URINARY TRACT INFECTION(S)-CYSTITIS

Question 1

Anatomy of a patient with Urinary Tract Infections.

Answer 1

(1) Kidneys
(2) Ureters
(3) Bladder
(4) Urethra
(5) Prosthetic Urethra in males
(6) Prostate
(7) Ureters
(8) Bladder
(9) Urethra
(10) Prosthetic Urethra in males
(11) Prostate

Question 2

g the most common entities encountered in medical

practice.

Answer 2

Urinary tract infections

Question 3

which Coliform bacteria is the responsible for most infections.**

Answer 3

Escherichia coli

Question 4

what is the most common route.**

Answer 4

Ascending infection from the urethra

Question 5

Hematogenous spread to the urinary tract is common or uncommon

Answer 5

uncommon

Question 6

Infection of the bladder.

Answer 6

Acute Cystitis

Question 7

Acute Cystitis

Most commonly due to what coliform bacteria

Answer 7

E coli

gram-positive bacteria (enterococci)

Question 8

Acute Cystitis

The route of infection is typically what

Answer 8

ascending from the urethra.

Question 9

Acute Cystitis

Uncomplicated cystitis in men is rare and implies

Answer 9

pathologic process such as infectedstones, prostatitis, or chronic urinary retention requiring further investigation.

Question 10

Acute Cystitis

Signs and symptoms**

Answer 10

(a) Irritative voiding symptoms (FUD)
(b) Suprapubic discomfort
(c) Women may experience hematuria and symptoms often appear following sexual intercourse
(d) Usually afebrile
(e) P.E. may elicit suprapubic tenderness with palpation

Question 11

Acute Cystitis

Differential Diagnosis for women

Answer 11

1) Vulvovaginitis

2) Pelvic inflammatory disease

Question 12

Acute Cystitis

Differential Diagnosis for men

Answer 12

1) Urethritis (urethral discharge)

2) Prostatitis (prostatic tenderness)

Question 13

Acute Cystitis

Differential Diagnosis for Noninfectious cystitis

Answer 13

1) Pelvic irradiation
2) Chemotherapy
3) Bladder carcinoma
4) Interstitial cystitis
5) Voiding dysfunction disorders
6) Psychosomatic disorders

Question 14

Acute Cystitis

Lab orders

Answer 14

(a) Urinalysis

(b) Urine culture

Question 15

Acute Cystitis
Laboratory Findings
Urinalysis may reveal:

Answer 15

1) Pyuria
2) Bacteriuria
3) Various degrees of hematuria

Question 16

Acute Cystitis
Laboratory Findings
Urine culture may reveal:

Answer 16

positive for the offending organism

Question 17

Acute Cystitis

Imaging

Answer 17

(a) Because uncomplicated cystitis is rare in men, elucidation of the underlying problem with appropriate investigations, such as abdominal ultrasonography or cystoscopy (or both), is warranted.
(b) Follow-up imaging using CT scanning is warranted if pyelonephritis, recurrent infections, or anatomic abnormalities are suspected.

Question 18

Acute Cystitis

Treatment

Answer 18

1) Women
a) Ciprofloxacin (Cipro) -Nitrofurantoin (Macrobid)
b) Trimethoprim/sulfamethoxazole (Bactrim)

2) In men, uncomplicated urinary tract infection is rare

3) regardless of gender
a) Phenazopyridine (Pyridium)
b) Sitz baths

Question 19

Acute Cystitis

Prevention

Answer 19

Women who have more than three episodes of cystitis per year are considered candidates for prophylactic antibiotic therapy to prevent recurrence after treatment of urinary tract infection

Question 20

Acute Cystitis
Prevention
The three most commonly used oral agents for prophylaxis are:

Answer 20

1) Trimethoprim-sulfamethoxazole (40 mg/200 mg) daily
2) Nitrofurantoin (100 mg) daily
3) Cephalexin (250 mg).
* Single dosing at bedtime or at the time of intercourse is the recommended schedule
for all three.

Question 21

Acute Cystitis

Follow Up

Answer 21

(a) Infections typically respond rapidly to therapy

Question 22

Acute Cystitis

Referral to Urology is indicated when:

Answer 22

1) Suspicion or radiographic evidence of anatomic abnormality.
2) Evidence of urolithiasis.
3) Recurrent cystitis due to bacterial persistence.