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X Clin Med II Exam 3 > UTIs and Interstitial cystitis > Flashcards

UTIs and Interstitial cystitis Flashcards

(54 cards)

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1
Q

When is the urine dipstick most accurate for predicting a UTI?

A

When positive for leukocyte esterase and/or nitrite in a symptomatic pt
BUT negative doesn’t always r/o and positive doesn’t always support when asymptomatic

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2
Q

What can cause a false negative nitrite urine dipstick result?

A

Non-nitrate reducing organisms

Frequent urination/urine in bladder < 4 hrs

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3
Q

What can cause false positive leukocyte esterase urine dipstick results?

A

Vaginal contamination

Trichomonas infection

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4
Q

Kinds of upper vs lower tract UTIs

A

Upper: pyelonephritis
Lower: cystitis, prostatitis, urethritis

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5
Q

What must you rule out with a UTI in males?

A

Urethritis and prostatitis

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6
Q

What causes most UTIs?

A

Ascending bacterial infection (rest are hematogenous)

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7
Q

What microbe causes most UTIs?

A

E. coli

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8
Q

Risk factors for UTIs

A

Reduced urine flow
Promote colonization
Facilitate ascent

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9
Q

Examples of reduced urine flow

A 
Urine outflow obstruction
Inadequate fluid intake
Neurogenic bladder (urinary retention)
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10
Q

Examples of colonization promotion in UTIs

A

Sex
Spermicide use
Recent antimicrobial use

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11
Q

Ways to facilitate ascent in UTIs

A

Catheters
Urinary incontinence
Fecal incontinence

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12
Q

What is acute simple cystitis?

A

Acute UTI presumed to be confined to bladder in a non-pregnant individual (only irritative voiding sxs)

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13
Q

What is an acute complicated UTI?

A

Acute UTI accompanied by sxs that suggest extension of infection beyond bladder
Sxs: fever, chills, rigor, fatigue, flank pain, CVAT, pelvic or perineal pain in men

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14
Q

Who are the special populations when considering UTIs?

A

Pregnant women
Men
Pts with comorbidities, immunocompromised conditions or underlying urologic abnormalities

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15
Q

Sxs of acute simple cystitis

A

Dysuria, urinary frequency and urgency (maybe hematuria or suprapubic discomfort)

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16
Q

What is an atypical presentation in elderly for UTIs?

A

Incontinence and mental status changes

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17
Q

What is seen on a urine dipstick in acute simple cystitis?

A

Leukocyte esterase and nitrites

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18
Q

What is seen on urine microscopy in acute simple cystitis?

A

Pyuria (>10 leukocytes/microL)
Bacteriuria
(may see hematuria)

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19
Q

B/c cultures are not usually needed for acute simple cystitis, when is it recommended?

A 
Atypical presentation/diagnostic uncertainty
Suspect complicated UTI
Sxs that do not resolve or recur
Suspect resistance
Special populations
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20
Q

What is diagnostic for acute simple cystitis on urine culture?

A

> 10000 CFU or uropathogen (positive culture is >1000 CFU in women with typical sxs)

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21
Q

Symptomatic tx for acute simple cystitis

A

Urinary analgesic, PTC phenazopyridine for urgency and frequency

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22
Q

How long should a pt use symptomatic tx for acute simple cystitis?

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A

2 days (don’t want to mask sxs)

23
Q

Abx tx for acute simple cystitis when not pregnant

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A

Nitrofurantoin (macrobid)
Bactrim
Fosfomycin
(can use augmentin, cefdinir, cipro, levaquin if needed)

24
Q

When would you not use nitro or fosfomycin for acute simple cystitis?

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A

If early pyelonephritis (due to low renal concentrations)

