Infectious/Inflammatory conditions Flashcards
what is cystitis
Bacterial infection of the bladder commonly called urinary tract infection.
Bacteria establishes infection by ascending from the urethra to the bladder
what are the RF for cystitis?
Female: 50-80% of women will develop at least 1 UTI in their lifetime
Hx of UTI
Recent sexual intercourse: use of diaphragm with spermicide
Diabetes
Incontinence
Indwelling catheter
Anatomic abnormality
What pathogens cause UTI?
E. coli account for 70-90% of isolates
Staph 5-15%
Klebsiella, proteus, enterococcus and citrobacter account for 5-10%
what is the most common cause of confusion in the elderly?
UTI
what are the clinical features of Cystitis or UTI?
Frequency, urgency, dysuria
Suprapubic discomfort
Gross hematuria
Fever is an indication of invasive infection
Unilateral back pain is indicative that upper urinary tract involved
PE unremarkable
What would you see on a U/A for a person with cystitis?
pyuria, Bacteriuria, poss hematuria
what is the Gold standard for dx of cystitis?
Urine culture, but results can take 24-48hrs
What is the Tx for cystitis?
short term abx
concern about resistance to TMP sulfa (bactrim)
sitz bath
Pyridium- urinary analgesics
what abx are used for cystitis
Bactrim: cheap and single dose Cephalexin: 1-3 days $16.60 Norfloxacin: 1-3 days $26.00 Ofloxacin: 1-3 days $28.30 Ciprofloxacin: 1-3 days $32.00 Nitrofurantoin: 7days $45
How is cystitis prevented?
limit use of indwelling catheters
women with
what is interstitial cystitis
painful bladder syndrome
pain when bladder fills and relieved by emptying
Associated with freq and urgency
Dx of exclusion
what is the epidemiology of interstitial cystitis
Females>males
Avg age 40
Likely to have childhood bladder problems
associated with allergies, IBS and IBD
what is the clinical presentation of interstitial cystitis?
pain w bladder filling and relief with urination
what are the lab findings for interstitial cystitis
lab and cystoscopy may be normal
what is the tx for interstitial cystitis?
no cure upto 50% may have spontaneous remission Amitriptyline, nifedipine TENS unit surgery
what is pyelonephritis?
acute infectious inflammatory dz affecting the kidney parenchyma and renal pelvis
Bacteria ascend from bladder to kidney
ITs a complication of a UTI
what are the clinical features of pyelonephritis?
Fever, flank pain, chills urgency, frequency, dysuria N/V Tachcardia CVA tenderness
what will labs show with pyelonephritis?
CBC increased WBC
UA shows pyuria, bacteriuria, hematuria
urine culture shows heavy growth for offending organism
what is the Tx for pyelonephritis?
1st line fluoroquinolones for acute uncomplicated
may need IV therapy & switch to oral t once response observed
If IV need use (ampicillin w/ aminoglycoside, quinolone or cephalosporin)
F/U urine cultures
what is a urinary tract obstruction?
obstruct outflow of urine which impairs renal and urinary function and chronic kidney disease
what are the clinical features of Urinary tract obstruction?
depends on location and extent Pt may be asymptomatic Pain, hematuria, change in urinary output HTN, palpable mass Incontinence
what will diagnostic test tell you?
U/A: hematuria, pyuria, bacteriuria Labs: CBC, Lytes, creat US Abd Xray stones IV urogram
what is the treatment for urinary tract obstruction?
restore normal urine flow ASAP
Tx coexisting infection
Tx depends on cause and location
Analgesics for stones
how common is urinary stone dz
common prob affects 240,000-720,000 americans
13.7% men
7% women
what is the pathophysiology of urinary stone disease
components that make up the stone are supersaturated in the urine
concentrations of the stone material exceeds their solubility so crystals form
what are 5 types of stones
MC- calcium calcium oxalate calcium phosphate uric acid cystine struvite
what are RF for stones
hot and humid environment Higher in summer sedentary occupation High protein high salt diet' genetic factors urinary stones dz
what are the clincial features of urinary stone dz
acute and severe pain localized to flank N/V episodic pain pt in constant motion pain may radiate to the groin testes or uvula
what will lab and imaging show for urinary stone dz
U/A: microscopic or gross hematuria
Ab-Xray/KUB and renal US will dx most stones
what is the Tx for urinary stone dz?
goal to achieve stone free status •↑ fluid intake •↓ sodium intake Limit animal protein •↓ intake of oxalate & purines Medical expulsive therapy of: alpha blockers, ibuprofen, oral steroid Uteroscopic stone extraction Shock wave lithotripsy Percutaneous nephrolithomy
what food are hight in oxalates?
blueberries, strawberries spinach, eggplant
what foods are hight in purines
mussels, sardines, yeast products
