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Clin Med 2 > Some UTI and bladder pain info > Flashcards

Some UTI and bladder pain info Flashcards

1
Q

How to get dx of bladder pain syndrome

A

History and physical

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2
Q

Lower UTI

A

Cystitis

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3
Q

Upper UTI

A

Pyelonephritis

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4
Q

Why do 95% of UTIs occur from ascending bacterial infection, usu e.coli?

A

Exposure to colonic bacteria that makes its way from butthole up into bladder.

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5
Q

3 Risk factor categories for UTI

A

Reduced Urine Flow
Promote Colonization
Facilitate ascent

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6
Q 
UTI pt who is:
Immunocompetent 
No comorbidities
Premenopausal
Not preggo
A

Uncomplicated UTI

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7
Q

Irritative sx of UTI

A

Dysuria
Frequency
Urgency

Possible hematuria and suprapubic discomfort but PE is ususally normal

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8
Q 
UTI pt who is:
Immunocompromised
Pregnant
Diabetic 
Male
Young
A

Complicated UTI

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9
Q

MOST VALUABLE DIAGNOSTIC TEST FOR UTI

A

Eval for pyuria on urinalysis

pus/WBV in urine

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10
Q

False + for nitrites may result from

A

Exposure of dipstick to air

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11
Q

Colony count that is diagnostic for acute UNcomplicated cystitis

A

> =1,000 (10 to the 3rd)

Routine culture not indicated, should get if case if refractory to tx or suspect kidney infxn

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12
Q

First line tx for acute UNcomplicated cysitits

A

BACTRIM (trimethoprim-sulfamethoxazole)

or

  • Nitrofurantoin (Macrobid)
  • Fosfomycin (Monurol)
  • Don’t give if suspect kidney infxn becz can’t get adequate levels in kidneys.
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13
Q

Second line tx for acute UNcomplicated cystitis

if sulfa allergy, resistance, availability issues with 1st line

A

Fluoroquinolones

Cipro, levo, ofloxacin

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14
Q

Third line tx for acute UNcomplicated cystitis

A

Oral beta lactams (7 days)

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15
Q

Why do you only give pyridium (a bladder analgesic) for 2 days?

A

Because it can mask symptoms of refractory infection, pt can’t tell that they are not getting better and tx not working

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16
Q

First line tx for acute complicated cysitits

A

Fluoroquinolones

17
Q

Manly acute uncomplicated cystitis

A

Bactrim
or
fluoroguinolones

18
Q

Pregnancy UTI meds

A

NOOOO fluoroquinolones

AUGMENTIN is safest bet
(amoxicillin

-can give Macrobid if early preggo

19
Q

Dysuria + frequency

no vag d/c

A

UTI usually

20
Q

Acute pyelonephritis can lead to these complications

A

Renal abscess
Sepsis
Septic shock
ARF

21
Q

Cystitis sx + flank pain

A

Acute pyelonephritis

and WBC casts

22
Q

Study of choice if need to do imaging for COMPLICATED pyelonephritis

(in uncomplicated imaging usu not indicated)

A

CT w/ contrast

Check renal function labs before using contrast

23
Q

Leukocytosis w/ left shift
WBC casts
Colony counts >=10,000

A

Acute pyelonephritis

24
Q

Differentiate between Acute pyelonephritis and kidney stones

A

Acute pyelonephritis has flank/CVA pain that is worse with palpation
Kidney stones - severe pain in waves, radiates to groin

25
Q

First line tx for acute UNcomplicated pyelonephritis

A

Fluoroquinolones

26
Q

Very important part of outpatient tx for Acute pyelonephritis

A

pt MUST FOLLOW UP IN 24-48 HOURS

-make sure your tx is working and they aren’t getting septic or other complications

27
Q

Cystitis sx for more than 6 weeks
Pain, pressure, discomfort in abscence of infection
Mostly women
Usu dx in 40’s
Often coexists with other chronic pain conditions*

A 
Interstitial cystitis 
aka
Bladder Pain Syndrome 
aka
Painful Bladder Syndrome
28
Q

Impacts of bladder pain syndrome

A

Sexual dysfunction
High rates of depression

(because pain all the time and crappy sex life)

29
Q

Most important central finding of bladder pain syndrome

A

Altered urothelium

30
Q

Glycosaminoglycan (GAG) layer commonly damaged

A

IC/BPS - Painful bladder syndrome

-neuropathic pain and voiding dysfxn

31
Q

Suprapubic/bladder pain, worse with bladder filling and relieved with voiding

A

IC/BPS - Painful bladder syndrome

32
Q

How to dx IC/BPS - Painful bladder syndrome

A

Exclusion:
r/o infection with urinalysis w/ microscopy and urine culture
Cytoscopy if in doubt

*K+ sensitivity test not indicated

33
Q

First thing to do in tx of IC/BPS - Painful bladder syndrome

A 
Lifestyle changes:
Food diary and elimination diet
Bladder training to hold it longer
Low impact exercise
Psychotherapy
34
Q

Second line tx for painful bladder syndrome

A

Oral meds:

Tricyclic antidepressants

35
Q

Why use amitriptyline (tricylcic antidepressant) instead of FDA recd Elmiron that has less side fx?

A

It works way faster

Clin Med 2 (9 decks)

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