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Gen Med Unit 5 > Prostatitis > Flashcards

Prostatitis Flashcards

1
Q

Define prostatitis

A

Inflammation of the prostate gland

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2
Q

Categories of prostatitis

A

Acute bacterial
Chronic bacterial
Nonbacterial

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3
Q

What is the etiology of acute bacterial prostatitis?

A
  1. Ascending urethral infection
  2. Most common pathogens (Gm-)
    -E. Coli (58-88%)
    -Proteus, Klebsiella, Serratia, Pseudomonas
    STD’s
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4
Q

What is the etiology of chronic bacterial prostatitis?

A
  1. Chronic recurrent sx’s w/prostate bacteria
    - E. coli (75-80%)
    - Enterococci (Proteus, et al),Pseudomonas
    - Chlamydia trachomatis
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5
Q

What is the etiology of chronic non- bacterial prostatitis?

A
  1. Chronic recurrent sx’s w/ no bacteria
  2. Cause unknown
    3.Theories:
    Noninfectious inflammation due to:
    -Pelvic muscle spasm
    -Ejaculatory duct obstruction
    -Autoimmune disorder
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6
Q

What is the most common type of prostatitis?

A

Chronic non bacterial

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7
Q

How do bacteria infect the body?

A

Ascent of infection up urethra and reflux into prostatic ducts

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8
Q

Which category of prostatitis is a diagnosis of exclusion?

A

Nonbacterial prostatitis

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9
Q

What are the sxs of acute bacterial prostatitis?

A
  1. Sudden or rapid progression of sx’s-acutely ill
  2. Fever, chills, malaise, myalgias
  3. Low back pain
  4. Perineal pain
  5. Irritative voiding sx’s:
    - Frequency, -decreased stream, -dribbling, -urgency, -dysuria
  6. Hesitancy
  7. Hematuria
  8. Cloudy urine
  9. Exquisite tenderness of prostate
  10. Enlarged, firm prostate
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10
Q

What are the sxs of chronic bacterial prostatitis?

A
  1. Sometimes asymptomatic
  2. +/- Hx of STD
  3. Recurrent UTI sx’s
  4. Irritative voiding sx’s
  5. +/- Suprapubic pain
  6. +/- Perineal, testical pain
  7. +/- Low back pain
  8. BM Discomfort
  9. Ejaculation pain +/- blood
  10. Prostate may feel normal or boggy
  11. Mildly tender
  12. +/- enlarged prostate
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11
Q

What are the sxs of chronic prostatitis/chronic pelvic pain syndrome?

A
  1. Obstructive sx’s
    -Slow stream, hesitancy, dribbling
  2. Pain:
    Perineum, low abdomen, testicles, penis, with ejaculation +/- blood
  3. Persistent irritative sx’s:
    -Urgency, frequency, nocturia
  4. Nontender or mildly tender prostate
  5. May be enlarged
  6. Firm prostate
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12
Q

What are the results of a U/A in Acute bacterial prostatitis?

A

Pyuria
Bacteriuria
+/- Hematuria: commonly has traces of blood

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13
Q

What are the results of a Ur C&S in Acute bacterial prostatitis?

A

Identifies pathogen

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14
Q

What are the results of a CBC in Acute bacterial prostatitis?

A

Leukocytosis

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15
Q

What are the results of PSA in Acute bacterial prostatitis?

A

Transient increased PSA

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16
Q

What are the results of a U/A in Chronic bacterial prostatitis?

A

Usually normal

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17
Q

What are the results of a prostatic secretion C & S in Chronic bacterial prostatitis?

A

Identifies pathogen
Confirms Dx
Rarely done

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18
Q

What are the DS results in nonbacterial prostatitis?

A

Diagnosis of Exclusion
(-) U/A
(-) UC
Bladder, testicular Sono, CT, etc.

