GU Flashcards
Bacteria of UTI
90 % e.coli gram -
UTI - Eval
UA = WBC, Nitrates, RBC
CVAT abdominal exam
Acute UTI
Acute simple cystitis
Relapsed UTI
Same pathogen occurs within 2 weeks of completion of UTI TX
Recurrent UTI
Arises more than two weeks after TX may or may not be caused by same pathogen
> 2 infections in 6 months or > 3 infections in one year
Complicated UTI
co morbidity - DM, immunospression, reduced renal function indwelling catheter , nuerogenic bladder
Intermediate susceptibility
May be effective but will have to five a higher dose that’s normal or more freq
MIC
Minimum inhibitory concentration
>100,000 organisms
Want the lowest number
UTI- uncomplicated TX
Bacteria : E. coli
Duration 3-5 days
Drugs : Nitrofunatoin BID x 5 days
Bactrim BID x 3 days (sulfa) Cipro x 3 days
UTI complicated
Duration : 7-10 days Drugs : Bactrim x 7 days Trimethoprim x 7 day (if sulfa allergy) Cipro ( if PCN allergy) Amplicillen ( not great cause it is QID ) Augmentin ( PCN allergy)
Can consider phenazopyrdine for bladder pain TID x 2 days
Preventative UTI
Post sex - one dose after sex
Recurrent : nitrofurin or bactrim 1 day for x 6 months
Refer to urology if 3 UTI in 6 months
Intersistial cystitis
Painful free urinations with voiding 60 times a day , nocturia, no infection, no response with antibitoics
Theory: leaking of teh inner lining of the bladder thereby inflaming the bladder wall
TX: elmiron - may take 2-4 month for relief
Elavil ( not great for elderly) - to relieve pain and urinary freq
Antihistamine - help with sleep and nocturia
Neurontin - help with nueropathic pain
Pyelonephritis
Infection of kidney
Can lead to atrophy and scarring of kidney may lead to renal failure
More common in women
Gram - ecoli, proteus
Sudden onset hight fever, shaking, flank pain
UA : bacteria RBC, WBC’s,
CVAT, WBC casts ***
TX: bactrim BID x 14 days
Amoxicillin TID x 14 days
Cipro BID x 10 days
Need to improve in 48-72 hours
Prostatitis
Common in adult male
4 types : acute bacterial , chronic bacterial, non bacterial, prostatidyna
Ecoli - bacterial
Chlamydia - non bacterial
Prostatodynia
Pain, discomfortn, problem with urinary flow, - may cause infertility or prostate ca
Prostatitis ROS / PE
Prostate - enlarged, tender , boggy,
GU - look for lesions and discharge
UA : WBC and Blood
Prostatitis TX
> 35 no STI
Bactrim or cipro ( 500 mg higher dose) for four weeks
< 35 STI
Ceftriazone PLUS Doxycline X 10 days
Cefixime + doxycline
Ceftriazone PLUS azothryomcin ( 1 time dose ) = g/c
BPH
Benign condition
Obstructive
- hesitancy , decreased force of stream post void dribbling,
Irritating
- freq, urgency, nocturia ( r/t decreased bladder capacity or infection)
PE: enlarged, non tender, firm but spongy
PSA
ACA - PSA at start at 50
45 if at risk (AA, 1st degree relative)
40 if at greater risk ( 1 st degree relative )
USPSTF - recommends against PSA screening
BPH treatment
5 -alpha reductase inhibitors
Proscar - dont give to men with pregnant wives
Dutasteride - concern for sexual function
BPH - alpha blockers
Relaxes bladder neck
Take with meals
Flomax - give at bedtime
BPH / erectile dysfunction
Phosphosiesteride type 5 inhibitor
Tadalafil - cialis
Can help with both
Take without regard to imting of sexual activity
Urge UI
Bladder muscles contract forcefully and unexpectedly and as a result internal sphincter is unable to retain urine
“ i know I have to go but i cant get there”
Stress
Loss of urine with use of abdominal muscles after coughing, laughing
Overflow
Blockage of urethra causes bladder to overstretch,
Silently leak
Functional UI
Unrelated to anatomy but rather immobility to tolitiing
DIAPPERS
Delirium , INfection, Atrophic urethritis , Pharm, Psychological, endocrine, restricted mobility, stool impact
Post void residual
Measure of urine left in bladder after voiding by catheter or bladder scan
< 50-100 normal
100-400 monitor
>400 needs urology
UI - Drugs
Anticholinergics
- OXYbutynin - most common 5 mg TID , 2.5 for older adults
- Detroit -
Side effects : hot, dry, mad, blind, red
Scrotal pain
Need to find underlying problem
Variocele
Varicose veins in spermatic cord - may see blue hue along scrotal sac, semen count low
- ligation for Vein
Hydrocele
Fluid acclimation from a tumor, infection or trauma - will see transluminate
None may require surgical intervention
Torsion
Redness, swelling, sudden onset, EMERGENCY must be treated in 6 hours or risk of necrosis
Occurs more in left testicle
Surgical intervention
Hernia
Swelling, pain especially with straining, worse with standing, improves when lying down
- surgery
Epididymitis
Consistent with infection - redness swelling, extreme tenderness, relief with elevation of scrotum,
E.coli or STD
Treat with antibiotic
Acute epididymitis men > 35
Most likely caused by bacteruria
Levo 500 mg daily for 10 days
Ofloxacin 300 mg 10 days
Acute epididymitis < 35
Ceftriazone PLUS levo X 10 day ( g/c + enteric)
Ceftriazone PLUS doxy BID 10 days
Kidney Stone
Peak age 20-30 not after 50
Men > w
Caused by foods - purines, fish, meat, calcium
Severe flank pain, groin n/v/, blood in urine
Fever, tachy, sweating,
1 stone = calcium which can be treated wit allopurinol
