Cystitis, Pyelonephritis, Prostatitis, Urinary Stones (Tyler)

Question 1

Cystitis DDx

Answer 1

Pyelonephritis

Urethritis

Vaginitis

Prostatitis

Asymptomatic bacteriuria (ASB)

Interstitial cystitis

Pelvic inflammatory disease (PID)

Urinary calculi

Radiation or chemical cystitis, e.g., cyclophosphamide

Bladder cancer

Urinary incontinence

Question 2

ASB

Answer 2

asymptomatic baceriuria

Question 3

when is a diagnosis of ASB made?

Answer 3

only when the pt does not have local or systemic symptoms referable to the urinary trct

bacteria is usually detected incidentally when patient undergoes screening urine culture for unrelated reason

Question 4

cystitis common sx

Answer 4

dysuria
urinary frequency
urgency

Question 5

elderly patients often present with cystitis how

Answer 5

asymptomatically because their immune system is weak and they fail to mount a response

Question 6

what is the main thing that differentiates cystitis from pyelonephritis

Answer 6

fever, with pyelonephritis

Question 7

fever of pyelonephritis

Answer 7

high spiking ‘picket fence’ pattern and resolves over 72hr of therapy

bacteremia develops in 20-30% of cases

Question 8

patients who have pyelonephritis with diabetes may present how

Answer 8

with obstructive uropathy associated with acute papillary necrosis when the sloughed off papillae obstruct the ureter

Question 9

when is papillary necrosis common besides DM

Answer 9

sickle cell
analgelsic nephropathy
obstruction

Question 10

emphysematous pyelonephritis

Answer 10

severe form of pyelonephritis that is associated with production of gas in renal and perinephric tissue that basically only happens in diabetic patients

Question 11

common complication of pyelonephritis

Answer 11

intraparenchymal abcess formation

Question 12

acute bacterial prostatitis presents how

Answer 12

dysuria
frequency
and pain in perineal area

fever and chills are usually present and often patient complains of pressure or pain in perineal pain

Question 13

chronic bacterial prostatitis presents

Answer 13

more insidiously as recurrent episodes of cystitis

sometimes with associated pelvic and perineal pain

men who present with recurrent cystitis should be evaluated for a prostatic focus as well as urinary retention

Question 14

complicated UTI

Answer 14

presents as a symptomatic episode of cystitis or pyelonephritis in a man or woman with an anatomic predisposition to infection, with a foreign body in the urinary tract, or with factors predisposing to a delayed response to therapy

Question 15

why does heart failure present with nocturia

Answer 15

HF can lead to reduced renal perfusion during the day while patient is upright, when you lie down it normalizes, creating diuresis

Question 16

Urinary Stone Disease essentials of diagnosis

Answer 16

severe flank plank

nausea and vomiting

identification on non-contrast CT or US

Question 17

Urinary Stone Disease general considerations

Answer 17

M:F 2.5:1

incidence is greatest during summer months

contributing factors to urinary stone formation

3rd and 4th decades

Question 18

Urinary Stone Disease genetic factors

Answer 18

Cystinuria

Distal renal tubular acidosis

High protein and high salt intake

Persons in sedentary occupations have a higher incidence than manual laborers

Increasing evidence is revealing that urinary stone disease may be a precursor to subsequent cardiovascular disease

Question 19

five major urinary stones

Answer 19

Calcium oxalates

Calcium phosphate

Struvite (magnesium ammonium phosphate)

Uric acid

Cystine

Question 20

calcium stones are

Answer 20

radiopaque

Question 21

uric acid stones are

Answer 21

radiolucent

Question 22

hyperuricosuric calcium nephrolithiasis

Answer 22

is secondary to dietary excess or uric acid metabolic defects

Question 23

Hypercalciuric calcium nephrolithiasis

Answer 23

can be caused by absorptive, resporptive, and renal disorders

Question 24

hyperoxaluric calcium nephrolithiasis

Answer 24

usually due to primary intestinal disorders including chronic diarrhea, IBD, and steatorrhea

Question 25

Uric acid calculi contributing factors

Answer 25

Low urinary pH

Myeloproliferative disorders

Malignancy with increased uric acid production

Abrupt and dramatic weight loss

Uricosuric medications

Question 26

struvite calculi

Answer 26

(magnesium-ammonium-phosphate, “staghorn” calculi)

Occur with recurrent urinary tract infections with urease-producing organisms, including Proteus, Pseudomonas, Providencia and, less commonly, Klebsiella, Staphylococcus, and Mycoplasma (but not Escherichia coli)

Urine pH ≥ 7.2

Question 27

Cystine Calculi

Answer 27

inherited disorder with recurrent stone disease

Question 28

Signs and Symptoms of Kidney stones

Answer 28

Colicky pain in the flank, usually severe

Nausea and vomiting

Patients constantly moving—in sharp contrast to those with an acute abdomen

Pain episodic and radiates anteriorly over the abdomen

With stone in the ureter, pain may be referred into the ipsilateral groin

With stone at the ureterovesical junction, marked urinary urgency and frequency; pain may radiate to the tip of the penis

After the stone passes into the bladder, there typically is minimal pain with passage through the urethra

Stone size does not correlate with severity of symptoms

Question 29

Laboratory Tests for stones

Answer 29

Urinalysis

Microscopic or gross hematuria (~90%)

Absence of microhematuria does not exclude urinary stones

urinary pH

Question 30

urinary pH <5.5

Answer 30

suggestive of uric acid or cystine stones

Question 31

Urinary pH of >7.2

Answer 31

suggestive of a struvite infection stone

Question 32

urinary pH between 5.5 and 6.8 indicates

Answer 32

calcium stone

Question 33

Acute bacterial Prostatitis diagnostic essentials

Answer 33

Fever

Irritative voiding symptoms

Perineal or suprapubic pain

Exquisite tenderness on rectal examination

Positive urine culture

Question 34

Acute bacterial Prostatitis considerations

Answer 34

usual organisms E. Coli and pseudomonas

less commonly enterococcus

Question 35

Acute bacterial Prostatitis signs and symptoms

Answer 35

Perineal, sacral, or suprapubic pain

Fever

Irritative voiding complaints

Obstructive symptoms

Urinary retention

Exquisitely tender prostate

Question 36

Acute bacterial Prostatitis lab tests

Answer 36

Complete blood count: leukocytosis and a left shift

Urinalysis: pyuria, bacteriuria, hematuria

Urine culture: positive

Question 37

Acute bacterial Prostatitis therapeutic procedures

Answer 37

Suprapubic drainage if urinary retention

Urethral catheterization, instrumentation, and prostatic massage is contraindicated

Question 38

Acute bacterial Prostatitis f/u

Answer 38

Posttreatment urine culture

Posttreatment examination of expressed prostatic secretions after completion of therapy

Prognosis

With effective treatment, chronic bacterial prostatitis is rare

Question 39

Acute bacterial Prostatitis when to refer

Answer 39

evidence of urinary retention

evidence of chronic prostatitis

Question 40

Acute bacterial Prostatitis when to admit

Answer 40

signs of sepsis

need for surgical drainage of bladder or prostatic abscess