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clin med II, exam 3 > UTI, pyelo, IC > Flashcards

UTI, pyelo, IC Flashcards

1
Q

What pathogen accounts for 75-95% of cases of UTI

A

Escherichia coli

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2
Q

What are the other pathogens of UTI

A
  • gram negative
    • Klebsiella
    • Proteus
    • Pseudomonas aeruginosa
  • gram positive
    • staph saprophyticus
    • enterococcus
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3
Q

Differentiate between upper and lower tract infections

A
  • upper tract
    • Pyelonephritis
  • lower tract
    • Cystitis
    • urethritis
    • prostatitis
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4
Q

Name the risk factors for UTI

A
  1. reduced urine flow
  2. promote colonization
  3. facilitate ascent
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5
Q

what are some causes of reduced urine flow that makes a person at risk for UTI

A
  • outflow obstruction
  • inadequate fluid intake
  • neurogenic bladder
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6
Q

what are some causes of things that promote colonization that makes a person at risk for UTI

A
  • sexual activit, spermicide use
  • estrogen depletion
  • recent antimicrobial use
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7
Q

what are some things that facilitate ascent that makes a person at risk for UTI

A
  • catheterization
  • urinary incontinence
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8
Q

Name the characteristics that make a UTI uncomplicated

A
  • immunocompetent
  • no comorbidies
  • no known urologic abnormalities
  • not pregnant
  • premonopausal
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9
Q

what is cystitis

A

infection of the bladder

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10
Q

acute cystitis has what 3 characteristic symptoms

A
  1. dysuria
  2. frequency
  3. urgency
  • can also have hematuria and/or suprapubic discomfort
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11
Q

probability of cystitis increases in women who have dysuria and frequency without

A

vaginal discharge/irritation

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12
Q

what parameter on urine dipstick is most specific for UTI

A

+ leukocyte esterase

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13
Q

nitrite can have a false positive with what medications

A
  • phenazopyridine (Azo, pyridium)
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14
Q

when are urine cultures recommended

A
  • suspect complicated infection
  • suspect acute pyelonephritis
  • symptoms that do not resolve
  • symptoms that recur
  • atypical presentation
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15
Q

what number of colony-forming units per mL is diagnostic for acute cystitis

A
  • > or = 103
    • ​102 is + is women with typical symptoms
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16
Q

what should be given in addition to antimicrobial therapy for UTI

A
  • Phenazopyridine (Pyridium) 200 mg TID x 2 days
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17
Q

What is the first line treatment options for acute, uncomplicated cystitis in women

A
  1. Timethoprim/Sulfamethozazole (Bactrim) 160/800 mg BID x 3 days
  2. Nitrofurantoin (Macrobid)
  3. Fosfomycin (Monurol): single dose
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18
Q

why would you not give bactrim for acute, uncomplicated cystitis in women

A
  • prevalence of resistant > 20%
  • used for UTI in previous 3 months
19
Q

What is the second line treatment options for acute, uncomplicated cystitis in women

A
  1. Fluoroquinolones
    1. Ciprofloxacin
    2. Cipro XR
    3. Levofloxacin
    4. Ofloxacin
20
Q

What is the third line treatment options for acute, uncomplicated cystitis in women

A
  • oral beta-lactams
21
Q

What is the first line treatment options for acute, complicated cystitis in nonpregnant women

A
  • Fluoroquinolones
22
Q

What is the first line treatment options for acute, uncomplicated cystitis in men

A
  1. bactrim or
  2. fluoroquinolones
23
Q

What is the first line treatment options for acute cystitis in pregnant women

A
  1. Macrobid
  2. Augmentin
  • ***Avoid fluoroquinolones!!!!!
24
Q

patient education for acute cystitis

A
  • push fluids
  • void when feel urgency
  • void before and after sexual intercourse
  • complete course of Abx
  • signs of pyelonephritis
25
Q

