Some UTI and bladder pain info

Question 1

How to get dx of bladder pain syndrome

Answer 1

History and physical

Question 2

Lower UTI

Answer 2

Cystitis

Question 3

Upper UTI

Answer 3

Pyelonephritis

Question 4

Why do 95% of UTIs occur from ascending bacterial infection, usu e.coli?

Answer 4

Exposure to colonic bacteria that makes its way from butthole up into bladder.

Question 5

3 Risk factor categories for UTI

Answer 5

Reduced Urine Flow
Promote Colonization
Facilitate ascent

Question 6

UTI pt who is:
Immunocompetent 
No comorbidities
Premenopausal
Not preggo

Answer 6

Uncomplicated UTI

Question 7

Irritative sx of UTI

Answer 7

Dysuria
Frequency
Urgency

Possible hematuria and suprapubic discomfort but PE is ususally normal

Question 8

UTI pt who is:
Immunocompromised
Pregnant
Diabetic 
Male
Young

Answer 8

Complicated UTI

Question 9

MOST VALUABLE DIAGNOSTIC TEST FOR UTI

Answer 9

Eval for pyuria on urinalysis

pus/WBV in urine

Question 10

False + for nitrites may result from

Answer 10

Exposure of dipstick to air

Question 11

Colony count that is diagnostic for acute UNcomplicated cystitis

Answer 11

> =1,000 (10 to the 3rd)

Routine culture not indicated, should get if case if refractory to tx or suspect kidney infxn

Question 12

First line tx for acute UNcomplicated cysitits

Answer 12

BACTRIM (trimethoprim-sulfamethoxazole)

or

• Nitrofurantoin (Macrobid)
• Fosfomycin (Monurol)
• Don’t give if suspect kidney infxn becz can’t get adequate levels in kidneys.

Question 13

Second line tx for acute UNcomplicated cystitis

if sulfa allergy, resistance, availability issues with 1st line

Answer 13

Fluoroquinolones

Cipro, levo, ofloxacin

Question 14

Third line tx for acute UNcomplicated cystitis

Answer 14

Oral beta lactams (7 days)

Question 15

Why do you only give pyridium (a bladder analgesic) for 2 days?

Answer 15

Because it can mask symptoms of refractory infection, pt can’t tell that they are not getting better and tx not working

Question 16

First line tx for acute complicated cysitits

Answer 16

Fluoroquinolones

Question 17

Manly acute uncomplicated cystitis

Answer 17

Bactrim
or
fluoroguinolones

Question 18

Pregnancy UTI meds

Answer 18

NOOOO fluoroquinolones

AUGMENTIN is safest bet
(amoxicillin

-can give Macrobid if early preggo

Question 19

Dysuria + frequency

no vag d/c

Answer 19

UTI usually

Question 20

Acute pyelonephritis can lead to these complications

Answer 20

Renal abscess
Sepsis
Septic shock
ARF

Question 21

Cystitis sx + flank pain

Answer 21

Acute pyelonephritis

and WBC casts

Question 22

Study of choice if need to do imaging for COMPLICATED pyelonephritis

(in uncomplicated imaging usu not indicated)

Answer 22

CT w/ contrast

Check renal function labs before using contrast

Question 23

Leukocytosis w/ left shift
WBC casts
Colony counts >=10,000

Answer 23

Acute pyelonephritis

Question 24

Differentiate between Acute pyelonephritis and kidney stones

Answer 24

Acute pyelonephritis has flank/CVA pain that is worse with palpation
Kidney stones - severe pain in waves, radiates to groin

Question 25

First line tx for acute UNcomplicated pyelonephritis

Answer 25

Fluoroquinolones

Question 26

Very important part of outpatient tx for Acute pyelonephritis

Answer 26

pt MUST FOLLOW UP IN 24-48 HOURS -make sure your tx is working and they aren't getting septic or other complications

Question 27

Cystitis sx for more than 6 weeks Pain, pressure, discomfort in abscence of infection Mostly women Usu dx in 40's **Often coexists with other chronic pain conditions***

Answer 27

``` Interstitial cystitis aka Bladder Pain Syndrome aka Painful Bladder Syndrome ```

Question 28

Impacts of bladder pain syndrome

Answer 28

Sexual dysfunction High rates of depression (because pain all the time and crappy sex life)

Question 29

Most important central finding of bladder pain syndrome

Answer 29

Altered urothelium

Question 30

Glycosaminoglycan (GAG) layer commonly damaged

Answer 30

IC/BPS - Painful bladder syndrome | -neuropathic pain and voiding dysfxn

Question 31

Suprapubic/bladder pain, worse with bladder filling and relieved with voiding

Answer 31

IC/BPS - Painful bladder syndrome

Question 32

How to dx IC/BPS - Painful bladder syndrome

Answer 32

Exclusion: r/o infection with urinalysis w/ microscopy and urine culture Cytoscopy if in doubt *K+ sensitivity test not indicated

Question 33

First thing to do in tx of IC/BPS - Painful bladder syndrome

Answer 33

``` Lifestyle changes: Food diary and elimination diet Bladder training to hold it longer Low impact exercise Psychotherapy ```

Question 34

Second line tx for painful bladder syndrome

Answer 34

Oral meds: | Tricyclic antidepressants

Question 35

Why use amitriptyline (tricylcic antidepressant) instead of FDA recd Elmiron that has less side fx?

Answer 35

It works way faster