25
Tx options for pregnant women with acute simple cystitis
Augmentin, cephalexin, cefpodoxime, fosfomycin Don't use nitro in 1st and 3rd trimester Avoid fluoroquinolones!
26
Tx options for men with acute simple cystitis
Primary therapy for longer (7 days) | R/o prostatitis
27
Tx for pts with comorbidities etc that have acute simple cystitis
Primary therapy for longer (1-2 wks)-low threshold to manage as complicated UTI
28
F/u urine cultures for acute simple cystitis?
Not needed when sxs resolve with tx (except pregnant) | *same for acute pyelonephritis
29
How does acute pyelonephritis arise?
Ascent of bacterial pathogen up ureters form bladder to kidneys
30
Presentation of acute pyelonephritis
``` Normal UTI sxs Flank pain Fever, chills, malaise N/v, anorexia, abdominal pain Fever CVAT ```
31
What is seen on the UA and urine culture in acute pyelonephritis?
``` +leukocyte esterase +nitrites Pyuria (>10 leukocytes/microL) Bacteriuria Maybe hematuria White blood cell casts (renal origin for pyuria) ```
32
What is a positive urine culture for acute pyelonephritis?
>1000000 CFU/mL
33
When is imaging indicated for acute pyelonephritis?
Severely ill Persistent sxs despite 48-72 hrs of abx Suspicion for urinary tract obstruction Recurrent sxs within few wks of sxs
34
What is the image of choice for acute pyelonephritis?
CT A/P (with or w/o contrast)
35
Tx of acute pyelonephritis for outpatient with mild-moderate illness
Fluoroquinolones (if resistance then have IV dose of ceftriaxone first) If susceptible to bactrim then do that for 7-10 days
36
When must a pt with acute pyelonephritis f/u?
24-48 hrs!
37
Indications for hospitalization with acute pyelonephritis
``` Critically ill/hemodynamic instability Persistently high fever Persistent pain/ marked debility Suspected or documented obstruction Metabolic derangements Unable to take liquids by mouth Concerns about compliance for f/u ```
38
Tx of acute pyelonephritis for complicated/severe illness
``` Fluroquinolone Extended spectrum cephalosporin Extended spectrum penicillin Carbapenem Aminoglycoside (plazomycin) *support (analgesics, anti-emetic, IVF) ```
39
Complications that might be associated with acute pyelonephritis
Sepsis with shock Renal failure Scarring or chronic pyelonephritis (kidney disease also) Renal abscess formation (inadequate therapy)
40
What is interstitial cystitis?
Bladder pain syndrome Chronic debilitating condition characterized by bladder pain and voiding sxs for over 6 wks in absence of infection or other causes *impacts psychosocial and quality of life
41
What often coexists with interstitial cystitis?
Chronic pain conditions (fibromyalgia, irritable bowel syndrome)
42
What is the pathophysiology of interstitial cystitis?
Altered urothelium due to combo of disruption of glycosaminoglycan layer, bladder urothelial injury, secretion of proinflammatory substances, neural hypersensitivity and neuropathic pain/voiding dysfunction
43
Presentation of interstitial cystitis
Suprapubic/bladder pain (worse with filling and relieved with voiding) +/- urinary urgency, frequency, nocturia +/- pain in pelvis, perineum, urethra, ABD, back +/- dyspareunia, vaginal burning Men: pelvic pain with sexual dysfunction
44
Why is a UA with microscopy and urine culture used in interstitial cystitis?
Diagnosis of exclusion Done to exclude infection and hematuria If + hematuria then urine cytology and cystoscopy (also this for +smoking history)
45
Why is postvoid residual urine volume used for interstitial cystitis?
R/O bladder outlet obstruction or neuro disorder
46
Why is cystoscopy used for interstitial cystitis?
If in doubt | Bladder hydrodistention done to detect glomerulation (submucosal hemorrhage)
47
What can be seen on a cystoscopy for interstitial cystitis?
ID altered urothelium (glomerulations, hunner lesions)
48
First line tx for interstitial cystitis
``` Self care and behavior modifications Diet Bladder retraining by increasing voiding intervals) Low impact exercise Psychotherapy Analgesics (pyridium) ```
49
Second line tx for interstitial cystitis
``` Oral meds (tricyclic antidepressant-amitriptyline, pentosan polysulfate-elmiron or antihistamines-hydroxyzine) Intravesical meds like lidocaine Pelvic PT ```
50
Third line tx for interstitial cystitis
Cystoscopy with short duration, low pressure bladder hydrodistention (anesthesia) Intravesical instillation of glycosaminoglycans Intravesical dimethyl sulfoxide *urology from here on
51
Fourth line tx for interstitial cystitis
Intradetrusor botulinum toxin | Sacral neuromodulation
52
Fifth line tx for interstitial cystitis
Cyclosporine
53
Sixth line tx for interstitial cystitis
Surgery (urinary diversion)
54
Indications for referral for interstitial nephritis
``` Hematuria Complex sxs (pain with incontinence) Incomplete bladder emptying Neurologic disorder that affects bladder function Prior pelvic radiation Prior pelvic surgery Not responded to initial tx ```

X Clin Med II Exam 3 (6 decks)

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