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Clin Med 2 > UTI and IC > Flashcards

UTI and IC Flashcards

1
Q

Outflow obstruction, inadequate fluid intake, neurogenic bladder

A

Reduced urine flow

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2
Q

sexual activity, spermicide use, estrogen depletion, recent antimicrobial use

A

Promote colonization

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3
Q

Catheterization and urinary incontinence

A

facilitate ascent

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4
Q

CP of cystitis

A

HISTORY IMPORTANT! Dysuria, Fq, urgency, +/- hematuria, +/- suprapubic discomfort

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5
Q

PE of cystitis

A

Typically normal except for 10-20% that experience suprapubic tenderness

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6
Q

PE elements to perform for cystitis

A 
assessment
signs of dehydration
check for CVA tenderness
Abd exam
\+/- pelvic exam in women
genital exam in men, +/- DRE
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7
Q

What does urethral discharge in a female usually indicate?

A

urethritis, not cystitis

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8
Q

What is the most valuable diagnostic tool in testing for UTI?

A

Pyuria evaluation
Abnormal is >10 leukocytes/mL
+hematuria (normal finding)
+nitrites

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9
Q

Which test is the most specific for UTI?

A

leukocyte esterase

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10
Q

What can you see a false + nitrite test with?

A

phenAZOpyridine (pyridium) OR

exposure to air causes false positives across the board

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11
Q

Is a culture indicated for acute cystitis?

A

No

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12
Q

When can you feel comfortable getting a urine culture?

A

if you suspect pyelonephritis, if sx don’t resolve, if sx recur, any atypical presentation

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13
Q

What is considered diagnostic for uncomplicated cystitis?

A

> 10^3 CFU if uncomplicated

>10^2 if it looks complicated

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14
Q

What other diagnostic test might be appropriate for a new UTI?

A

PGN test

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15
Q

What might a UTI look like? (DDx)

A 
Vaginitis
urethritis
structural urethral abnormalites
IC/Painful bladder syndrome
PID

Men: prostatitis, urethritis

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16
Q

What is first-line treatment for uncomplicated cystitis in women?

A

Bactrim 160/800
Nitrofurantoin (macrobid)
Fosfomycin

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17
Q

second-line treatment for uncomplicated cystitis in women

A

Fluoroquinolones

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18
Q

For acute uncomplicated cystitis 3rd-line

A

Beta-lactams

19
Q

First line for complicated cystitis in nonpregnant female

A

Fluroroquinolone- try parenteral if can’t tolerate oral

20
Q

For acute uncomplicated cystitis in men (still kind of considered complicated)

A

bactrim then fluoro

21
Q

What is the DOC for woman in PGN with any kind of UTI?

A

Amoxicillin-clavulanate (augmentin) then
Nitrofurantoin (avoid near term)
NEVER USE A FLUOROQUINOLONE

22
Q

What will a pyelonephritis UA reveal?

A

positive pyuria
+/- hematuria
WBC casts (not always seen, but if you see it, you have this)

23
Q

What will a urine culture for pyelonephritis reveal?

A

> 10^5 CFU/mL

24
Q

What will a CBC and BMP reveal in pyelonephritis?

A

leukocytosis with left shift

+/- impaired renal function

25
Q

When is imaging indicated for pyelonephritis?

A

When there is no improvement or when there is a recurrence OR if the patient is severely ill

26
Q

What is the image of choice for pyelonephritis?

A

CT with contrast (caution nephropathy)

renal U/S and MRI too

27
Q

What might pyelonephritis look like?

A 
Appendicitis
diverticulitis
cholecystitis
lower lobe pneumonia
PID
NEPHROLITHIASIS with colick-y pain, not only with CVA tenderness
28
Q

What is used to treat mild-moderate pyelonephritis outpatient? What about if there is resistance detected?

A

FLUOROQUINOLONES. If there is resistance, do quinolones PLUS CEFTRIAXONE shot

29
Q

When must you follow up with pyelopnephritis (aka SEE THEM IN OFFICE)?

A

24-48 hours after diagnosis

30
Q

What is the CP in pyelonephritis?

A

hx of lower or upper UTI in PMH, FEVER, chills, n/v/pain, CVA TENDERNESS, possible suprapubic tenderness

31
Q

What are indications for hospitalization of acute pyelonephritis?

A 
DM
kidney disfunction
liver or heart dz
Male
LOOKS SICK
SEVERE PAIN
FEVER OVER 103
UNABLE TO DRINK
LOW BP
32
Q

When is IC most commonly diagnosed?

A

in the 30s, sometimes even in peds

33
Q

What does IC often exist with?

A

Other chronic pain conditions such as fibromyalgia, IBS, VULVODYNIA

34
Q

What else do many IC patients experience besides urinary sx?

A

Depression, sexual disfunction

35
Q

What is the most important central finding in IC?

A

altered urothelium of GAG layer (hyperplasia)

36
Q

What small lesion will you find in IC?

A

granulations of petechiae

37
Q

What percentage of IC patients have ulcerative IC? Nonulcerative?

A

10% (Hernen ulcers)

90%

38
Q

What is the CP of IC like?

A

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

39
Q

How is the clinical diagnosis of IC made?

A

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?

40
Q

What should a PE of IC include?

A

Abd, BIMANUAL PELVIC, rectal exam in males

+/- pelvic floor muscle spasm due to irritable nerves

41
Q

Since IC is a diagnosis of exclusion, what must you do to rule it in?

A

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)

42
Q

Treatment of IC

A

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

43
Q

When to refer patient with IC?

A

Heme, PAIN WITH INCONTINENCE

Have not responded with initiall tx of oral meds

Clin Med 2 (13 decks)

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