Infectious/Inflammatory conditions

Question 1

what is cystitis

Answer 1

Bacterial infection of the bladder commonly called urinary tract infection.
Bacteria establishes infection by ascending from the urethra to the bladder

Question 2

what are the RF for cystitis?

Answer 2

Female: 50-80% of women will develop at least 1 UTI in their lifetime
Hx of UTI
Recent sexual intercourse: use of diaphragm with spermicide
Diabetes
Incontinence
Indwelling catheter
Anatomic abnormality

Question 3

What pathogens cause UTI?

Answer 3

E. coli account for 70-90% of isolates
Staph 5-15%
Klebsiella, proteus, enterococcus and citrobacter account for 5-10%

Question 4

what is the most common cause of confusion in the elderly?

Answer 4

UTI

Question 5

what are the clinical features of Cystitis or UTI?

Answer 5

Frequency, urgency, dysuria
Suprapubic discomfort
Gross hematuria
Fever is an indication of invasive infection
Unilateral back pain is indicative that upper urinary tract involved
PE unremarkable

Question 6

What would you see on a U/A for a person with cystitis?

Answer 6

pyuria, Bacteriuria, poss hematuria

Question 7

what is the Gold standard for dx of cystitis?

Answer 7

Urine culture, but results can take 24-48hrs

Question 8

What is the Tx for cystitis?

Answer 8

short term abx
concern about resistance to TMP sulfa (bactrim)
sitz bath
Pyridium- urinary analgesics

Question 9

what abx are used for cystitis

Answer 9

Bactrim: cheap and single dose
Cephalexin: 1-3 days $16.60
Norfloxacin: 1-3 days $26.00
Ofloxacin: 1-3 days $28.30
Ciprofloxacin: 1-3 days $32.00
Nitrofurantoin: 7days $45

Question 10

How is cystitis prevented?

Answer 10

limit use of indwelling catheters

women with

Question 11

what is interstitial cystitis

Answer 11

painful bladder syndrome
pain when bladder fills and relieved by emptying
Associated with freq and urgency
Dx of exclusion

Question 12

what is the epidemiology of interstitial cystitis

Answer 12

Females>males
Avg age 40
Likely to have childhood bladder problems
associated with allergies, IBS and IBD

Question 13

what is the clinical presentation of interstitial cystitis?

Answer 13

pain w bladder filling and relief with urination

Question 14

what are the lab findings for interstitial cystitis

Answer 14

lab and cystoscopy may be normal

Question 15

what is the tx for interstitial cystitis?

Answer 15

no cure
upto 50% may have spontaneous remission
Amitriptyline, nifedipine
TENS unit
surgery

Question 16

what is pyelonephritis?

Answer 16

acute infectious inflammatory dz affecting the kidney parenchyma and renal pelvis
Bacteria ascend from bladder to kidney
ITs a complication of a UTI

Question 17

what are the clinical features of pyelonephritis?

Answer 17

Fever, flank pain, chills
urgency, frequency, dysuria
N/V
Tachcardia
CVA tenderness

Question 18

what will labs show with pyelonephritis?

Answer 18

CBC increased WBC
UA shows pyuria, bacteriuria, hematuria
urine culture shows heavy growth for offending organism

Question 19

what is the Tx for pyelonephritis?

Answer 19

1st line fluoroquinolones for acute uncomplicated
may need IV therapy & switch to oral t once response observed
If IV need use (ampicillin w/ aminoglycoside, quinolone or cephalosporin)
F/U urine cultures

Question 20

what is a urinary tract obstruction?

Answer 20

obstruct outflow of urine which impairs renal and urinary function and chronic kidney disease

Question 21

what are the clinical features of Urinary tract obstruction?

Answer 21

depends on location and extent
Pt may be asymptomatic
Pain, hematuria, change in urinary output
HTN, palpable mass
Incontinence

Question 22

what will diagnostic test tell you?

Answer 22

U/A: hematuria, pyuria, bacteriuria
Labs: CBC, Lytes, creat
US
Abd Xray stones
IV urogram

Question 23

what is the treatment for urinary tract obstruction?

Answer 23

restore normal urine flow ASAP
Tx coexisting infection
Tx depends on cause and location
Analgesics for stones

Question 24

how common is urinary stone dz

Answer 24

common prob affects 240,000-720,000 americans
13.7% men
7% women

Question 25

what is the pathophysiology of urinary stone disease

Answer 25

components that make up the stone are supersaturated in the urine concentrations of the stone material exceeds their solubility so crystals form

Question 26

what are 5 types of stones

Answer 26

``` MC- calcium calcium oxalate calcium phosphate uric acid cystine struvite ```

Question 27

what are RF for stones

Answer 27

``` hot and humid environment Higher in summer sedentary occupation High protein high salt diet' genetic factors urinary stones dz ```

Question 28

what are the clincial features of urinary stone dz

Answer 28

``` acute and severe pain localized to flank N/V episodic pain pt in constant motion pain may radiate to the groin testes or uvula ```

Question 29

what will lab and imaging show for urinary stone dz

Answer 29

U/A: microscopic or gross hematuria | Ab-Xray/KUB and renal US will dx most stones

Question 30

what is the Tx for urinary stone dz?

Answer 30

``` goal to achieve stone free status •↑ fluid intake •↓ sodium intake Limit animal protein •↓ intake of oxalate & purines Medical expulsive therapy of: alpha blockers, ibuprofen, oral steroid Uteroscopic stone extraction Shock wave lithotripsy Percutaneous nephrolithomy ```

Question 31

what food are hight in oxalates?

Answer 31

blueberries, strawberries spinach, eggplant

Question 32

what foods are hight in purines

Answer 32

mussels, sardines, yeast products