UTI and IC Flashcards
Outflow obstruction, inadequate fluid intake, neurogenic bladder
Reduced urine flow
sexual activity, spermicide use, estrogen depletion, recent antimicrobial use
Promote colonization
Catheterization and urinary incontinence
facilitate ascent
CP of cystitis
HISTORY IMPORTANT! Dysuria, Fq, urgency, +/- hematuria, +/- suprapubic discomfort
PE of cystitis
Typically normal except for 10-20% that experience suprapubic tenderness
PE elements to perform for cystitis
assessment signs of dehydration check for CVA tenderness Abd exam \+/- pelvic exam in women genital exam in men, +/- DRE
What does urethral discharge in a female usually indicate?
urethritis, not cystitis
What is the most valuable diagnostic tool in testing for UTI?
Pyuria evaluation
Abnormal is >10 leukocytes/mL
+hematuria (normal finding)
+nitrites
Which test is the most specific for UTI?
leukocyte esterase
What can you see a false + nitrite test with?
phenAZOpyridine (pyridium) OR
exposure to air causes false positives across the board
Is a culture indicated for acute cystitis?
No
When can you feel comfortable getting a urine culture?
if you suspect pyelonephritis, if sx don’t resolve, if sx recur, any atypical presentation
What is considered diagnostic for uncomplicated cystitis?
> 10^3 CFU if uncomplicated
>10^2 if it looks complicated
What other diagnostic test might be appropriate for a new UTI?
PGN test
What might a UTI look like? (DDx)
Vaginitis urethritis structural urethral abnormalites IC/Painful bladder syndrome PID
Men: prostatitis, urethritis
What is first-line treatment for uncomplicated cystitis in women?
Bactrim 160/800
Nitrofurantoin (macrobid)
Fosfomycin
second-line treatment for uncomplicated cystitis in women
Fluoroquinolones
For acute uncomplicated cystitis 3rd-line
Beta-lactams
First line for complicated cystitis in nonpregnant female
Fluroroquinolone- try parenteral if can’t tolerate oral
For acute uncomplicated cystitis in men (still kind of considered complicated)
bactrim then fluoro
What is the DOC for woman in PGN with any kind of UTI?
Amoxicillin-clavulanate (augmentin) then
Nitrofurantoin (avoid near term)
NEVER USE A FLUOROQUINOLONE
What will a pyelonephritis UA reveal?
positive pyuria
+/- hematuria
WBC casts (not always seen, but if you see it, you have this)
What will a urine culture for pyelonephritis reveal?
> 10^5 CFU/mL
What will a CBC and BMP reveal in pyelonephritis?
leukocytosis with left shift
+/- impaired renal function
When is imaging indicated for pyelonephritis?
When there is no improvement or when there is a recurrence OR if the patient is severely ill
What is the image of choice for pyelonephritis?
CT with contrast (caution nephropathy)
renal U/S and MRI too
What might pyelonephritis look like?
Appendicitis diverticulitis cholecystitis lower lobe pneumonia PID NEPHROLITHIASIS with colick-y pain, not only with CVA tenderness
What is used to treat mild-moderate pyelonephritis outpatient? What about if there is resistance detected?
FLUOROQUINOLONES. If there is resistance, do quinolones PLUS CEFTRIAXONE shot
When must you follow up with pyelopnephritis (aka SEE THEM IN OFFICE)?
24-48 hours after diagnosis
What is the CP in pyelonephritis?
hx of lower or upper UTI in PMH, FEVER, chills, n/v/pain, CVA TENDERNESS, possible suprapubic tenderness
What are indications for hospitalization of acute pyelonephritis?
DM kidney disfunction liver or heart dz Male LOOKS SICK SEVERE PAIN FEVER OVER 103 UNABLE TO DRINK LOW BP
When is IC most commonly diagnosed?
in the 30s, sometimes even in peds
What does IC often exist with?
Other chronic pain conditions such as fibromyalgia, IBS, VULVODYNIA
What else do many IC patients experience besides urinary sx?
Depression, sexual disfunction
What is the most important central finding in IC?
altered urothelium of GAG layer (hyperplasia)
What small lesion will you find in IC?
granulations of petechiae
What percentage of IC patients have ulcerative IC? Nonulcerative?
10% (Hernen ulcers)
90%
What is the CP of IC like?
SUPRAPUBIC/BLADDER PAIN, OFTEN WORSE WITH BLADDER FILLING AND RELIEF WITH EMPTYING, +/- pain anywhere else
+/- urinary urgency, fq, nocturia
+/- dyspareunia, vaginal bleeding
+/- painful ejaculation, sexual dysfunction
How is the clinical diagnosis of IC made?
DURATION OF SX FOR 6 WEEKS
PMH: Prior recurrent UTIs, pelvic trauma, etc
Use bathroom more because it hurts not to
how many times a day do they void?
What should a PE of IC include?
Abd, BIMANUAL PELVIC, rectal exam in males
+/- pelvic floor muscle spasm due to irritable nerves
Since IC is a diagnosis of exclusion, what must you do to rule it in?
UA with microscopy and culture to r/o infection and hematuria, if hematuria, then cytology and cystology
CYTOLOGY IMMEDIATELY if smoking history (no blood needed)
Urine culture if sexually active
+/- postvoid residual urine volume test
+/- cystoscopy (not required for dx)
Treatment of IC
voiding log
First-line: lifestyle changes, behavioral modification, low-impact exercise, psychotherapy
Second-line:
NON-FDA APPROVED but fast: Amitriptyline
FDA-APPROVED but slow (3-6 months): Elmiron (pentosan polysulfate)
Histimines for mast cell stabalization
Intravesicular meds (DMSO, heparin, lidocaine)
Physical Therapy
When to refer patient with IC?
Heme, PAIN WITH INCONTINENCE
Have not responded with initiall tx of oral meds
