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Clinical Med II > Exam 3 - Interstitial Cystitis > Flashcards

Exam 3 - Interstitial Cystitis Flashcards

1
Q

What can cause false negative nitrite urine dipstick results?

A
  • Non-nitrate reducing organisms

- Frequent urination/urine in bladder < 4 hours (not enough time to be reduced)

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2
Q

What can cause false positive leukocyte esterase urine dipstick results?

A
  • Vaginal contamination

- Trichomonas infection

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3
Q

What is the term for an upper urinary tract infection?

A

Pyelonephritis

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4
Q

What terms are used for a lower urinary tract infection?

A
  • Cystitis
  • Prostatitis
  • Urethritis
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5
Q

The urinary tract is normally sterile and resistant to bacterial colonization, so what do they occur from?

A

Ascending bacterial infections

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6
Q

What bacteria accounts for most UTI cases?

A

E. coli

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7
Q

Describe an acute simple cystitis.

A

Confined to the bladder with no signs or symptoms suggestive of an upper urinary tract or systemic infection

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8
Q

Describe an acute complicated UTI.

A

Acute UTI with signs/symptoms that suggest extension beyond the bladder such as fever, chills, flank pain, CVA tenderness, pelvic pain.

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9
Q

What special populations are more at risk of developing a complicated UTI?

A
  • Pregnant women
  • Men
  • Those with comorbidities, immunocompromised, or have underlying urologic abnormalities
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10
Q

What are common symptoms associated with ac acute simple cystitis?

A
  • Dysuria, urinary frequency, urgency
  • +/- hematuria
  • +/- suprapubic discomfort
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11
Q

Based on the following UA results, what do you suspect?

  • (+) Leukocyte esterase
  • (+) Nitrites
  • (+) Pyuria (> 10 leukocytes)
  • Bacteriuria
  • No WBC or RBC casts
A

Acute simple cystitis

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12
Q

When is a urine culture recommended?

A
  • Atypical presentation
  • Suspect complicated UTI
  • Symptoms do not resolve or recur
  • Suspect antimicrobial resistance
  • Special populations
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13
Q

What represents a positive culture in women with typical symptoms of cystitis?

A

> 10^2 CFU/mL

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14
Q

What can be used for symptomatic treatment in acute simple cystitis?

A

OTC Phenazopyridine (Pyridium) 200 mg TID prn for 2 days

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15
Q

What are the primary antibiotic therapies for acute simple cystitis in a non-pregnant woman?

A
  • Nitrofurantoin (Macrobid)
  • Bactrim
  • Fosfomycin

***Avoid Nitrofurantoin and Fosfomycin if early pyelonephritis due to low renal concentrations/unlikely to be effective

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16
Q

What are alternative antibiotic therapies for acute simple cystitis in a non-pregnant woman?

A
  • Beta-lactams (Augmentin, Cefdinir)

- Fluoroquinolones (Cipro, Levaquin)

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17
Q

What are the antibiotics options for acute simple cystitis in a pregnant woman?

Which antibiotic should be avoided?

A
  • Augmentin, Cefpodoxime, Fosfomycin
  • Nitrofurantoin or Bactrim - use/avoid based on trimester (consult/refer to OB)

Avoid Fluoroquinolones

18
Q

What are the primary antibiotic therapies for acute simple cystitis in men?

A
  • Nitrofurantoin (Macrobid)
  • Bactrim
  • Fosfomycin

***Same choices as a non-pregnant female, but must be given for longer duration of 7 days

19
Q

What are the primary antibiotic therapies for acute simple cystitis in patients with comorbidities, immunocompromised, or underlying urologic abnormalities?

A
  • Nitrofurantoin (Macrobid)
  • Bactrim
  • Fosfomycin

***Same choices as a non-pregnant female and men, but must be given for longer duration of 1-2 weeks

20
Q

Are follow-up urine cultures needed in patients with acute simple cystitis whose symptoms resolve on antibiotics?

A

No, except for pregnant women

21
Q

What are typical signs/symptoms in a patient with acute pyelonephritis/complicated UTI?

