B5.076 Big Case: Dysura/UTI Flashcards
typical symptoms of cystitis
dysuria urgency frequency burning or pressure sensation fever or chills if severe (more common in pyelonephritis)
atypical symptoms of cystitis
lethargy
anorexia
new incontinence
psychiatric changes- mania, anorexia, delirium
who more commonly presents with atypical symptoms and why?
more common in the elderly
alterations in immune function may prevent some of the other “typical” symptoms
broad categories for differential diagnosis of dysuria
infectious
non-infectious
infectious causes of dysuria
cystitis (acute or chronic)
non cystitis infections (like STIs)
examples of noninfectious causes of dysuria
interstitial cystitis/bladder pain syndrome/chronic prostatitis chemical cystitis radiation cystitis BPH atrophic vaginitis bladder cancer
what is acute bacterial cystitis
bacterial infection of the lower urinary tract (bladder/urethra)
commonly called a UTI
symptoms of acute bacterial cystitis
inflammation in bladder and urethra causes dysuria, frequency, hematuria, urgency, incontinence
where do bacteria for UTIs originate?
GI tract
common: E.coli (85%), klebsiella, enterobacter, enterococcus
why are females more at risk for bacterial cystitis
shorter urethra
proximity of urethra to anus
bacterial cystitis related sexual activity in female gender
increased infections with increased sexual activity (honeymoon cystitis)
sexual activity leads to increased deposition of bacteria into urethra and bladder
void after sex or consider pericoital antibiotic prophylaxis
additional risk factors for bacterial cystitis outside of female gender
urinary retention/ incomplete bladder emptying
bladder stones or foreign bodies
urine “yo-yo”
what are bladder diverticula and how do they increase risk for cystitis
out pouching of bladder wall due to lack of muscle
when bladder contracts to expel urine, urine fills diverticula rather than exiting urethra due to path of lower resistance
what is vesicoureteral reflux (VUR)
congenital condition where urine can reflex from bladder into the kidney
muscles don’t close off ureters during voiding
what is acute bacterial pyelonephritis
bacterial infection of the kidney
infection of the upper urinary tract, usually a complication of a lower urinary tract infection
2 mechanisms for acute bacterial pyelonephritis
- ascending infection (most common, starts in bladder and migrates up ureters)
- hematogenous spread (uncommon, bacteria in bloodstream filter and deposit in kidneys)
symptoms of pyelonephritis
local: flank pain (SEVERE)
systemic: fever, chills, malaise, lethargy, nausea, vomiting
complication of pyelonephritis
bacteria can get into the bloodstream due to infecting the “filter”
more readily causes bacteremia compared to cystitis
can lead to sepsis
what are some manifestations of STIs that may mimic UTIs
urethritis from G&C in males
cervicitis in females
related to recent sexual contact
what is interstitial cystitis/bladder pain syndrome
an unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms
more than six weeks duration
absence of infection or other identifiable causes
causes associated with interstitial cystitis/bladder pain syndrome
increased stress pelvic floor trigger points menopause/atrophic vaginitis idiopathic psychosomatic changes in bladder sensation changes in bladder glycosaminoglycans
causes of chemical cystitis
caffeine (bladder irritant)
spicy foods
acidic foods (change bladder pH)
describe radiation cystitis
dysuria with negative culture in a patient with previous radiation
often had colon, prostate, or cervical neoplasms
what is BPH
benign prostatic hypertorphy
