Interstitial Cystitis Flashcards
1
Q
Interstitial cystitis definitions
A
- An unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, assoc. w/ lower urinary tract symptoms of more than 6wks duration, in the absence of infection or other identifiable causes
- Bladder pain syndrome/intersititial cystitis (BPS/IC) is a condition diagnosed on a clinical basis and consists of chronic pelvic pain often exacerbated by bladder filling and assoc. w/ urinary freq.
- IC is a chronic, yet manageable, inflammatory bladder condition characterized by recurring discomfort or pain in the bladder and/or pelvic region
2
Q
Interstitial cystitis diagnosis
A
- Diagnosis of exclusion
- There is no specific test or marker that is diagnostic
3
Q
Interstitial cystitis symptoms
A
- Complaint of suprapubic pain related to bladder filling, accompanied by other symptoms such as increased daytime and night time freq., in the absence of proven urinary infection or other obvious pathology
- Recurrent UTIs w/ neg. cultures
4
Q
Most common comorbidity among interstitial cystitis pts.
A
- Allergies and irritable bowel
5
Q
Difference b/w IC and an overactive bladder?
A
- IC presents w/ pain
6
Q
IC physical exam findings
A
- Bladder neck tenderness
- Suprapubic tenderness
- Levator ani tenderness
- Cervical motion tenderness
- Posterior vaginal tenderness
- Rectal tendernesse
7
Q
IC initial work-up
A
- Initial assessment consits of a freq/volume chart, focused physical exam, urinalysis, and urine culture
- Cytology and cystoscopy are recommended if clinically indicated
8
Q
Mast cells and IC
A
- Have freq been reported to be assoc. w/ IC, both as a pathogenetic mechanism and as a pathognomonic marker
- Mast cells are strategically localized in the urinary bladder close to blood vessels, lymphatics, nerves and detrusor smooth muscle
- Studies strongly suggest that IC is a syndrome w/ neural, immune, and endocrine components in which activated mast cells play a central, although not primary, pathogenetic role in many pts.
9
Q
O’Leary-Sant IC symptom and Problem Index Questionnaire and the Pelvic Pain and Urgency/Frequency (PUF) Questionnaire
A
- Assess the pt. for the likelihood of IC
- Consider IC if O’Leary score is >6
- Consider IC if PUF score is >10
10
Q
Glomerulations and IC
A
- The finding of glomerulation on hydrodistention is variable and not consistent w/ clinical presentation
- Absence of glomerulation can lead to false neg. assessment of pts who present w/ clinical findings consistent w/ IC/BPS
- Seen in many clinical situations
*radiation therapy, defunctionalized bladders, bladder cancer, chemotherapeutic or toxic drug exposure, normal bladders
11
Q
Hunner’s Ulcer
A
- A pos. finding that can confirm the diagnosis of IC in pts who meet the definition criteria
- Are very painful
- Acute phase (inflamed, friable, denuded area)
- Chronic phase (blanched, non-bleeding area)
- Provides a therapeutic option
*can cauterize or inject them w/ steroids
12
Q
Antiproliferative Factor
A
- Frizzle-related peptide growth inhibitor
- Produced by the urothelium of pts w/ IC
- Found in bladder urine but not in renal pelvic urine
- May prove to be the most accurate marker of PBS/IC when confirmed by other centers
- Appears to have the highest sensitivity and specificity of the variety of possible markers tested and fits nicely into an etiologic schema
*94% and 95% respectively
13
Q
Antiproliferative factor physiological function
A
- Seems to have role in increasing cell permeability
- Induces reversible inhibition of HBEGF production and normal bladder epithelial cell proliferation
14
Q
KCl (potassium chloride) challenge
A
- An intravesical injection of KCl comparing the sensory nerve provocative ability of sodium vs. potassium
- Pain and provocation of symptoms constitutes a pos. test
- Used as a diagnostic test for IC, the KCl test is not valid
- Too painful for pts. so has been done away w/
15
Q
IC conservative treatment options
A
- Pt. educ. and reassurance
- Timed voiding, voiding diary, behavioral therapy where freq. primary symptom
- Stress reduction
- Biofeedback, pelvic massage
