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Clin Med- Renal/GU > Cystitis + PyeloStone > Flashcards

Cystitis + PyeloStone Flashcards

1
Q

What is acute cystitis

A

is a symptomatic bacterial infection of the bladder
Commonly called Urinary Tract Infection (UTI)
Bacteria establishes infection by ascending from the urethra to the bladder

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2
Q

What are some risk factors for cystitis? (6)

A 
Female
50%-80% of women will develop at least one UTI in their lifetime
Hx of UTI
Recent sexual intercourse
Diabetes
Incontinence/Indwelling Catheter
Anatomic Abnormality
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3
Q

What are the common pathogens of cystitis? (3)

A

E. coli accounts for 70%-90% of isolates
Staph saprophyticus 5%-15%
Klebsiella, Proteus, Enterococcus, and Citrobacter 5%-10%

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4
Q

What are clinical features for cystitis? (6)

A

Frequency, urgency, dysuria
Suprapubic discomfort
Gross hematuria
Fever is an indication of invasive infection
Unilateral back pain indicative that upper urinary tract involved
Physical exam often unremarkable
UTI is most common cause of confusion in elderly

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5
Q

What are some diagnostic testing done for cystitis

A

Urinalysis-Pyuria, Bacteriuria, Poss Hematuria
Urine Culture-Gold Standard but results can take 24-48hrs
Imaging only for abnormal presentation
CT, US, cystoscopy

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6
Q

What is the treatment for cystitis (5)

A 
Short term ABX therapy
Concern about resistance to TMP Sulfa
Sitz bath
Urinary analgesics
Pyridium
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7
Q

How do you prevent cystitis?

A

Women with 3 or more episodes per year are candidates for prophylactic ABX
Limit use of indwelling catheters

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8
Q

prognosis for cystitis

A

Infections respond rapidly to tx

Lack of response sugest ABX resistance or other cause for s/s

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9
Q

what is Interstitial Cystitis

A

Painful Bladder Syndrome
Pain when bladder fills and relieved by emptying
Associated urgency and frequency
Dx of exclusion

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10
Q

Epidemiology for interstitial cystitis

A

Affects females>males
Avg age of onset is 40yo
Likely to report childhood bladder problems

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11
Q

Etiology for interstitial cystitis?

A

Cause unknown, may be a combo of different entities with similar symptoms
Associated diseases include severe allergies, IBS, IBD
Theories include neurogenic and autoimmune causes

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12
Q

Clinical features for interstitial cystitis

A

Pain with bladder filling and relief with urination

Urgency, frequency, nocturia

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13
Q

What is the treatment for interstitial cystitis

A 
No cure
Up to 50% may have spontaneous symptom remission
Hydrodistention
Amitriptyline, nifedipine
TENS unit, accupuncture
Surgery is last resort-ureter diversion
Urology referral
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14
Q

Pyelonephritis

A

Acute infectious inflammatory disease affecting the kidney parenchyma and renal pelvis
Bacteria ascend from bladder to ureter to kidney
Complication of a UTI

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15
Q

What are the clinical features for pyelonephritis

A 
Fever, flank pain, chills
Urgency, frequency, dysuria
Associated nausea, vomiting, diarrhea
Tachycardia
Pronounced CVA tenderness
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16
Q

Diagnostic studies for pyelonephritis

A

CBC shows increased WBC
UA shows pyuria, bacteriuria, hematuria
Urine culture shows heavy growth of offending organism
Blood cultures
Imaging only done for complicated disease
Renal US, CT

17
Q

What is the treatment for pyelonephritis

A

Choose tx based on offending organism
Fluoroquinolones for first line tx for acute uncomplicated pyelo
May need IV therapy initially and switch to oral tx once response to tx observed

18
Q

If IV treatment needed for pyelonephritis should be what?

A

If IV tx needed a combo of drugs is desirable
Ampicillin with an aminoglycoside, quinolone, or broad spectrum cephalosporin
Follow up urine cultures once tx complete

19
Q

What are the 4 complications for pyelonephritis

A

Sepsis and shock
Abscess formation
Scarring
Chronic pyelonephritis

20
Q

Epidemiology for Urinary Stone Disease

A

Urinary stone disease is a common urologic problem
Afflicts 240,000-720,000 Americans per year
Lifetime incidence in US is 13% for men and 7% for women
Most common to present in 3rd and 4th decades of life

21
Q

5 major types of stones

A

Calcium oxalate, calcium phosphate, struvite, uric acid, and cystine
Most common types are composed of calcium

22
Q

5 risk factors for urinary stone disease

A 
Geography-Hot and humid climate 
Incidence is higher in summer
Sedentary occupation
High protein high salt diet
Genetic factors
Urinary stone disease may be precursor to CV disease
23
Q

Clinical features of urinary stone disease

A

Acute and severe pain, localized to flank
Nausea and vomiting
Pain may be episodic
Patient in constant motion
Pain may radiate to the groin, testes, or vulva

24
Q

4 diagnostic tests for urinary stone disease

A

UA shows microscopic or gross hematuria
Abdominal Xray (KUB) and renal US will dx most stones
CT may be done to evaluate flank pain
PTH and serum calcium levels

25
Q

Treatment for urinary stone disease

A 
Goal is to achieve a stone free status
Any small stone fragments may cause future stone development
Increase fluid intake
Decrease sodium intake
Limit animal protein intake
Decrease intake of oxalate and purines
26
Q

Medical Expulsive Therapy for urinary stone disease

A

Alpha blocker, ibuprofen, oral steroid
Appropriate for the first weeks
May need additional pain med

27
Q

Urinary Tract obstruction

A

Obstruction to the flow of urine
Impairs renal and urinary conduit function
Common cause of acute and chronic kidney disease
Early dx and tx are essential

28
Q

Urinary Tract Obstruction clinical features

A

Depends on location, extent (partial or complete), and duration
Also depends if one or both kidneys are affected
Pt may be asymptomatic
Pain, Hematuria, change in urinary output
HTN, palpable mass, repeated UTI
Hesitancy, urgency, incontinence, change in stream, nocturia

29
Q

diagnostic testing for urinary tract obstruction

A 
UA-hematuria, pyuria, bacteriuria
Labs-CBC, Lytes, BUN/Creat
US
Abdominal xray-stones
CT
IV Urogram
Endoscopic evaluation
30
Q

Urinary Tract Obstruction

A

Restore normal urine flow as quickly as possible
Tx coexisting infection
Tx depends on cause and location of obstruction
Analgesics (stones)
BPH-Alpha 2 blockers, surgery

Clin Med- Renal/GU (7 decks)

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