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Clinical Med II Exam 3 (Annie and Lauren) > Cystitis, Pyelo, Interstitial Cystitis > Flashcards

Cystitis, Pyelo, Interstitial Cystitis Flashcards

1
Q

Urine dipstick is most accurate in predicting UTI when positive for _________ and/or _________ in ______patients

A

Leukocyte esterase

Nitrite

Symptomatic

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2
Q

Does a negative dipstick rule out UTI in symptomatic pts

A

No

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3
Q

Does a positive dipstick support a UTI in asymptomatic pts

A

No

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4
Q

What can cause false negative nitrite on a dipstick

A

Non-nitrate reducing organisms

Frequent urination/urine in bladder <4hrs

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5
Q

What can cause a false positive leukocyte esterase on dipstick

A

Vaginal contamination

Trichomonas

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6
Q

Upper urinary tract infections are called

A

Pyelonephritis

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7
Q

Lower UTIs are called

A

Cystitis

Or prostatitis or urethritis but thats not what this lecture is about

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8
Q

In men aged 20-50 yo, most UTIs are _________

A

Urethritis or prostatitis

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9
Q

UTI’s are 50x more common in

A

Women

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10
Q

95% of UTIs occur from _____________

A

Ascending bacterial infection

The rest are hematogenous

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11
Q

What bacteria most commonly causes UTI

A

E. coli

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12
Q

Let’s see a list of other pathogens that cause UTIs in immunocompromised ppl

A

Let’s not because its prob not on test

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13
Q

What are the 3 broad categories of UTI risk factors

A
  1. Reduced urine flow- obstruction, dehydrated, neurogenic bladder
  2. Promote colonization- sex, spermicide use, recent abx use
  3. Facilitate ascent- catheterization, urinary/fecal incontincenc
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14
Q

What is the definition of Acute Simple Cystitis

A

UTI confined to the bladder

Non pregnant

No sx that suggest upper UTI/systemic infection

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15
Q

What is the definition of acute complicated UTI

A

S/s that suggest extension of infection beyond the bladder:

Fever, chills, rigor, fatigue/malaise, flank pain, CVA tenderness, pelvic/perineal pain in men

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16
Q

Who are “special populations” when they get UTIs

A

Pregnant women

Men

Pts with comordiities, immunocompromised, urologic abnormalities

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17
Q

What are irritative voiding sx

A

Dysuria

Urinary frequency

Urgency

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18
Q

What population may have an atypical presentation of UTI

A

Elderly

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19
Q

Can acute simple cystitis include hematuria or suprapubic discomfort

A

Yes, may or may not be present.

Irritative voiding sx ALWAYS present though

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20
Q

What will you find when you do your exam on someone with acute simple cystitis

A

NORMAL EXAM

Mightttt find suprapubic tenderness but thats it

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21
Q

What do you need to do with your patients urine sample if they have acute simple cystitis

A

Dipstick: +leukocyte esterase and nitrites

Microscopy: Pyuria and Bacteriura

+/- pregnancy test

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22
Q

Do you need to a urine culture for acute simple cystitis

A

No

Might do it to check for drug resistance bugs

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23
Q

When do you NEED to do a urine culture for acute simple cystitis

A

Atypical presentation/diagnostic uncertainty

Suspect complicated UTI

Sx do not resolve

Suspect antimicrobial resistance (recently took abx)

Special populations- men, pregnant, immunocompromised

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24
Q

What values on your urine culture will represent positive cultures

A

10^3 CFUs

But….. 10^2 CFUs is considered positive if the patient has typical UTI symptoms

25
Q

How do you treat the sx of acute simple cystitis

A

OTC Phenazopyridine (Pyridium) 200mg TID prn

NO MORE THAN 2 DAYS

TURNS PEE ORANGE

(Dont know if dosages are important )

26
Q

What is the antibiotic treatment for Acute Simple Cystitis for a NON-pregnant person

A

Nitrofurantoin (Macrobid) 100mg BID x 5 days

Bactrim 160/800 BID x 3 days

Fosfomycin (monaural) 3gm PO single dose

27
Q

When should you not use bactrim for acute simple cystitis

A

20% of the local E. coli are resistant

28
Q

Can you use nitrofurantoin (macrobid) or Fosfomycin (Monurol) for early pyelonephritis

A

No, they do not penetrate the kidney enough

29
Q

What are some alternative abx for acute simple cystitis in a non pregnant person if you’re concerned about allergies or cost or whatever (probably not on test)

A

Beta lactams- augmentin, cefdinir

Fluoroquinolones- Ciprofloxacin, Levaquin etc

30
Q

What are your antibiotic options for acute simple cystitis in a PREGNANT woman

A

Augmentin, cephalexin, cefpodoxime, fosfomycin

Nitrofurantoin/Bactrim- ask their OB if its ok

**AVOID FLUOROQUINOLONES **!!

31
Q

How do you treat acute simple cystitis in MEN

A

Primary therapies for a longer duration (7 days)

**must rule out prostatitis - dribbling, enlarged prostate, etc

32
Q

How do you treat acute simple cystitis in patients who are immunicompromised or have underlying urologic abnormalities

A

Primary therapies for longer (1-2 weeks)

-low threshold to manage as complicated UTI

33
Q

What are the things you need to educate your pt about for acute simple cystitis

A

Drink more water

Void when you need to

Wash your snatch

Pee after sex?

