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Clin Med III - GU/Renal > Cystitis, Pyelonephritis Maclary > Flashcards

Cystitis, Pyelonephritis Maclary Flashcards

1
Q

Define acute cystitis

A
  • Symptomatic bacterial infection of bladder

- Commonly called UTI

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2
Q

How does acute cystitis occur?

A

Bacteria establishes infection by ascending from urethra to the bladder

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3
Q

Risk factors for acute cystitis

A
  • Female
  • Hx of UTI
  • Recent sexual intercourse (use of diaphragm w/spermicide)
  • Diabetes
  • Incontinence/indwelling catheter
  • Anatomic abnormality
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4
Q

Pathogens of acute cystitis

A
  • E coli (70-90%)
  • Staph saprophyticus (5-15%)
  • Klebsiella, proteus, enterococcus, citrobacter (5-10%)
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5
Q

Clinical features of acute cystitis

A
  • Frequency, urgency, dysuria
  • Suprapubic discomfort
  • Gross hematuria
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6
Q

In acute cystitis, what does fever indicate?

A

Invasive infection

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7
Q

In acute cystitis, what does unilateral back pain indicate?

A

Upper urinary tract involvement

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8
Q

What is the MC cause of confusion in elderly?

A

UTI

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9
Q

What does urine dipstick show in acute cystitis?

A

Positive nitrites or leukocyte esterase

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10
Q

What does urinalysis show in acute cystitis?

A
  • Pyuria
  • Bacteriuria
  • Possible hematuria
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11
Q

What is the gold standard for diagnosis of acute cystitis?

A

Urine culture (but can take 24-48 hrs)

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12
Q

What is diagnostic for UTI?

A

100K colonies on urine culture

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13
Q

Treatment of UTI

A
  • Short term abx
  • Sitz bath
  • Urinary analgesics (pyridium)
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14
Q

Who qualifies for prophylactic abx to UTI?

A

Women with 3 or more episodes per year

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15
Q

Define interstitial cystitis

A
  • Painful bladder syndrome

- Pain when bladder fills and relieved by emptying

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16
Q

Who is most affected by interstitial cystitis?

A

Females
Age of onset 40 yo
Childhood bladder problems

17
Q

Diseases a/w interstitial cystitis

A
  • Severe allergies
  • IBS
  • IBD
18
Q

Treatment of interstitial cystitis

A
  • No cure, up to 50% may have spontaneous symptom remission
  • Hydrodistention
  • Amitriptyline, nifedipine
  • TENS unit, acupuncture
19
Q

What is the surgical treatment of interstitial cystitis?

A

Ureter diversion (last resort)

20
Q

Define pyelonephritis

A
  • Acute infectious inflammatory disease affecting kidney parenchyma and renal pelvis
  • Complication of a UTI
21
Q

How does pyelonephritis occur?

A

Bacteria ascend from bladder to ureter to kidney

22
Q

Pathogens of pyelonephritis

A
  • E coli, proteus, klebsiella, enterobacter, pseudomonas

- S aureus (usually spread by a hematogenous route)

23
Q

Clinical features of pyelonephritis

A
  • Fever, flank pain, chills
  • Urgency, frequency, dysuria
  • N/V, diarrhea
  • Tachycardia
  • CVA tenderness
24
Q

What do diagnostic studies of pyelonephritis show?

A
  • CBC: increased WBCs
  • UA: pyuria, bacteriuria, hematuria
  • Urine culture: heavy growth of offending organism
25
Q

Treatment of pyelonephritis

A
  • 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
26
Q

If IV tx is needed for pyelonephritis, how should it be given?

A
  • Combo of drugs

- Ampicillin w/an aminoglycoside, quinolone, or broad spectrum cephalosporin

27
Q

Who is most affected by urinary stone disease?

A
  • Males

- 3rd and 4th decades of life

28
Q

5 major types of urinary stonres

A
  1. Ca oxalate
  2. Ca phosphate
  3. Struvite
  4. Uric acid
  5. Cystine
29
Q

Risk factors for urinary stone disease

A
  • Hot humid climate
  • Sedentary
  • High protein, high salt diet
  • Genetic
30
Q

Urinary stone disease may be precursor to what disease?

A

CV disease

31
Q

Clinical features of urinary stone disease

A
  • Acute and severe pain to flank
  • N/V
  • Pain may radiate to groin, testes, vulva
32
Q

What will diagnose most urinary stones?

A

Abdominal x-ray and renal US

33
Q

What does UA show for urinary stone disease?

A

Microscopic or gross hematuria

34
Q

Treatment of urinary stone disease

A
  • Increase fluid intake
  • Decrease Na, animal protein, oxalate, purine intake
  • Medical expulsive therapy
  • Ureteroscopic stone extraction
  • Shockwave lithotripsy
  • Percutaneous nephrolithotomy
35
Q

High oxalate foods?

A

Blueberries
Strawberries
Spinach
Eggplant

36
Q

High purine foods?

A

Mussels
Sardines
Yeast products (beer)

37
Q

What are med treatments of urinary stone disease?

A

Alpha blocker
Ibuprofen
Oral steroid
(appropriate for first weeks, may need additional pain med)

Clin Med III - GU/Renal (9 decks)

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