GU- Adults Flashcards
lower UTI
involves bladder & urethra–> cystitis
upper UTI
Ureters & Kidneys–> Pyelonephritis
classification of UTI
o Uncomplicated
refers to infections which occur in healthy, immunocompetent, non-pregnant women (but can occur in men too!) who do not have significant UTI history or any urological structural abnormalities
Symptoms: Mild-moderate
o Complicated
Existing structural or functional abnormality of urinary tract
UTIs in pregnancy are “complicated” & require closer f/u
UTI “complicated” if there are s/sx suggesting infection has spread beyond bladder (pyelo s/sx)
o Recurrent
UTI that occurs after complete resolution of previous & recent UTI
o Asymptomatic bacteriuria (ABU)
Urine has significant bacteria colony count (>100,000/mL) but no s/sx UTI
most causative agent of UTI
E. coli
risk factors for UTI in women
o Anatomy–> short urethra
o Fecal bacteria in the vaginal area
o Decreased fluid intake or irregular bladder emptying
o Sexual intercourse; ideally void within 10-15 mins after having sex
o Spermicide use
o Symptomatic partner
o Pregnancy
o Menopause
o Hyperuricemia, neurogenic bladder, kidney disease, immunosuppression; co-morbidities like DM: also risk in men
o Urological abnormalities/instrumentation: also risk in men
risk factors for UTI in men
o BPH
o Anal intercourse (also a risk for women)
risk factors for UTI in children
o Constipation, anatomical abnormalities, immunosuppression, dysfunctional voiding
**Red flags (suggestive of pyelonephritis or urosepsis)
o Ill appearing
o Fever/chills
o Tachycardia
o Flank pain
o Nausea/vomiting
o Costovertebral (CVA) tenderness
o Urosepsis: severe infection of urinary tract which spreads into bloodstream
- More common in elders, cis-women. Precursor is often complicated UTI. Higher risk in those with urological structural abnormalities, persons with diabetes, immunocompromised persons
1st line diagnostic for UTI
dipstick
tx for uncomplicated UTI
o Nitrofurantoin (Macrobid)
o Trimethoprim-sulfamethoxazole (Bactrim)
o Fosfomycin
UTI in pregnancy tx
amox-clavuante
doxy and fluoroquinolones contraindicated
geriatric considerations with UTI
- before giving Nitrofuratoin, check renal clearance (creatinine clearance)
- only tx if there are symptoms
older adult with UTI considerations
- diagnose based on symptoms and urine culture
- in LTC settings, do not tx right away for vague symptoms (ex lethargy, increased falls)
- assess for worsening symptions such as incontinence, suprapubic tenderness, then order urine C & S
recurrent UTIs in younger women
- more than 2 UTIs in 6 months or more than 3 infections in 1 year
- risk factors: spermicide use or new partner in the past year, genetics, first UTI before age 15
to decrease recurrence of UTI
- increase fluids 2-3 L/day
- avoid spermicides/diaphragms
- post sex voiding, ideally within 10-15 mins
UTI prophylaxis
can be considered in women who have had more than 2 or more symptomatic UTIs in 6 months or 3 or more in 12 months
pt education on UTIs
- encourage plenty of fluids
- drink fluids before sex to faciliate voiding after
- void within 10-15 mins after sex
- proper hygiene (front to back)
- empty bladder frequently
- educate on proper abx use
UTI in men: risk factors
- uncircumcised,
- anal intercourse
referral or hospitalization with UTIs
- presence of macroscopic hematuria, recurrent UTIs ofr infection
- hospitalization is recommended for pregnant pts with pyelonephritis
- hx of DM, sickle cell anemia, nephrolithiasis, or excessive analgesic use
acute pyelonephritis
infection of kidney; considered to be complicated UTI
risk factors of acute pyelonephritis
- female
- elderly
- anatomical abnormalities
- stress incontinence
- pregnancy
- pts with DM
- indwelling urinary caths
- recurrent kidney disease
UA findings in pyelo
- dip or microscopic: positive leukocytes (pyuria), hematuria
- UA may show WBC casts
referral to hospitalization with acute pyelonephritis
o Inability to maintain oral hydration/take meds
o Dehydration
o Vomiting
o Fever > 101.2 F (39.0 C)
o High WBC
o Hypotension
o Sepsis or s/sx suggestive of this
o Multiple co-morbidities
o Unsure diagnosis
o Pregnancy
interstititial cystitis/bladder pain syndrome
- An unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than six weeks duration, in the absence of infection or other identifiable causes
- most common in women
Interstitial Cystitis/Bladder Pain Syndrome: associated disorders
o Allergies
o IBS
o Sjogren Syndrome
o Fibromyalgia
o Chronic fatigue syndrome
o Crohn disease
o Ulcerative colitis
o Depression
o Anxiety
Interstitial Cystitis/Bladder Pain Syndrome: s/s
o persistent unpleasant sensations attributable to the bladder, of which the most consistent feature is an increase in discomfort with bladder filling and a relief with voiding
o Bladder symptoms are usually described as painful but can include pressure, discomfort, or spasms
o Usually constant but may vary from one day to the next , range in severity from mild to severe.
o Location usually suprapubic or urethral, also can be unilateral lower abdominal pain or low back pain with bladder filling
o Usually gradual in onset and worsen over a period of months. However, some patients describe symptoms that are abrupt or severe from their onset.
o Some patients have developed symptoms after an uncomplicated urinary tract infection or surgical procedure, or after a trauma, such as a fall onto the coccyx.
o Exacerbation of IC/BPS symptoms may occur after intake of certain foods or drinks, during stress, after certain activities (eg, exercise, sexual intercourse, prolonged sitting), or during the luteal phase of the menstrual cycle
diagnostics for Interstitial Cystitis/Bladder Pain Syndrome
o 1st line urine dip, culture and sensitivity to rule out UTI
o Would order urinalysis with microscopy (to exclude infection; evaluate for hematuria)
o If pt is sexually active would consider STI testing if they report dysuria
tx of Interstitial Cystitis/Bladder Pain Syndrome
o Pelvic floor therapy
o First line – amitriptyline; check med list for contraindications: MAOIs, Cisapride, Cimetidine, many anticonvulsants
o Second line – pentosan polysulfate sodium or PPS; contraindication for persons with macular eye dz
o Antihistamines for persons with concomitant allergies; hydroxyzine first line
o Adjuvant/rescue analgesia – NSAIDs, acetaminophen, phenazopyridine, methenamine, intravesical lidocaine
managment
o Evaluate for comorbid conditions
o Evaluate psychosocial needs
o Importance of self care and lifestyle modification
o Application of heat or cold to bladder or perineum
o Fluid management – A fluid and voiding diary
o Bladder training with urge suppression
pt education bladder pain syndrome
o Certain foods can trigger flares Caffeine, alcohol, citrus, carbonated beverages, acidic foods
o Avoid prolonged sitting; be aware that sex may increase symptoms
o Avoid tight fitting clothes which may cause discomfort
o Diagnostic criteria
o Variability of symptoms
o Chronic nature of the condition
o Review normal bladder function
o Encourage pt to keep diary to identify activities, foods, behaviors that may exacerbate symptoms