What is pyelonephritis? what conditions can it lead to

A

infection of the kidney

  • can lead to
    • renal abcess
    • sepsis
    • shock
    • ARF
26
Q

These UA results are consistent with

  • pyuria (> 10 leukocytes/micoL)
  • bacteriuria
  • +/- hematuria
  • white blood cell casts
A

pyelonephritis

27
Q

When is imaging indicated in acute pyelonephritis? what imaging is indicated

A
  • complicated pyelonephritis or
  • appear severely ill
  • CT +/- contrast
28
Q

Tx for mild-moderate acute pyelonephritis (outpatient management)

A
  • Fluoroquinolones x 1 week
  • if local resistance in Ecoli > 10 %
    • add Ceftriaxone (rocephin)
  • Must f/u in 24-48 hours
29
Q

What are the indications to admit a patient with acute pyelonephritis

A
  • concerns about compliance
  • comorbid conditions
  • hemodynamic instability
  • male
  • metabolic derangement (acidosis)
  • pregnancy
  • severe pain
  • toxic appearance
  • unable to take liquids by mouth
  • very high fever (>103 F)
30
Q

inpatient tx for nonpregnant women with acute pyelonephritis

A
  • fluoroquinolone
31
Q

What is interstitial cystitis? What patient population does it commonly affect

A
  • bladder pain syndrome; diagnosis of exclusion
  • women
  • >40 yo
  • often coexists with other chronic pain conditions: fibromyalgia, IBS
32
Q

What is the most important central finding in interstitial cystitis

A

altered urothelium

  • Glycosaminoglycan (GAG) layer commonly damaged
    • impedes urothelial growth -> chronic inflammation -> mast cel activation -> upregulation of sensory innervation -> pain
33
Q

as interstitial cystitis progesses, fibrosis can occur, what sign is common

A

Glomerulations: bladder hemorrhages

34
Q

What is the percentage breakdown of interstitial cystitis in terms of ulcerative and nonulcerative type

A
  • nonulcerative type: 90%
  • ulcerative type: 10%
35
Q

clinical presentation

  • highly variable
  • suprapubic bladder pain
    • ​worse with bladder filling, relieved with voiding
  • increased urinary frequency
  • Dyspareunia (difficult or painful sexual intercourse), relationship of pain to menstruation
  • males: +/- painful ejaculation
A

interstitial cystitis

36
Q

How is interstitial cystitis diagnosed

A

clinically

  • sx duration > or = 6 weeks
  • location, character of pain
  • PMH: prior recurrent UTIs, pelvic trauma, surgery, radiation
37
Q

Since interstitial cystitis is a diagnosis of exclusion, what are tests you should run to make sure something else is going on

A
  1. UA with microscopy and urine culture
    • check for chlamydia
  2. urine cytology if + smoking history
  3. +/- postvoid residual urine volume
    • r/o bladder outlet obstruction or neuro disorder
  4. +/- cytoscopy -> indicated if in doubt
38
Q

for interstitial cystitis treatment, what should be done to establish baseline symptoms

A
  1. voiding log
  2. O’Leary-Sant symptoms and problem questionnaire
  3. Pelvic pain and urgency/frequency questionnaire
39
Q

First line tx for interstitial cystitis

A
  1. Lifestyle changes: avoid citrus, spicy food, caffeine, ETOH, carbonated beverages
  2. Behavior modification: bladder retraining
  3. Low impact exercise
  4. support groups
40
Q

second line tx for interstitial cystitis

A
  • oral medication
    • *Tricyclic antidepressant (Amitriptyline)
    • Pentosan Polysulfate (Elmiron)
      • may take 3-6 months to respond
41
Q

indications for referral with interstitial cystitis

A
  • hematuria
  • complex symptoms (pain with incontinence)
  • incomplete bladder emptying
  • neurologic disorder that affects bladder function
  • prior pelvic radiation or surgery
  • not responding to initial tx with oral meds
42
Q

clinical presentation

  • fever
  • flank pain
  • N/V
  • CVA tenderness
A

pyelonephritis

43
Q

what must you do prior to initiating Abx for all pyelonephritis cases

A

must culture

clin med II, exam 3 (6 decks)

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