Quiz 3 - UTIs and Nephrolithiasis Flashcards
Adjunctive trick
Bromelain 300 mg TID to enhance tissue penetration
Chronic urethritis causes
STIs, indwelling catheter, diapers, intercourse, diapers
Bladder CA RFs
smoking second-hand smoke env exposure high coffee intake high animal protein/fat radiation schistosomiasis
Cystitis Tx
if other tx not working within 24-48 hrs or signs of pyelo
nitrofuratoin or TMP-SMX
If acute pyelo does not resolve after 5 days of tx
Renal abscess (or perinephric abscess)
Tx with abx!
Refer for percutaneous aspiration under CT or US
Surgery
Imaging = CT
Bladder CA Dx
UA- hematuria
cytoscopy + biopsy
UTI Urine collection
MSCC
only radiolucent stone
Uric acid
Acute urethritis in women
tetracyclines (eg doxycycline) and fluoroquinolones (eg Cipro) are contraindicated in pregnancy.
Struvite stones etio
urea-splitting organisms Proteus, klebsiella, pseudomonas
GCU ssxs in men
purulent dc, dysuria, itching
meatal edema, tenderness
Dx Interstitial cystitis
dx of exclusion
Hunner’s ulcers
Glomerulations on cystoscopic exam
pain associated with the bladder OR urinary urgency
Abx for pyelo
Cipro or
TMP-SMX
Pyelo DDX
Emphysematous pyelo
Focal or multifocal bacterial nephritis
Pyonephrosis
Xanthogranulomatous pyelonephritis
GCU complications
asymptomatic carriage, which may result in chronic infertility, chronic prostatitis, chronic epididymitis, recurrent acute infections, etc. (do cultures of urethra, pharynx, rectum as needed)
Tx Spastic Bladder
anticholinergics
catheter
neurorestorative herbs
NGU complications
epididymitis, prostatitis, proctitis, Reactive arthritis (reactive arthritis triad: arthritis, uveitis, urethritis), lymphogranuloma venereum
Labs tests for male urethritis
Urine NAAT PCR
Cystitis caused by E. coli…
D-mannose works (if type 1 pili)
Tx stress incontinence
alpha adrenergic agonists, estrogen
chronic stone former work-up
24-hour urine
PTH
Serum calcium and phosphorus
UTIs in boys and men <50
abnormality of urinary tract
Naturopathic Tx Cystitis
vit C, vit A, vit E, D-mannose
white undies
botanicals
alt sitz bath, COPs
Ca oxalate stones etiology
(75% of stones)
Low water intake
Hyperoxaluria, hypercalciuria
Hyperuricosuria, hypocitriuria
hyperPTH
Tx Flaccid Bladder
crede’s
acetylcholine derivatives
catheter
neurorestorative herbs
IC Tx
prednisone LDN hydrodistension avoid bladder irritants anxiolytics antispasmodics
Interstitial cystitis Complication
gradual ureteral stenosis or reflux –> hydronephrosis
Cystitis Dx
UA.. if + then
Urine C&S (>100,000 to exclude contamination)
minerals/molecules that increase risk of stones
calcium, oxalate, phosphate, uric acid
Tx of Chlamydia
azithromycin (1gm) SD OR
doxycycline 100mg bid for 7d
NGU
Dysuria, scant dc
Less acute onset (longer incubation period)
Meatal edema and erythema
Pathognomonic for pyelo…
Glitter cells (neutrophils with cytoplasmic granules)
recurrent cystitis
vesicoureteral reflex
what (physiologically) causes non-colicky pain
distention of renal capsule
Stone PE
Restlessness
CVA tenderness
Abdominal mass with obstruction and hydronephrosis
sxs of staghorn stone
silent unless recurrent UTIs
minerals/molecules that decrease risk of stones
sodium, citrate, mag, sulfate
Tx of GCU
Ceftriaxone (250mg IM) PLUS Azirthomycin OR doxyclycline bid for 7 days
Causes of Neurogenic bladder
spastic + flaccid
MS, spinal cord injury, DM, ALS, Parkinson’s, spinal or pelvic surgery, degeneration from aging or inflammation
Chronic pyelo
BL pyogenic kidney infection or congenital reflux nephropathy with renal parenchymal scarring and atrophy of the calyces.
Course over 20+ yrs
usu asx
Strangury
painful frequent urination in small amounts
if stone blocks ureter
what (physiologically) causes renal colic
stretching of ureter by obstruction of flow