A
  • Dysuria, urinary frequency, urgency (lower urinary tract symptoms)
  • Flank pain
  • Fever, chills
  • GI symptoms
  • CVA tenderness
22
Q

Based on the following UA results, what do you suspect?

  • (+) Leukocyte esterase
  • (+) Nitrites
  • (+) Pyuria (> 10 leukocytes)
  • Bacteriuria
  • WBC casts present
A

Acute pyelonephritis

23
Q

What is the imaging test of choice if needed in acute pyelonephritis?

A

CT A/P (with and without contrast)

24
Q

What is the outpatient management for mild-moderate acute pyelonephritis?

A
  • Fluoroquinolones (Cipro or Levaquin x 5-7 days)
  • Bactrim x 7-10 days if pathogen is known to be susceptible
  • Initial IV/IM dose of Ceftriaxone followed by either Cipro or Levaquin if known to be FLQ resistant
  • Pyridium x 2 days for dysuria
25
Q

What a major part of the patient education in outpatient management for mild-moderate acute pyelonephritis?

A

Must follow-up in 48-72 hours!

26
Q

Describe Interstitial Cystitis.

A

Chronic debilitating condition characterized by bladder pain which often coexists with other chronic pain conditions. Patient experience symptoms for an average of 5-7 years before receiving a diagnosis.

27
Q

What is the general pathophysiology of Interstitial Cystitis?

A

Altered urothelium

28
Q

The following clinical presentation is associated with what condition?

  • Gradual onset with symptom duration of 6 weeks or greater
  • Suprapubic discomfort which often worsens with bladder filling and is relieved with voiding
  • +/- urinary urgency, frequency, nocturia
  • Pelvic pain with sexual dysfunction in men
A

Interstitial Cystitis/Bladder Pain Syndrome

29
Q

When evaluating Interstitial Cystitis/BPS, what should the physical exam include?

A
  • Abdominal exam
  • Bimanual pelvic exam in women
  • Rectal exam in males
30
Q

Knowing that IC/BPS is a diagnosis of exclusion, what should you do if there is positive hematuria on UA?

A

Order urine cytology and cystoscopy to rule out cancer

31
Q

Knowing that IC/BPS is a diagnosis of exclusion, what should you do if your patient has a positive smoking history?

A

Urine cytology

32
Q

Why would you order a postvoid residual urine volume when evaluating for IC/BPS?

A

To rule out bladder outlet obstruction or neuro disorder

33
Q

What will be seen on cystoscopy to support the diagnosis of IC/BPS?

A

May identify altered urothelium

  • Glomerulations
  • Hunner lesions
34
Q

What is the 1st line treatment for IC/BPS?

A
  • Behavioral and diet modifications
  • Bladder retraining
  • Psychotherapy/support groups
  • Pyridium for flares
35
Q

What is the 2nd line treatment for IC/BPS?

A
  • Tricyclic antidepressant (Amitriptyline)
  • Pentosan Polysulfate (Elmiron)
  • Antihistamines (Hydroxyzine)
  • Lidocaine
  • Pelvic PT
36
Q

What are some indications for referral in IC/BPS?

A
  • Hematuria
  • Complex symptoms (pain with incontinence)
  • Incomplete bladder emptying
  • Neuro disorder that affects bladder function
  • Prior pelvic radation
  • Prior pelvic surgery
  • Have not responded to initial tx with oral meds
37
Q

What is the etiology of overactive bladder (OAB)?

A

Detrusor muscle overactivity, leading to involuntary bladder contractions that cause leakage

38
Q

The following clinical presentation is most consistent with what disorder?

  • Frequent small volume voids that may keep patient up at night or worsen after taking a diuretic
  • Urge to void
A

Overactive Bladder (OAB)

39
Q

What is the 1st line treatment for OAB?

A
  • Pelvic floor muscle exercises
  • Lifestyle/Behavioral modifications
  • Bladder training
40
Q

What is the 2nd line treatment for OAB?

A
  • Antimuscarinics (Oxybutynin, Tolterodine, Solifenacin, Darifenacin - caution with side effects)
  • Beta 3 agonist (Mirabegron)

Clinical Med II (17 decks)

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