UTI disorders Flashcards
who most commonly gets UTIs
infants <1yo (males)
females 1-65
>65yo (equal)
what causes UTIs
E coli and positive nitrites will be seen on UA
risk factors for UTI?
sexual activity, hygiene, hormones, BMI, low fluid intake, delayed voiding, GU anomalies, catherization
symptoms/signs of lower tract UTIs
urgency, incontinence, frequency, suprapubic/flank/low back pain,
dysuria, microscopic hematuria
signs/symptoms of upper tract UTIs
fever, chills, N/V, flank pain or CVA tenderness, lethargy, myalgia,
odorous urine, macroscopic hematuria
diagnosis of UTI: what must you rule out
STI, IC, stones, epididymitis, prostatitis, vagnitis
diagnosis of UTI: labs
UA dipstick and microscopic tests, Urine culture
diagnosis of UTI: imaging
US, KUB, MRI, IVP/IVU, cystoscopy, renogram
treatment considerations for UTI includes…
age, gender, complicated vs uncomplicated, risk factors, pregnancy (must treat pregnant women with/without symptoms)
what is usual treatment for UTIs?
antibiotics varying in duration depending on complexity
prevention of UTIs: for men
urinate frequently, saw palmetto, cranberry, hydration, lactobacillus
prevention of UTIs in women
D-mannose, cranberry, hydration, lactobacillus
what is pyelonephritis
infection/inflammation of kidney/renal pelvis
causes of pyelonephritis?
infection secondary to ascending lower UTI
signs/symptoms of pyelonephritis
: fever (>102 F), CVA tenderness/flank pain, chills, tachycardia, N/V,
leukocytosis, bacteriuria, hematuria, WBC casts
DDx for pyelonephritis
: cystitis, appendicitis, cholecystitis, pancreatitis, diverticulitis, epididymitis, prostatitis,
ectopic pregnancy, PID
treatment for pyelonephritis
oral or IV antibiotics
complications of pyelonephritis
recurrence of pyelonephritis, perinephric abscess (infection around
kidney), sepsis, acute renal failure
urinary stones: what are nephrolithiasis vs ureterolithiasis
nephrolithiasis: calculi in kidney while ureterolithiasis is calculi in ureter (usually originate in kidney)
urinary stones: who gets them
male/caucasian 35 (30-55 females)
cause of urinary stones
supersaturation=salts become concentrated if volume of urine is significantly reduces or if high amounts of crystal-forming salts are present
urinary stones risk factors:
pregnancy, urinary tract abnormalities, Southern U.S., specific foods,
obesity, stress, bedridden, medical conditions (HTN x3, IBD, etc), meds (thyroid
hormones, diuretics, antacids, etc)
urinary stones: signs and symptoms
sudden onset of acute/colicky/flank or back pain radiating to groin, CVA
tenderness, location of pain travels w/ stone, rebound tenderness, dysuria, urgency,
increased frequency, hematuria, systemic symptoms (diarrhea, N/V, diaphoresis)
are bigger stones more painful?
signs of stone does not predict severity of pain
labs for urinary stones?
UA → ~85% exhibit hematuria, CBC, Blood chem (serum electrolytes, creatinine,
Ca, uric acid, phosphorus)
• If recurrent → 24 hour collection
imaging for urinary stones
plain film of abdomen will often show stone and watchful waiting is OK for
asymptomatic stones, non-contrast spiral CT, IVP
DDx for urinary stones in males
testicular torsion, pyelonephritis, acute prostatitis, appendicitis, pancreatitis
DDx for urinary stones in females
ovarian cyst or torsion, ectopic pregnancy, pyelonephritis, appendicitis,
pancreatitis
treatment for urinary stones
NSAIDs with medical expulsive therapy (MET) and wait for stone to pass (<5 mm
diameter should pass within 3 weeks). Do not use opioids for pain.
• If obstruction and infection present → ER surgery.
prevention of urinary stones
increase fluids (~2L/day), diet low in sodium/protein/purine/oxalate, increase EFAs
for prevention of urinary stones: if hypercalcuria what do you not want to limit and what should you take
do not limit Ca intake, and take dandelion lead
for prevention of urinary stones: if hyperoxaluria what do you want to limit and what should you take
limit oxalates and take magnesium and B6
who most often gets incontinence?
women twice as likely to get them . MC in homebound/instinutionalized elderly (>50%)
causes of incontinence
carious neuro disorders from CNS, spinal cord, or peripheral n causing uncoordinated detrusor contraction with external sphincter relaxation
what are 4 types of incontinence? (which is MC?)
stress (MC), urge, mixed, and overflow
what causes stress incontinence?
poor sphincter function and or urethral mobility
what causes urge incontinence?
detrusor overactivity/instability or related to BPH
what is mixed incontinence? and who gets it MC
mix of both stress and urge incontinence seen in women over 65
what causes overflow incontinence?
detrusor paralysis or bladder outflow obstruction
what are risk factors for incontinence?
: any damage to pelvic floor mm or nn, vaginal deliveries, chronic increase in
intra-abdominal pressure, pelvic organ prolapse, smoking, pelvic/prostate surgery,
estrogen deficiency, BPH, UTI, bladder outlet obstruction, foreign bodies, neuro
disorders, DM, meds
what are management options for incontinence
pelvic floor exercises, electrical stim/biofeedback, barriers, behavioral
modification, absorbent products, surgery, meds
• Anticholinergic, antispasmodic, antidepressant, Ca channel blocker, betaagonist, estrogen
what is interstitial cystitis?
a painful bladder condition that results in recurring discomfort or pain in the bladder and the surrounding pelvic region
who gets interstitial cystitis MC
women (90%), Caucasian, 40yo
conditions that can lead to interstitial cystitis in women?
chronic pelvic pain, dyspareunia, vulvodynia, improves w/ pregnancy
conditions that can lead to interstitial cystitis in men?
chronic NB prostatitis, BPH, prostadynia
signs/symptoms of interstitial cystitis?
mild discomfort, pressure, tenderness or intense pain in the bladder and pelvic
area which may vary with bladder filling or emptying. Also urgency, nocturia, frequency
(>60x/day!!), (pre)menstrual exacerbation, dyspareunia
causes of interstitial cystitis
Unclear. Possibly: infectious, autoimmune, mechanical injury, mast cell activation,
alteration in bladder lining (GAGs)
how to dx interstitial cystitis
r/o other causes and confirm via cystoscopy w/ hydrodistention and bladder biopsy
treatment for interstitial cystitis
relieve symptoms since causes unknown. Bladder distension is diagnostic and early treatment. possibly anti-inflamm diet, quit smoking, exercise, bladder training, support GAGs, decrease NO, increase bioflavonoids. meds
