Epididymitis, Hydrocele, Cystitis Flashcards
What drug can accumulate and cause epididymitis?
amiodarone
What inflammatory condition can cause epididymitis?
Behcet’s disease (painful oral and genital ulcers, uveitis)
If an acute baterial infection is to blame for epididymitis, what organisms are usually to blame in what age groups?
Men <35 = Neisseria gonorrhoeae, Chlamydia
Men >35 = E. coli
If epididymitis is suspected how can you treat the patient?
Antibiotics (Ceftriaxone IM if STD, Levofloxacin if no STD)
+ scrotal support, pain medications, scrotal support
Technically how long do symptoms need to last for it to be considered chronic epididymitis?
3 months
Acute vs. Chronic Epididymitis: which will a Doppler ultrasound of the scrotum be more helpful?
Ultrasound more helpful in Chronic epididymitis
Hydrocele: etiology (3)
- Epididymitis
- Torsed appendix testis
- Idiopathic**
Hydrocele: Presentation and examination
- Unilateral enlargement
- Transillumination
- Ultrasound
Hydrocele: Treatment
- injection of sclerosing agent (Doxycycline) [done in office, local anesthesia]
- Hydrocelectomy [not likely to recur, done in the OR]
How is cystitis diagnosed?
Urinalysis:
- Leukocytes esterase positive
- Nitrite positive
- Pyuria >5
- Bacteria
Urine culture:
>100,000 organisms, monoculture
What is the most common cause of cystitis?
E. coli
others: Klebsiella, Enterobacter, Proteus, Pseudomonas
If your patient has Cystitis what are the 2 first line treatment options?
Trimethoprim/Sulfamethoxazole DS BID for 3 days
or
Nitrofurantoin (Macrobid) 100mg BID for 7 days
What are 3 important considerations with Nitrofurantoin (Macrobid)
- Long term use is associated with pulmonary fibrosis in elderly
- Not powerful enough to treat pyelonephritis
- Need to monitor Creatinin
What are two other antibiotics that can be used for cystitis but are not 1st line?
Amoxicillin
Fluroquinolones
What should be done if symptoms persist post treatment?
- ensure compliance
- Re-culture
- Check post void residual
