Cystitis + PyeloStone Flashcards
What is acute cystitis
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
What are some risk factors for cystitis? (6)
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
What are the common pathogens of cystitis? (3)
E. coli accounts for 70%-90% of isolates
Staph saprophyticus 5%-15%
Klebsiella, Proteus, Enterococcus, and Citrobacter 5%-10%
What are clinical features for cystitis? (6)
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
What are some diagnostic testing done for cystitis
Urinalysis-Pyuria, Bacteriuria, Poss Hematuria
Urine Culture-Gold Standard but results can take 24-48hrs
Imaging only for abnormal presentation
CT, US, cystoscopy
What is the treatment for cystitis (5)
Short term ABX therapy Concern about resistance to TMP Sulfa Sitz bath Urinary analgesics Pyridium
How do you prevent cystitis?
Women with 3 or more episodes per year are candidates for prophylactic ABX
Limit use of indwelling catheters
prognosis for cystitis
Infections respond rapidly to tx
Lack of response sugest ABX resistance or other cause for s/s
what is Interstitial Cystitis
Painful Bladder Syndrome
Pain when bladder fills and relieved by emptying
Associated urgency and frequency
Dx of exclusion
Epidemiology for interstitial cystitis
Affects females>males
Avg age of onset is 40yo
Likely to report childhood bladder problems
Etiology for interstitial cystitis?
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
Clinical features for interstitial cystitis
Pain with bladder filling and relief with urination
Urgency, frequency, nocturia
What is the treatment for interstitial cystitis
No cure Up to 50% may have spontaneous symptom remission Hydrodistention Amitriptyline, nifedipine TENS unit, accupuncture Surgery is last resort-ureter diversion Urology referral
Pyelonephritis
Acute infectious inflammatory disease affecting the kidney parenchyma and renal pelvis
Bacteria ascend from bladder to ureter to kidney
Complication of a UTI
What are the clinical features for pyelonephritis
Fever, flank pain, chills Urgency, frequency, dysuria Associated nausea, vomiting, diarrhea Tachycardia Pronounced CVA tenderness
Diagnostic studies for pyelonephritis
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
What is the treatment for pyelonephritis
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
If IV treatment needed for pyelonephritis should be what?
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
What are the 4 complications for pyelonephritis
Sepsis and shock
Abscess formation
Scarring
Chronic pyelonephritis
Epidemiology for Urinary Stone Disease
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
5 major types of stones
Calcium oxalate, calcium phosphate, struvite, uric acid, and cystine
Most common types are composed of calcium
5 risk factors for urinary stone disease
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
Clinical features of urinary stone disease
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
4 diagnostic tests for urinary stone disease
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
