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Unit 3 Clin Med II > L18: Cystitis + Pyelonephritis > Flashcards

L18: Cystitis + Pyelonephritis Flashcards

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1
Q

Upper tract infections

A

Pyelonephritis

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2
Q

Lower tract infections (3)

A
  1. Cystitis
  2. Prostatitis
  3. Urethritis
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3
Q

in men aged 20-50, most UTIs are

A

Urethritis

Prostatitis

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4
Q

In women aged 20-50, most UTIs are

A

cystitis

pyelonephritis

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5
Q

how do 95% of UTIs occur

A

ascending bacterial infection

remaining are hematogenous

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6
Q

Causes of most UTIs

A

E coli

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7
Q

UTI risk factors: reduced urine flow

A
  1. Urine outflow obstruction
  2. inadequate fluid intake
  3. neurogenic bladder
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8
Q

UTI risk factors: promote colonization

A
  1. sex
  2. spermicide
  3. recent abx
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9
Q

UTI risk factors: facilitate ascent

A
  1. Catheters
  2. Urinary incontinence
  3. Fecal incontinence
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10
Q

Acute complicated UTI

A

acute UTI + extension of infection beyond the bladder

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11
Q

what symptoms might suggest a UTI is complicated?

A 
Fever > 99.9
Chills, rigor, fatigue/malaise
Flank pain
CVA tenderness
Pelvic or perineal pain (men)
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12
Q

who is more at risk for complicated UTI

A 
Pregnant women
Men
Comorbidities
Immunocompromised
Urologic abnormalities
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13
Q

Irritative voiding symptoms of acute cystitis

A 
***
Dysuria
Urinary frequency
Urinary urgency
***

+/- hematuria, suprapubic discomfort

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14
Q

Physical exam of acute simple cystitis

A

TYPICALLY NORMAL

Women +/- suprapubic tenderness

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15
Q

Urine dipstick acute simple cystitis

A

+ Leukocyte esterase and nitrites

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16
Q

Urine microscopy acute simple cystitis

A

Pyuria: >10 leukoctyes/micrL

Bacteriuria

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17
Q

When to do a urine culture for acute simple cystitis

A 
Atypical presentation
Diagnosis uncertain
Suspect complicated
Sx do not resolve/recur
Suspect abx resistance
Special populations
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18
Q

Diagnostic urine culture for UTI

A

> 1000 CFU

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19
Q

Diagnostic urine culture in women with typical UTI sx

A

> 100 CFU

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20
Q

Symptomatic relief for UTI

A

Phenazopyridine (pyridium)

2 days

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21
Q

When to avoid TMP-SMX for acute simple cystitis

A

more than 20% of local e coli are resistant

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22
Q

When to avoid nitrofurantoin and fosfomycin

A

early pyelonephritis

due to low renal concentrations

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23
Q

3 primary therapies for acute simple cystitis

A
  1. Nitrofurantoin 100 mg po BID 5 days
  2. TMP-SMX 160/800 mg po BID 3 days
  3. Fosfomycin 3 g PO single dose
  • men: 7 days
    • comorbidies, immunocompromised, urologic abnormalities: 1-2 weeks
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24
Q

Alternative therapies for acute simple cystitis

A

Beta-lactams (augmentin, cefdinir)

Fluoroquinolones (ciprofloxacin, levaquin)

