UTI/Cystitis Flashcards by Wendy Pitts

Lower tract UTI is?

Cystitis

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Upper tract UTI is?

Pyelonephritis

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In Men 20-50 yo, UTI’s U from what?

urethritis

prostatitis

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UTI risk factors: reduced urine flow

outflow obstruction
↓ fluid intake
neurogenic bladder (no control)

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UTI risk factors: promote colonization

sex activity, spermicide use
estrogen depletion
recent abx

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UTI risk factors: facilitate ascent

catheterization

incontinence

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Uncomplicated UTIs are?

Otherwise healthy/whole
Not pregnant
Premenopause

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Complicated UTIs are?

Men UTIs (U) complicated
Hx of UTIs
Immuno ↓
Preadolescent/Postmenopausal
Metabolic disorder (i.e. DM)
Uro abnormalities (i.e. stones, stents, neuro)

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Acute Cystitis presentation?

pain
frequency
urgency
(P) blood, suprapub pain

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Probability of cystitis if +dysuria/frequency and no vaginal d/c?

90%

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Acute Cystitis physical exam should include?

General (look ill?)
Dehydration
CVA tenderness
Abd exam
(P) pelvic
Genital (men), (P) digital rectal

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Acute Cystitis diagnostics?

UA = pyuria (WBCs >10^3)
Dip = +LE/+nitrites
Cx if complicated, pyeloneph, unresolving, atypical
Pregnancy test

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False + for nitrites when?

if taking pyridium or if strip left exposed to air

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Acute Cystitis tx: 1st line for uncomplicated?

Trimeth-sulfa* or
Macrobid or
Monurol

*use this if suspect pyeloneph

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Acute Cystitis tx: 2nd line for uncomplicated?

(if allergies, cost, etc)

Cipro (fluoroquins)

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Acute Cystitis and use of Pyridium?

only give for 2 days ->

if abx not working, pain is masked and pt may not return for change in tx

Acute Cystitis tx: 1st line for complicated

Non-preggos?

Preggos?

NON-preggos:
Cipro (fluoroquins) oral or parenteral

PREGGOS:
Augmentin or
Macrobid (but not near term)
NO fluoroquins!

Acute Pyelonephritis presentation?

UTI sxs
Flank pain
Fever, chills, malaise
N/V/D

Acute Pyelonephritis labs? (4)

UA =
pyruia >10
+/- hemat
WBC CASTS

Cx = + >10^5 colony count

CBC = WBC L shift

BMP: assess renal fxn

Acute Pyelonephritis imaging?

Only if complicated or severely ill:

CT w/ contrast
Renal US

Acute Pyelonephritis tx: 1st line mild/mod?

Cipro (Fluoroquin)

if e. coli resistant add Rocephin (ceftriaxone)

Acute Pyelonephritis outpt f/u?

48 hrs!!

Acute Pyelonephritis reasons to hospitalize? (9)

Comorbids
Hemo instability (sepsis/shock)
Male
Metabolic dysf (acidosis)
Pregnancy
Severe pain
Toxic appearance
Can't take PO fluids
Fever > 103

Interstitial Cystitis/Bladder Pain Synd (PBS) is?

infectionless discomfort in bladder

a/w cystitis sxs > 6wks

PBS epidemiology?

W > M 4th decade a/w chronic pain conditions

PBS impact on quality of life?

sex dysfxn | depression

PBS pathophys?

multifactorial K+ leak thru tissue depols nn -> damages tissue Most important finding: ALTERED UROTHELIUM (U Glycosaminoglycan layer)

Glycosaminoglycan damage results in?

``` ↓ urothelial growth chronic inflam mast cell activity sensory nn upreg void dysfxn ```

PBS presentation?

Suprapubic/bladder pain: worse when full, better when empty | P) frequency/urgency (P) dyspareunia (sex pain

PBS hx?

``` sxs > 6 wks location/severity/character of pain recurrent UTIs pelvic trauma/surgery/radiation void several times/day ```

PBS physical exam should include?

Abd Biman pubic (W) Rectal (M)

PBS diagnostics?

EXCLUSIONARY UA/Cx: r/o infection (chalmydia)/hemato Urine cytology if smoker Post-void residual urine vol: r/o obstruction, neuro disorder

PBS management?

Establish baseline sxs (pt log) 1st LINE: Lifestyle Δ (diet, ↓ void frequency, low-impact exercise, psychotherapy) 2nd LINE: TCAs (high s/e but fast relief) Elmiron (low s/e but slow relief)