infections Flashcards
cystitis
infx of the normal bladder most commonly caused by coliform bacteria (E. coli) and some gram positive (enterococci)
CF of cysitis
irritative voiding sx, suprapubic discomfort
grow hematuria may occur, sx inn women often may appear following sexual intercourse
PE- may elicit suprapubic tenderness
cystitis UA
pyuria, bacteriruria, varying degrees of hematuria
urine culture
imaging in cystitis?
only if suspected pyelonephritis, recurrent infx, or anatomic abnormalities
tx for cystitis
women- fluoroquinolone or nitrofurantoin (macrobid) X5 days
Bactrim if resistant bacteria
cystitis symptomatic relief
hot sitz baths, urinary analgesics,
phenazopyridine (azo)- turn pee orange/yellow
what is the most common cause of epidiymitis in men younger than 35? older than 35?
chlamydia and gonococci
E. coli
what are the clinical features of epidiymitis?
heaviness and dull, aching discomfort in the affected hemiscrotum which can radiate upt he ipsilateral flank
what may a hx of pt with epidim reveal?
healy lifftin, trauma, sexual activity
PE findings for epidid.
swollen and tender to touch, eventually becoming a warm, erythematous, enlarged scrola mass
+/- fever
+ positive phrens sign: pain relief w/ elevation
tx of epid. in men younger than 35? older than 35?
ceftriaxone IM + doxy or azithromycin (test for cure in 1 wk_
ciprofloxacin
pyelonephritis?
involves kidney parenchyma and renal pelvis
+most common in DM and elderly women
what is the most common causative agent of pylenephritis?
gram negative: e. coli (#1), proteus, klebsiella, enterbackter, psuedomonas
what is chronic pyelonephritis?
progressive inflammation of the renal interstitium cuased by bacterial infection
- pts with vesicoureteral reflux (backward flow of urine into bladder)
what are the clinical features of pyelon?
fever, flank pain, shaking chills, irritative voiding sx
N, V, D
PE of pyelon?
Fever, tacycardia, CVA tenderness
dx studies for pyelon?
CBC: WBC and left shift
UA: pyuria (pus), bacteriruia, hematura, WBC casts
+complicated cases: renal US may show hydronephrosis secondary to obstructions
tx of pyleon?
FQ or bactrim
tx of hospitalized pyleonep. pts?
IV FQ or ampicili or gentamicin while waiting for sensitivy results
what if tx of pyleone. fails/?
US to exclude complicating factors like stones
what is prostatitis?
caused by ascending infection of gram- neg rods
can be acutee or chronic
what is the most common of the prostatitis syndromes?
chronic nonbacterial prostatitis: unknown cause
may present as an noninfectious inflammatory disorder perhaps w/ autoimmune origin (chrnic pelvic pain syndrome)
what is a complication of acute bacterial prostatitis? (if fever doesnt resolved in 36 hours after tx)
prostatic abscess
what are the clinical features of acute prostatitis?
sudden onset of high fever, chills, low back pain and perineal pain
what are the clinical features of chronic prostatitis?
variable : asx to acute symptomatology
what are the clinical features of acute and chronic prostatitis?
irritative bladder sx and some obstruction
PE of prostatitis?
porstate is swollen and tender; avoid vigorous prostae exam bc it may cause septicemia (if suspected acute)
what dx studies for prostatitis?
UA: pyruia, hematuria, bacteruria
Prostatic fluids: WBC
what bacteria cuases acute prostatitis?
e coli
what bacteria cuases chronic prostatitis?
enterococcus
tx of uncomplicated prostatitis?
cipro or levo or bactrim
tx of chronic prostatits?
FQ
what other meds may be helpful for prostatitis?
nsaids, alpha 1 blockers