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25
When can nitrofurantoin and TMP-SMX be used in pregnant women
"use/avoidance based on trimester"
26
Options for pregnant women
Augmentent Cephalexin Cefpodoxime Fosfomycin
27
DON'T give to pregnant women
**** Fluoroquinolones (ciprofloxacin, levaquin) ****
28
who needs follow up cultures in acute simple cystitis or pyelonephritis
pregnant women | symptoms do not resolve on abx
29
pyelonephritis cause
ascent of bacteria up ureters from bladder to the kidneys
30
Symptoms of pyelonephritis
``` UTI symptoms Flank pain Fever, chills, malaise GI: N/V/A, abdominal pain Fever CVA tenderness ```
31
what differentiates pyelonephritis from UTI on UA?
same findings except pyelonephritis has **white blood cells casts**
32
Positive urine culture for pyelonephritis
>10^5 CFU/ml (100,000)
33
when is a CBC and BMP necessary for acute pyelonephritis
hospitalized patients
34
CBC of pyelonephritis
leukocytosis with left shift
35
BMP of pyelonephritis
assess renal function, hydration, lytes
36
when to do imaging for acute pyelonephritis
Severely ill symptoms 48-72 hours after abx suspect obstruction recurrence
37
image of choice for pyelonephritis
CT A/P with and without contrast | other: US, MRI if contrast/radiation undesirable
38
mild-moderate outpatient pyelonephritis tx
Fluoroquinolones: Ciprofloxacin 500 mg PO BID x 5-7 days Ciprofloxacin ER 1000 mg PO once daily x5-7 days Levofloxacin 750 mg PO once daily x 5-7 days
39
Acute pyelonephritis: Mild/Moderate, outpatient, fluoroquinolone-resistant E coli: tx
Initial IV/IM dose of Ceftriaxone 1gm + fluoroquinolone therapy
40
Acute pyelonephritis: Mild/Moderate, outpatient: uropathogen known to be TMP-SMX susceptible
TMP-SMX 160/800 mg PO BID x 7-10 days
41
what must an outpatient pyelonephritis case do
MUST FOLLOW UP IN 24-48 HOURS | ***to check abx susceptibility studies and
42
who to hospitalize for pyelonephritis
Critically ill/hemodynamic instability Fever >103 F Persistent pain/marked debility Suspected or documented urinary tract obstruction Metabolic derangements (renal dysfunction) Unable to take liquids by mouth Concerns with follow up compliance as outpatient
43
Acute pyelonephritis: complicated/severe, inpatient tx
``` IV abx: Fluoroquinolone Extended spectrum cephalosporin or penicillin Carbapenem: Vabomere Aminoglycoside: Zemdri ```
44
Supportive care for Acute pyelonephritis: complicated/severe, inpatient
Analgesics/Antipyretics Antiemetic IV fluids
45
all the names for bladder pain syndrome
bladder pain syndrome interstitial nephritis painful bladder syndrome
46
who gets interstitial nephritis
Women >40 +/- fibromyalgia, IBS
47
bolded thing about interstitial nephritis
Impacts psychosocial funtioning and quality of life -sleep dysfunction, sexual dysfunction, depression
48
Pathophysiology of interstitial nephritis
Altered urothelium: multifactorial: +/- Disruption of glycosaminoglycan layer Bladder urothelial injury Secretion of proinflammatory substances, mast cell activation, fibrosis Neural hypersensitivity Neuropathic pain & voiding dysfunction
49
Presentation of interstitial nephritis
HIGHLY VARIABLE: Suprapubic/bladder pain, often worse with filling, relieved with voidinG +/- urgency, frequency, nocturia +/- pain: pelvic, perineum, urethra, lower abdomen/back +/- dyspareunia, vaginal burning
50
Presentation of interstitial nephritis in men
pelvic pain with concomitant sexual dysfunction
51
interstitial nephritis history
Gradual onset of sx >6 weeks Triggers: food/beverages, stress, activities, menstruation # of void/day Validated symptom scales: assess severity, monitor progress Prior/recurrent UTIs, pelvic trauma/surgery/radiation
52
Physical exam of interstitial nephritis should include
Abdominal exam Women: bimanual Men: rectal
53
Physical exam of interstitial nephritis may show
variable tenderness +/- pelvic floor muscle spasm
54
How is interstitial nephritis diagnosed?
diagnosis of exclusion: | UA, microscopy are unremarkable
55
Get a urine cytology in interstitial nephritis patients with
smoking history (cancer)
56
if an interstitial nephritis UA comes back with hematuria:
do urine cytology and cystoscopy
57
Postvoid residual urine volume is used to rule out
bladder outlet obstruction | neuro disorders
58
Cystoscopy if indicated
if in doubt of interstitial nephritis diagnosis
59
done to detect glomerulations (submucosal hemorrhage)
bladder hydrodistention
60
what would cystoscopy show for interstitial nephritis?
altered urothelium glomerulations hunner lesions
61
Refer interstitial nephritis when
Hematuria Complex symptoms (pain with incontinence) Incomplete bladder emptying Neurologic disorder that affects bladder function Prior pelvic radiation or surgery Has not responded to oral meds
62
1st line interstitial nephritis tx
Self-care/behavioral modifications Diet modifications: avoiding citrus, acidic/spicy foods, caffeine, EtOH, carbonation Bladder retraining: increase voiding intervals Low-impact exercise Psychotherapy, support groups Urinary analgesics for flares: Pyridium
63
2nd line interstitial nephritis tx
Oral medication: → Tricyclic antidepressant (amitriptyline) Pentosan polysulfate (elmiron) (takes months to respond) Antihistamines: Hydroxyzine Intravesical medication: lidocaine Pelvic physical therapy
64
3rd line interstitial nephritis tx
Cystoscopy + short duration low pressure bladder hydrodistention under anesthesia Intravesical instillation of glycosaminoglycans Intravesical dimethyl sulfoxide (DMSO)
65
4th line interstitial nephritis tx
Intradetrusor botulinum toxin | Sacral neuromodulation
66
5th line interstitial nephritis tx
Cyclosporine
67
6th line interstitial nephritis tx
Urinary diversion surgery
68
what line of tx for interstitial nephritis is pyridium?
1st line for flares
69
what line of tx for interstitial nephritis is pelvic physical therapy?
2nd line
70
Amitriptyline
Tricyclic antidepressant
71
Pentosan
Tricyclic antidepressant
72
Hydroxyzine
Antihistamine
73
Lidocaine is given
intravesically (2nd line)
74
what line of tx for interstitial nephritis are tricyclic antidepressants
2nd line
75
what line of tx for interstitial nephritis is intravesical lidocaine
2nd line
76
what line of tx for interstitial nephritis are antihistamines?
2nd line
77
what line of tx for interstitial nephritis is Cystoscopy + short duration low pressure bladder hydrodistention under anesthesia
3rd line
78
what line of tx for interstitial nephritis is intravesical instillation of glycosaminoglycans
3rd line
79
what line of tx for interstitial nephritis is intravesical Dimethyl sulfoxide (DMSO)
3rd line

Unit 3 Clin Med II (8 decks)

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