Cystitis, Pyelonephritis Maclary Flashcards
Define acute cystitis
- Symptomatic bacterial infection of bladder
- Commonly called UTI
How does acute cystitis occur?
Bacteria establishes infection by ascending from urethra to the bladder
Risk factors for acute cystitis
- Female
- Hx of UTI
- Recent sexual intercourse (use of diaphragm w/spermicide)
- Diabetes
- Incontinence/indwelling catheter
- Anatomic abnormality
Pathogens of acute cystitis
- E coli (70-90%)
- Staph saprophyticus (5-15%)
- Klebsiella, proteus, enterococcus, citrobacter (5-10%)
Clinical features of acute cystitis
- Frequency, urgency, dysuria
- Suprapubic discomfort
- Gross hematuria
In acute cystitis, what does fever indicate?
Invasive infection
In acute cystitis, what does unilateral back pain indicate?
Upper urinary tract involvement
What is the MC cause of confusion in elderly?
UTI
What does urine dipstick show in acute cystitis?
Positive nitrites or leukocyte esterase
What does urinalysis show in acute cystitis?
- Pyuria
- Bacteriuria
- Possible hematuria
What is the gold standard for diagnosis of acute cystitis?
Urine culture (but can take 24-48 hrs)
What is diagnostic for UTI?
100K colonies on urine culture
Treatment of UTI
- Short term abx
- Sitz bath
- Urinary analgesics (pyridium)
Who qualifies for prophylactic abx to UTI?
Women with 3 or more episodes per year
Define interstitial cystitis
- Painful bladder syndrome
- Pain when bladder fills and relieved by emptying
Who is most affected by interstitial cystitis?
Females
Age of onset 40 yo
Childhood bladder problems
Diseases a/w interstitial cystitis
- Severe allergies
- IBS
- IBD
Treatment of interstitial cystitis
- No cure, up to 50% may have spontaneous symptom remission
- Hydrodistention
- Amitriptyline, nifedipine
- TENS unit, acupuncture
What is the surgical treatment of interstitial cystitis?
Ureter diversion (last resort)
Define pyelonephritis
- Acute infectious inflammatory disease affecting kidney parenchyma and renal pelvis
- Complication of a UTI
How does pyelonephritis occur?
Bacteria ascend from bladder to ureter to kidney
Pathogens of pyelonephritis
- E coli, proteus, klebsiella, enterobacter, pseudomonas
- S aureus (usually spread by a hematogenous route)
Clinical features of pyelonephritis
- Fever, flank pain, chills
- Urgency, frequency, dysuria
- N/V, diarrhea
- Tachycardia
- CVA tenderness
What do diagnostic studies of pyelonephritis show?
- CBC: increased WBCs
- UA: pyuria, bacteriuria, hematuria
- Urine culture: heavy growth of offending organism
Treatment of pyelonephritis
- Choose tx based on organism
- Fluoroquinolones 1st line for acute uncomplicated pyelo
- May need IV therapy initially and switch to oral once response is observed
- FU urine culture once tx is complete
If IV tx is needed for pyelonephritis, how should it be given?
- Combo of drugs
- Ampicillin w/an aminoglycoside, quinolone, or broad spectrum cephalosporin
Who is most affected by urinary stone disease?
- Males
- 3rd and 4th decades of life
5 major types of urinary stonres
- Ca oxalate
- Ca phosphate
- Struvite
- Uric acid
- Cystine
Risk factors for urinary stone disease
- Hot humid climate
- Sedentary
- High protein, high salt diet
- Genetic
Urinary stone disease may be precursor to what disease?
CV disease
Clinical features of urinary stone disease
- Acute and severe pain to flank
- N/V
- Pain may radiate to groin, testes, vulva
What will diagnose most urinary stones?
Abdominal x-ray and renal US
What does UA show for urinary stone disease?
Microscopic or gross hematuria
Treatment of urinary stone disease
- Increase fluid intake
- Decrease Na, animal protein, oxalate, purine intake
- Medical expulsive therapy
- Ureteroscopic stone extraction
- Shockwave lithotripsy
- Percutaneous nephrolithotomy
High oxalate foods?
Blueberries
Strawberries
Spinach
Eggplant
High purine foods?
Mussels
Sardines
Yeast products (beer)
What are med treatments of urinary stone disease?
Alpha blocker
Ibuprofen
Oral steroid
(appropriate for first weeks, may need additional pain med)
