GU Packet 3 Flashcards
What most commonly cause bacterial cystitis
E. Coli
What is the best diagnosis of bacterial cystitis
UA, clean-catch, mid-stream
What are the first line antibiotics for bacterial cystitis
- nitrofurantoin (Macrobid)
- trimethoprim-sulfamethoxazole (Bactrim)
What can be used for up to two days to help with irritative voiding symptoms caused by bacterial cystitis
phenazopyridine (Pyridium); should be limited to two days so that it does not mask a persistent infection
What is urethritis often associated with
Chlamydia trachomatis, Neisseria gonorrhoeae
What are the two classifications of urethritis
gonococcal and non-gonococcal
What is the typical male presentation of urethritis
profuse and purulent urethral discharge
urethral itching/tenderness
dysuria
What is the typical female presentation of urethritis
tenderness, swelling, and inflammation of the urethral meatus; dyspareunia; mucopurulent cervicitis
What will be found on urine culture for urethritis
low/no bacteria count
What is the treatment for gonococcal urethritis
Gonorrhea: single IM 500 mg dose of ceftriaxone (Rocephin)
Chlamydia: add 2g single dose of azithromycin
What is the treatment for non-gonococcal urethritis
doxycycline 100 mg orally twice daily x 7 days
What are the complications of urethritis
Males: urethral stricture
Females: PID
What is acute pyelonephritis
serious, potentially life threatening infectious inflammation process involving the renal pelvis and parenchyma when bacteria spreads from the urinary bladder to the kidneys
What causes acute pyelonephritis
Gram negative bacteria, usually E.coli
What will be found diagnostically in pyelonephritis
leukocytosis on CBC
pyruia, bacteriuria, hematuria on UA
heavy growth of causative organism on urine C&S
How should a clinically stable pt with acute pyelonephritis be treated
fluoroquinolones (Cipro) or trimethoprim-sulfamethoxazole (Bactrim) x 10-14 days
What should a hospitalized pt with acute pyelonephritis be treated with
ampicillin/gentamicin or third gen cephalosporin
IV fluoroquinolones or ampicillin and gentamycin for 24-48 hours after pt becomes afebrile, then oral antibiotics to finish 2 wk therapy
What is vesicoureteral reflux
Backward flow of urine from the bladder into the ureters often due to congenital abnormalities
What is hydronephrosis
renal parenchyma can be slowly destroyed by the accumulation of urine in the renal pelvis
What is the best diagnostic tool for VUR
Renal US and contrast voiding cystourethrogram (VCUG)
What are some non-surgical treatment options for VUR
prophylactic antibodies
periodic radiographic evaluation
Antibiotics: Amoxicillin until 8 weeks old then trimethoprim sulfamethoxazole (Bactrim) or nitrofurantoin (Macrobid)
What are surgical treatment options for VUR
cystoscopy and endoscopic injection of dextranomer/hyaluronic acid or open surgical tx
What is the complication risk of VUR
acute pyelonephritis leading to renal scarring and CKD