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19
Q

In pt Tx for Acute bacterial prostatitis

A
  1. Hospitalization if septic
  2. IV antibiotics
    A. Ciprofloxacin (Cipro) 400 mg IV q 12h + gentamicin
    5 mg/kg/d
    After pt afebrile for 24-48 hours, change to oral
    Cipro 500 mg bid or Levaquin 500 mg qd x 6 weeks
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20
Q

What catheter is preferred for acute bacterial prostatitis?

A

Urine catheterization is CONTRAINDICATED

Percutaneous catheter is preferred

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21
Q

What is the outpt tx for acute bacterial for men under 35 yrs?

A
  1. Ceftriaxone (Rocephin) 250 mg IM + doxycycline 100 mg bid x 10 d or azithromycin (Zithromax) 1 gm po x 1 d
  2. Ciprofloxacin (Cipro) 500 mg po bid x 4-6 wks
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22
Q

What is the outpt tx for acute bacterial for men over 35 yrs?

A

Ciprofloxacin (Cipro) 500 mg po bid x 10-14 days

Trimethoprim /sulfamethazole (Bactrim) DS po bid x 10-14 days

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23
Q

Tx for Chronic bacterial prostatitis?

A
  1. Ciprofloxacin (Cipro) 500 mg bid x 6 wks or
  2. Trimethoprim /sulfamethazole (Bactrim) DS 1 po bid x 4-12 wks
    or
  3. Azithromax (Zithromax) 500 mg 3x/week x3 wks (Chlamydia)
  4. Anti-inflammatory agents
  5. Hot sitz baths
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24
Q

Tx for nonbacterial protatitis?

A

1.Alpha 14 Blockers + Antibx
Tamsulosin (Flomax) 0.4 mg qd + Ciprofloxacin (Cipro) 500 mg bid x 6 wks
2. NSAIDS
3. Sitz baths