Finish abx- expect relief within 48hrs

go to ER if sx of pyelonephritis

34
Q

Do you need to do follow up urine cultures for acute simple cystitis ?

A

only pregnant women

35
Q

What are some sx that suggest pyelonephritis instead of cuystsits

A

Flank pain

Constitutional sx (fever,chills, maialise)

GI sx (N/V abdominal pain)

CVA tenderness

36
Q

What do you need to do with the urine sample if you suspect pyelonephritis

A

Dipstick: leukocyte esterase, nitrites

Microscopy: Pyuria (>10 leukocytes/mL), bacteriuria, WBC casts***

Culture: positive if >10^5 CFU

37
Q

Do you need to do a CBC or BMP for pyelonephritis

A

No, but if you did:

CBC: leukocytosis w left shift

BMP: assess renal function, hydration, electrolytes (due to nausea/vomiting)

38
Q

Do you need to do imaging for pyelonephritis?

A

No. Only if you suspect an obstruction.

You’d do a CT with and without contrast

39
Q

What is the antibiotic treatment for mild-moderate pyelonephritis?

A

Cipro 500mg BID x 5-7 days

Cipro-ER 1000mg once/day x 5-7 days

Levofloxacin- 750mg once/day x 5-7 days

If local resistance to Fluoroquinolones, provide an initial IV/IM dose of ceftriaxone 1g in addition to Fluoroquinolones

40
Q

If you treat your pt for mild-mod pyelonephritis as an outpatient, when do they NEED to follow up?

Do you need to get follow up cultures?

A

24-48hrs!!!

F/u cultures only if pregnant

41
Q

When do you need to hospitalize your pt for pyelonephritis

A

Suspected obstruction***

Critically ill/hemodynamically unstable

Persistently high fever >103 F

Marked pain

Metabolic derangements

Unable to take liquids PO

Concerns about compliance with f/u

42
Q

What kind of IV antibiotics can you give during inpatient treatment for complicated/severe pyelonephritis?

A

Fluoroquinolones

Broad spectrum cephalosporin

Broad spectrum PCN

Carbapenem

Aminoglycoside

43
Q

What complications are you looking for at the 24-48 hr follow up

A

Sepsis

Renal failure

Scarring/chronic pyelo

Renal abscess formation

44
Q

What are the other 2 names for interstitial cystitis

A

Bladder pain syndrome

Painful bladder syndrome

45
Q

What is the definition of IC

A

Unpleasant sensation perceived to be related to the bladder, associated with UTIO sx of more than 6 weeks duration in the absence of infection or other identifiable causes

46
Q

Who usually gets IC?

A

Women

4th decade or older

Other chronic pain: fibromyalgia, IBS

47
Q

Interstitial Cystitis is: Chronic debilitating condition characterized by bladder pain

A

No question just read it becasue she put it in red and I didn’t know how to make a card

48
Q

How can IC impact your life

A

Psychosocial functioning

Quality of life

Sexual dysfucntion

Sleep dysfunction

Depression

49
Q

What is the pathophysiology of IC?

A

ALTERED UROTHELIUM🐝

Caused by some combination of these things that probably wont be on the test:

Disruption of GAG layer

Bladder urothelilal injury

Secretion of proinflammatory substances, mast cell activation, fibrosis

Neural hypersensitivity

Neuropathic pain and voiding dysfunction

50
Q

What are the presenting symptoms of IC

A

Suprapubic/bladder pain that is often WORSE with bladder filling and RELIEVED with voiding***

+/- urgency, frequency, nocturia

+/- pain in other areas, vaginal burning

51
Q

How long must sx last for a diagnosis of IC

A

6 weeks *******

52
Q

Yes yes we all know that IC is a ~diagnosis of exclusion~ but what are the most important things to rule out

A

Cancer

Infection

53
Q

What will you see on cystoscopy if the patient has IC?

A

ALTERED UROTHELIUM

54
Q

What is the 1st line tx for IC

A

Self care

Diet mods- avoid citrus, acid, spicy, caffeine, etoh, soda

Bladder retraining (⬆️voiding intervals)

exercise

psychotherapy/support gourps

Pyridium (short term 2 day use for flares)

55
Q

What is the 2nd line to for IC?

A

Tricyclics antidepressant (Amitriptyline)

Pentosan Polysulfate (Elmiron) - FDA approved for IC. Takes 3-6 months to work

Antihistamines (Hydroxyzine)

Lidocaine in the bladder

Pelvic physical therapy

56
Q

What is the 3rd line tx for IC

A

Cystoscopy with short duration bladder hydro distention (under anesthesia)

Intravesical instillation of GAGs

Intravesical Dimethyl sulfoxide

57
Q

What are the 4-6th line tx of IC

A

4th: Botox, sacral neuromodulation
5th: cyclosporine
6th: surgery

58
Q

Do you NEED to do cystoscopy to diagnose IC?

A

No, but it will support you dx when you see that ALTERED UROTHELIUM

Clinical Med II Exam 3 (Annie and Lauren) (5 decks)

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