Exam 3: UTI, Cysitis, Pyelo Flashcards
** is the most accurate in predicting UTI when positive for ** in symptomatic patients.
Urine dipstick
Leukocyte esterase
What can cause false negative nitrate in urine dipstick results?
- Non-nitrate reducing organisms
- Frequent urination/urine in bladder <4 hrs
What can cause false positive leukocyte esterase in urine dipstick?
- Vaginal contamination
- trichomonas infection
What kind of UTI is pyelonephtritis?
Upper urinary tract infection?
What are the 3 kinds of lower urinary tract infections?
Cystitis, prostatitis, and urethritis
95% of UTIs occur from what?
An ascending bacterial infection
What bacteria accounts for the majority of of UTIs?
E. Coli
What are the risk factors for UTI?
- Reduced urine flow (obstruction, inadequate fluid, neurogenic bladder)
- Promote colonization (Sexual activity, recent Abx)
- Facilitating ascent (catheterization, urinary incontinence, and fecal incontinence)
What kind of UTI is most common in men?
Prostatitis and urethritis
What is it called when there is an acute UTI presumed to be confined to the bladder in a non-pregnant individual?
Acute simple cystitis
What is it called when you have an acute UTI accompanied by s/s that suggest extension of infection beyond the bladder, such as fever, chills, CVA tenderness, and pelvic pain?
Acute complicated UTI
What populations are are risk for a complicated UTI?
-Pregnant women, men, and patients with comorbidities, immunocompromised conditions, or underlying urologic abnormalities
A patient presents with irritation voiding symptoms such as dyslexia, urinary frequency, and increased urgency. Patient has hematuria and suprapubic discomfort. What are you concerned about?
Acute simple cystitis
What is found on PE in acute simple cystitis?
- The exam is typically normal
- 10-20% of women have suprapubic tenderness 4
What tests should be ordered for acute simple cystitis and what will they show?
- Urine dipstick with positive leukocyte esterase and nitrites
- Urine microscopy with pyuria (Abnormal >10), bacteriurua, and possibly hematuria
When is a urine culture indicated fro acute simple cystitis?
- atypical presentation
- suspect complicated UTI
- Symptoms do not resolve
- Suspect antimicrobial resistance
What is diagnostic of acute simple cystitis on a urine culture?
> 10^3 CFU/mL
What is the symptomatic treatment of acute simple cystitis?
-Urinary analgesic (pyridium) 200mg TID for most of 2 days
What is the treatment for acute simple cystitis in a non-pregnant individual?
- Nitrofurantoin (macrobid)
- Bactrim
- Fosfomycin
What medications should you avoid if early pyelonephritis due to low renal penetration?
Macrobid and fosfomycin
What is the treatment for acute simple cystitis in pregnant women?
- Augmentin, cefpodoxime, or fosfomycin
- Avoid fluoroquinolones
What is acute pyelonephritis?
-Infectious inflammatory process involving the kidney parenchyma and renal pelvis
What will be seen on UA and urine culture in pyelonephritis?
- Leukocyte esterase
- nitrites
- pyuria
- bacteriuria
- WBC casts
What do WBC casts suggest?
Renal origin for pyruia
Although imaging is not typically indicated with pyelonephritis, what is the test of choice when it is indicated?
CT A/P with and without contrast
What is the outpatient management of acute mild-moderate pyelonephritis?
- Cipro 500mg PO BID x 5-7 days
- Cipro ER 1000mg PO once daily x 5-7 days
- Levofloxacin 750mg PO once daily x 5-7 days
If a patient with mild-moderate acute pyelonephritis has local FLQ resistance to E. Coli, how should you treat?
Initial IV or IM dose of Ceftriaxone followed by one of the FLQs
When must a patient with Pyelonephritis follow up?
48-72 hours
What are some of the indications for hospitalization in acute Pyelonephritis?
- Critically ill and hemodynamically unstable
- Persistent fever
- suspected obstruction
- metabolic derangement
- cant take PO
- Compliance concerns
What are the acceptable IV Abx for inpatient management of complicated/severe Pyelonephritis?
- Fluoroquinolone
- Extending spectrum cephalosporin
- Extended spectrum penicillin
- Carbapenem
- Aminoglycoside
What are the possible complications with acute Pyelonephritis?
- Sepsis/shock
- renal failure
- scarring or chronic Pyelonephritis
- renal abscess
Interstitial cystitis (IC) is synonymous with what other terms?
Bladder pain syndrome (BPS) and painful bladder syndrome (PBS)
What is a chronic and debilitating conditions characterized by bladder pain?
IC
How is IC diagnosed?
- Usually a diagnosis of exclusion
- UA with microscopy and urine culture (generally unremarkable)
- Urine cytology
- STI testing
- PVR
- Cystocopy
What may be seen on cystoscopy with IC?
-May identify urothelium (glomerulations and hunner lesions)
What is the first line treatment for IC?
- Self care and behavioral modifications
- Diet modifications
- bladder retraining
- low impact exercise
- psychotherapy
- urinary analgesics
What are the second line treatments for IC?
- Tricyclic Antidepressants (Amitriptyline)
- Pentosan Polysulfate (Elmiron)
- Antihistamines (Hydroxyzine)
- Intravesical medications (lidocaine)
What is the third line therapy for IC?
- Cystoscopy with short duration, low pressure hydrodistention
- Intravesical instillation of GAGs
- Intravesical Dimetheyl Sulfoxide (DMSO)
What is fourth line treatment for IC?
- Intradestrusor botulinum toxin
- Sacral neuromodulation
What is a syndrome characterized by urinary urgency, with or without incontinence, often accompanies by nocturnal and urinary frequency?
Overactive bladder
What is the etiology of OAB?
Detrusor muscle overactivity, leading to involuntary bladder contractions that cause leakage
What is the first line treatment for OAB?
- Kegel exercises
- Lifestyle and behavioral modifications
- Bladder training
What is the second line treatment for OAB?
- Antimuscarinics such as oxybutynin, tolterodine, solifenacin, and darifenacin
- *caution with anticholinergics side effect
- Beta 3 agonists such as mirabegron
