Painful bladder syndrome and cystitis Flashcards

1
Q

What is differential diagnosis for chronic pelvic pain?

A

Gynecological, urological, nephrolithiasis, painful bladder syndrome, bowel/IBS, MSK, supratentorial.

differential for painful bladder syndrome: UTI, OAB, urolithiasis, bladder lesions (polyp/tumor), urethritis.

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2
Q

What are the causes/diagnosis of painful bladder syndrome?

A

etiology unknown - defects allow irritants to enter bladder wall. Clinical diagnosis.
- Unexplained bladder pain >6 weeks, incr discomfort w/ bladder filling and relief w/ voiding (pts void frequently to avoid pain from bladder filling), absence of infection or other cause (r/o with UA, UCX, PVR).
- have flares alternating w/ periods of relief. co-occurs w/ pelvic pain, other pain syndromes (fibromyalgia or IBS).
1/3 of pts w/ CPP may have painful bladder syndrome.

Ddx: UCx, PVR (normal is <100). cystoscopy NOT required for diagnosis.
- Classic findings on cysto: hunner’s ulcers (highly specific, only in 5-10% pts), glomerulations (petechiae) - nonspecific. If refractory to medical management, can fulgurate.

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3
Q

What is the treatment for painful bladder syndrome?

A
  • behavior modification
  • avoid triggering foods: Artificial sugars, Caffeine, alcohol, spicy foods.
  • 12wk trial of PFPT.
    Tx:
  • amitriptyline=1st line.
  • gabapentin/Pregabalin.
  • PENTOSAN POLYSULFATE=FDA approved (incr risk macular eye disease so need detailed ophthalmology exam and retinal exams q6mo).
  • Anti-histamines if IC and allergies together.
  • If refractory, can do bladder hydrodistension (DMSO dimethyl sulfoxide bladder instillation for flares), botox, sacral nerve modulation. .
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4
Q

What is differential diagnosis for recurrent dysuria after intercourse?

A

recurrent postcoital bacteriuria/UTI
Lubrication deficit with tissue trauma
Allergy to contraceptive product
Underlying UTI

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4
Q

What is recurrent cystitis?
What is workup and management?

A

> 2 infections in 6 mo or >3 in 12 mo

Workup: assess for anatomic abnormalities, upper tract (renal US, CT/MRI), lower tract (cysto).

Manage by treating underlying issue
- glycemic control
- infection (urethritis, vaginitis, STI)
- proper duration of abx and pt compliance
- selection of abx not affecting fecal flora (predispose to yeast)
- STI testing
- incr fluid intake
- consider post-coital void.

IF nothing helps, try single dose abx after each act of coitis (50-100mg macrobid, Bactrim, cephalexin).
- if not coitus related: antibiotic suppression w/ daily Bactrim or macrobid x6mo, behavior modification, consider estrogen, probiotics.

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5
Q

How do you manage hematuria that persists after infection treated?

A

eval for kidney stones, bladder polyp, bladder cancer.

consider underlying factor predisposing to recurrent infection:
- diabetes, spermicide, infected stone, inflammatory condition of lower genital tract (urethritis, BV, candida, STI), genetic component.

-possible resistant organism.

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6
Q

What is postpartum urinary retention?

A

2/2 injury to pudendal nerve during birth process.

Overt PUR: absence of spontaneous urinartion within 6 hours of SVD or 6 hrs post removal of foley after CD.
- tx=intermittent catheterization

Covert PUR: PVR>150cc after spontaneous void. can have pudendal nerve dysfunction for up to 2-3mo PP.
- tx=intermittent catheterization q4-6 hrs or when pt has urge to void. continue until PVR <150cc.

differential: bladder atony, bladder pain 2/2 intrapartum injury, obstructive effect of hematoma, urethral spasm.

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7
Q

What antibiotics should you give for empiric treatment for UTI?

A

Most likely organism is E. coli
- Antibiotics could be Nitrofurantoin (Macrobid) x 5d or Bactrim (Trimethoprim-sulfamethoxazole)

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8
Q

Differential for midline anterior mass?

A

urethral diverticulum, UTI, Gartner cyst, vaginal inclusion cyst.

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9
Q

What organisms cause UTI?

A

KEEPS: Klebsiella, E. Coli. Enterobacter, Pseudomonas, Staph saphrophyticisu.

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10
Q

When should asymptomatic bacteruria be treated?

A

Pregnancy, urologic procedures, catheter-acquired that persists after catheter removal

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11
Q

Cause of treatment failure of UTI?

A

non-compliance, antibiotic resistance, inadequate duration of treatment. Management: treat underlying cause (i.e. glycemic control)

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12
Q

What is treatment of pyelonephritis?
Complications of pyelo?

A

cefpoxodime BID or keflex 500 QID.

ARDS, urosepsis, preterm labor, preterm contractions.

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13
Q

What are risk factors for pyelonephritis?

A

UTI, kidney stones.

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14
Q

What factors increase risk of UTI?

A

Hx UTI, frequent sexual activity, parity, DM, obesity, anatomic abnormalities, repetiive bladder catheterization.

Post-menopausal: atrophy, incomplete bladder emptying, prolapse, DM

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