  1. Refer to Urologist if sx’s persist
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25
Define Orchitis
Acute inflammatory reaction of the testicle secondary to infection (viral or bacterial)
26
What is the pathophys of mumps orchitis?
Most common etiology. Mumps orchitis follows the development of parotitis by 4-7 days -20-25% of prepubertal patients with mumps develop orchitis
27
What is the pathophys of bacterial orchitis?
Bacterial orchitis can be associated with epididymitis or prostatitis - Occur in sexually active males older than 15 years or in men older than 50 years w/ BPH - Ascending bacterial infection from urinary tract: Chlamydia, gonorrhea
28
What pathogens cause the most common form of acute orchitis?
Viral
29
What are common bacterial pathogens for orchitis?
``` Neisseria gonorrhea Chlamydia trachomatis Pseudomonas aeruginosa E. coli Klebsiella pneumonia ```
30
What complications can occur from orchitis?
Unilateral testicular atrophy occurs in 60% of patients with orchitis Drop in sperm count 1 in 10 males
31
What are the symptoms of orchitis?
1. Testicular pain and swelling -Mild discomfort to severe pain 2. Assoc. systemic sx’s: Fatigue Malaise Myalgias Fever and chills Nausea
32
What are the signs of orchitis?
1. Fever 2. Testicular swelling & tenderness 3. Erythematous & edematous scrotal skin 4. Enlarged epididymis associated with epididymo-orchitis
33
What are the DS: U/A, results in bacterial orchitis?
pyuria & bacteriuria, +/- GC, Chlamydia
34
Why is a doppler U/S performed in orchitis?
R/O testicular torsion or abscess
35
What is the tx of orchitis?
1. Bed rest 2. Hot or cold packs for analgesia 3. Support of the scrotum 4. Analgesics 5. Antibiotics for bacterial orchitis A.< 35 yr Ceftriaxone (Rocephin) 250 mg IM + doxycycline 100 mg bid x 10 d B. 35 yr or > Ceftriaxone (Rocephin) 250 mg IM + ciprofloxacin (Cipro) 500 mg bid x10d
36
Define acute epididymitis
Inflammation of epididymis
37
What is the prevalence of epididymitis?
Incidence is less than 1 case in 1,000 males per year Common ages 19 – 40 years Most common cause of intrascrotal inflammation
38
What is the route of infection in epididymitis?
Urethra  ejaculatory duct  vas deferens  epididymis
39
What is the pathophys of epididymitis?
1. Secondary to trauma 2. Causative organism is identified in 80% of patients - Agent Varies according to the age of the patient
40
What pathogens cause Epididymitis in prepubertal males?
E. coli
41
What pathogens cause Epididymitis in sexually active males?
1. Chlamydia trachomatis | 2. Neisseria gonnorhea
42
What pathogens cause Epididymitis in elderly males?
1. E. coli | 2. Pseudomonas
43
What are the sxs in epididymitis?
1. Swelling & pain of scrotum - May radiate up to ipsilateral flank 2. +/- Irritative voiding sx’s 3. +/-Urinary retention - Bladder outlet obstruction in older patients 4. +/- Fever and chills 5. +/- Urethral discharge 6. Exquisitely tender epididymis 7. Erythematous edematous scrotum
44
What is the Prehn sign and what is it used for?
1. Prehn sign is a classic sign of epididymititis | 2. Not reliable for distinguishing epididymitis from testicular torsion
45
What are the U/A results for epididymitis?
Pyuria or bacteriuria (50%)
46
Who should have a Urine C&S performed for epididymitis?
Prepubertal and elderly patients
47
What are the urethral gram stain and culture for epididymitis?
Gram (-) intracellular diplococci
48
What pathogens do you look for in epididymitis?
GC/Chlamydia | Test for syphilis and HIV
49
When is a CBC ordered in epididymitis?
If patient appears systemically ill or toxic | Leukocytosis with left shift
50
Why is a doppler ultrasound ordered in epididymitis?
R/O testicular torsion
51
What is the tx for epididymitis?
1. Obtain immediate urologic consultation if unable to clearly differentiate testicular torsion from epididymitis or other scrotal pathology 2. Antibiotic therapy 3. Analgesics for pain control: generally w/ anti-inflammatory component 4. Supportive care - Scrotal support - Ice pack
52
What antibiotics should be used in epididymitis?
1. Ciprofloxacin (Cipro) 500 mg bid x 10d or Trimethoprim/ sulfamethoxazole Bactrim) DS po bid x 10d 2. Ceftriaxone 250 mg IM + Doxycycline 100 mg bid x 7d Neisseria gonnorhea Chlamydia trachomatis
53
Define urethritis
Inflammation of urethra
54
What are common pathogens for urethritis?
1. N. gonorrhea 2. C. trachomatis 3. Mycoplasma genitalium 4. Ureaplasma urealyticum 5. Trichomonas vaginalis 6. “Nongonococcal”
55
What are the noninfectious causes of urethritis?
Reactive arthritis (Reiter Syndrome)
56
What are the sxs of urethritis in men?
1. Irritative void sx’s 2. Dysuria 3. Inflamed urethral orifice 4. Serous or milky urethral discharge 5. +/- blood-tinged
57
What are the sxs of urethritis in women?
1. Irritative voiding sx’s 2. Purulent urethral discharge 3. Urethral orifice erythema 4. Assoc. w/ vaginitis and cervicitis: GC active during menses
58
How is urethritis diagnosed?
1. Urine C&S 2. Gram stain and Culture 3. Nucleic acid amplication testing (NAAT): A. For N. gonorrhea & C. trachomatis -Endocervical swab -Vaginal swab -Urethral swab (men) -Urine (men & women) 1st urine
59
What complications can arise from urethritis?
``` 1. Disseminated gonococcal disease A. Septic arthritis B. Conjunctivitis -Purulent -Can rapidly progress to panophthlamitis and loss of the eye unless prompt tx ```
60
How is gonococccal urethritis treated?
1. Ceftriaxone 250 mg IM + azithromycin (Zithromax) 1 gm po or doxycycline 100 mg po bid x 7d

Gen Med Unit 5 (8 decks)

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