Prostatitis Flashcards
describe upper UT UTI
pyelonepritis!
signs:
-fever
-sepsis
-abdominal pain
-PU/PD
- +/- LUT signs
CBC:
-dehydration
-anemia
-leukocytosis
biochem:
-azotemia
-hyperphosphatemia
-metabolic acidosis
-hypoglycemia
-+/- potassium?
imaging:
-renomegaly (if acute)
-pyelectasia
culture: usually find bacteria
-acute (urine)
-chronic (renal biopsy, pelvic urine)
biomarkers:
-cystatin B
-SDMA
what do you definitely want to look for with upper urinary UTI?
casts!!
cylindrical in shape
if see cellular (made of RBC or WBC): ALWAYS abnormal!!!!
-means there is bleeding or inflammation or both enough to form casts inside lumen of tubules
describe most common pathogenesis of upper urinary UTI
most of the time is an ascending infection!
- colonization
- uroepithelium penetration
- acension
- pylonephritis
-less common in dogs and cats bc of the hook at the urethra - acute kidney injury
describe treatment of UT UTI
- immediate antimicrobial therapy: quinolone, potentiated beta lactam
- systemically ill: IV
-not systemically ill: PO - 10-14 days (if pus in renal pelvis, abx don’t penetrate abscesses well)
-if respond, will see within a few days - once obtain C/S results:
-if using 2+ antimicrobials, may discontinue one
-if resistance, use c/s
-if resistance + no improvement: change antimicrobial, manage comorbidities
-if resistance but improvement: continue antimicrobial - follow up:
-5-7d post antimicrobial: UA +/- c/s
-recheck c/s if clinical signs
-if c/s shows same organism: try to figure out why persistence
-if c/s positive but no clinical signs: subclinical bacteiruria
describe acute/abscess prostatitis
PE:
-systemically ill
-painful
-HL weakness
-purulent/bloody discharge
labs: hematuria, UTI, septic
imaging: prostatomegaly, cyst (abscess)
cytology: difficult to collect, hematuria/UTI
describe chronic prostatis
PE: usually no signs, prostatomegaly
labs: hematuria/ UTI
imaging: prostatomegaly, asymmetric
cytology: hematuria/UTI
describe the most common organisms that cause prostatis
E. coli most common BUT
ALWAYS check for brucella!!!!
describe antimicrobial considerations for bacterial prostatis
blood-prostate barrier
-need trimethoprim sulfate (can cause KCS, some liver stuff, some red cell stuff; just don’t use in black and tan dogs!! much more sensitive!!)
-or quinolones to cross
describe clinical signs of acute prostatis
- 10% septic shock
- 73% painful abdomen
- septic prostatic fluid
- tenesmus and LUT signs usually
describe diagnosis of bacterial prostatitis
- CBC. chem, UA
- urine culture
- imaging
- fluid collection
- FNA, biopsy
- REMEMBER BRUCELLA
describe treatment of bacterial prostatitis
acute/abscess:
1. empirical: E. coli
2. need to penetrate blood prostate barrier, but is usually weak or broken with acute so no biggie
-trimethoprim sulfate, quinolones
-DONT use ciprofloxacin (unpredictable bioavailability)
3. treat for 4 weeks
chronic:
1. blood prostate barrier INTACT
2. NO ciprofloxacin
3. treat 4-6 weeks
4. longer if abscess or no castration
other:
1. castration: after some antimicrobial therapy
2. finasteride
3. flutamine
4. GnRH agonists
describe how to monitor bacterial prostatis treatment
- poor response to treatment: castrate and redo c/s
- monitor: ultrasound, rectal palpation
- recheck: ultrasound 8-12 weeks post treatment
- C/S urine/prostatic fluid/tissue
describe abscess treatment
ultrasound (U/S) + methanol ablation
- US guided drainage and methanol
- 10% relapse at 30 days so usually 2 treatments required
- no complications, good success rate!
