’s normal or more freq
MIC
Minimum inhibitory concentration
>100,000 organisms
Want the lowest number
UTI- uncomplicated TX
Bacteria : E. coli
Duration 3-5 days
Drugs : Nitrofunatoin BID x 5 days
Bactrim BID x 3 days (sulfa) Cipro x 3 days
UTI complicated
Duration : 7-10 days Drugs : Bactrim x 7 days Trimethoprim x 7 day (if sulfa allergy) Cipro ( if PCN allergy) Amplicillen ( not great cause it is QID ) Augmentin ( PCN allergy)
Can consider phenazopyrdine for bladder pain TID x 2 days
Preventative UTI
Post sex - one dose after sex
Recurrent : nitrofurin or bactrim 1 day for x 6 months
Refer to urology if 3 UTI in 6 months
Intersistial cystitis
Painful free urinations with voiding 60 times a day , nocturia, no infection, no response with antibitoics
Theory: leaking of teh inner lining of the bladder thereby inflaming the bladder wall
TX: elmiron - may take 2-4 month for relief
Elavil ( not great for elderly) - to relieve pain and urinary freq
Antihistamine - help with sleep and nocturia
Neurontin - help with nueropathic pain
Pyelonephritis
Infection of kidney
Can lead to atrophy and scarring of kidney may lead to renal failure
More common in women
Gram - ecoli, proteus
Sudden onset hight fever, shaking, flank pain
UA : bacteria RBC, WBC’s,
CVAT, WBC casts ***
TX: bactrim BID x 14 days
Amoxicillin TID x 14 days
Cipro BID x 10 days
Need to improve in 48-72 hours
Prostatitis
Common in adult male
4 types : acute bacterial , chronic bacterial, non bacterial, prostatidyna
Ecoli - bacterial
Chlamydia - non bacterial
Prostatodynia
Pain, discomfortn, problem with urinary flow, - may cause infertility or prostate ca
Prostatitis ROS / PE
Prostate - enlarged, tender , boggy,
GU - look for lesions and discharge
UA : WBC and Blood
Prostatitis TX
> 35 no STI
Bactrim or cipro ( 500 mg higher dose) for four weeks
< 35 STI
Ceftriazone PLUS Doxycline X 10 days
Cefixime + doxycline
Ceftriazone PLUS azothryomcin ( 1 time dose ) = g/c
BPH
Benign condition
Obstructive
- hesitancy , decreased force of stream post void dribbling,
Irritating
- freq, urgency, nocturia ( r/t decreased bladder capacity or infection)
PE: enlarged, non tender, firm but spongy
PSA
ACA - PSA at start at 50
45 if at risk (AA, 1st degree relative)
40 if at greater risk ( 1 st degree relative )
USPSTF - recommends against PSA screening
BPH treatment
5 -alpha reductase inhibitors
Proscar - dont give to men with pregnant wives
Dutasteride - concern for sexual function
BPH - alpha blockers
Relaxes bladder neck
Take with meals
Flomax - give at bedtime
BPH / erectile dysfunction
Phosphosiesteride type 5 inhibitor
Tadalafil - cialis
Can help with both
Take without regard to imting of sexual activity
Urge UI
Bladder muscles contract forcefully and unexpectedly and as a result internal sphincter is unable to retain urine
“ i know I have to go but i cant get there”
Stress
Loss of urine with use of abdominal muscles after coughing, laughing
