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X Clin Med II Exam 3 > UTIs and Interstitial cystitis > Flashcards

UTIs and Interstitial cystitis Flashcards

1
Q

When is the urine dipstick most accurate for predicting a UTI?

A

When positive for leukocyte esterase and/or nitrite in a symptomatic pt
BUT negative doesn’t always r/o and positive doesn’t always support when asymptomatic

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2
Q

What can cause a false negative nitrite urine dipstick result?

A

Non-nitrate reducing organisms

Frequent urination/urine in bladder < 4 hrs

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3
Q

What can cause false positive leukocyte esterase urine dipstick results?

A

Vaginal contamination

Trichomonas infection

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4
Q

Kinds of upper vs lower tract UTIs

A

Upper: pyelonephritis
Lower: cystitis, prostatitis, urethritis

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5
Q

What must you rule out with a UTI in males?

A

Urethritis and prostatitis

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6
Q

What causes most UTIs?

A

Ascending bacterial infection (rest are hematogenous)

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7
Q

What microbe causes most UTIs?

A

E. coli

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8
Q

Risk factors for UTIs

A

Reduced urine flow
Promote colonization
Facilitate ascent

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9
Q

Examples of reduced urine flow

A 
Urine outflow obstruction
Inadequate fluid intake
Neurogenic bladder (urinary retention)
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10
Q

Examples of colonization promotion in UTIs

A

Sex
Spermicide use
Recent antimicrobial use

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11
Q

Ways to facilitate ascent in UTIs

A

Catheters
Urinary incontinence
Fecal incontinence

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12
Q

What is acute simple cystitis?

A

Acute UTI presumed to be confined to bladder in a non-pregnant individual (only irritative voiding sxs)

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13
Q

What is an acute complicated UTI?

A

Acute UTI accompanied by sxs that suggest extension of infection beyond bladder
Sxs: fever, chills, rigor, fatigue, flank pain, CVAT, pelvic or perineal pain in men

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14
Q

Who are the special populations when considering UTIs?

A

Pregnant women
Men
Pts with comorbidities, immunocompromised conditions or underlying urologic abnormalities

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15
Q

Sxs of acute simple cystitis

A

Dysuria, urinary frequency and urgency (maybe hematuria or suprapubic discomfort)

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16
Q

What is an atypical presentation in elderly for UTIs?

A

Incontinence and mental status changes

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17
Q

What is seen on a urine dipstick in acute simple cystitis?

A

Leukocyte esterase and nitrites

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18
Q

What is seen on urine microscopy in acute simple cystitis?

A

Pyuria (>10 leukocytes/microL)
Bacteriuria
(may see hematuria)

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19
Q

B/c cultures are not usually needed for acute simple cystitis, when is it recommended?

A 
Atypical presentation/diagnostic uncertainty
Suspect complicated UTI
Sxs that do not resolve or recur
Suspect resistance
Special populations
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20
Q

What is diagnostic for acute simple cystitis on urine culture?

A

> 10000 CFU or uropathogen (positive culture is >1000 CFU in women with typical sxs)

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21
Q

Symptomatic tx for acute simple cystitis

A

Urinary analgesic, PTC phenazopyridine for urgency and frequency

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22
Q

How long should a pt use symptomatic tx for acute simple cystitis?

A

2 days (don’t want to mask sxs)

23
Q

Abx tx for acute simple cystitis when not pregnant

A

Nitrofurantoin (macrobid)
Bactrim
Fosfomycin
(can use augmentin, cefdinir, cipro, levaquin if needed)

24
Q

When would you not use nitro or fosfomycin for acute simple cystitis?

A

If early pyelonephritis (due to low renal concentrations)

25
Q

Tx options for pregnant women with acute simple cystitis

A

Augmentin, cephalexin, cefpodoxime, fosfomycin
Don’t use nitro in 1st and 3rd trimester
Avoid fluoroquinolones!

26
Q

Tx options for men with acute simple cystitis

A

Primary therapy for longer (7 days)

R/o prostatitis

27
Q

Tx for pts with comorbidities etc that have acute simple cystitis

A

Primary therapy for longer (1-2 wks)-low threshold to manage as complicated UTI

28
Q

F/u urine cultures for acute simple cystitis?

A

Not needed when sxs resolve with tx (except pregnant)

*same for acute pyelonephritis

29
Q

How does acute pyelonephritis arise?

A

Ascent of bacterial pathogen up ureters form bladder to kidneys

30
Q

Presentation of acute pyelonephritis

A 
Normal UTI sxs
Flank pain
Fever, chills, malaise
N/v, anorexia, abdominal pain
Fever
CVAT
31
Q

What is seen on the UA and urine culture in acute pyelonephritis?

A 
\+leukocyte esterase
\+nitrites
Pyuria (>10 leukocytes/microL)
Bacteriuria
Maybe hematuria
White blood cell casts (renal origin for pyuria)
32
Q

What is a positive urine culture for acute pyelonephritis?

A

> 1000000 CFU/mL

33
Q

When is imaging indicated for acute pyelonephritis?

A

Severely ill
Persistent sxs despite 48-72 hrs of abx
Suspicion for urinary tract obstruction
Recurrent sxs within few wks of sxs

34
Q

What is the image of choice for acute pyelonephritis?

A

CT A/P (with or w/o contrast)

35
Q

Tx of acute pyelonephritis for outpatient with mild-moderate illness

A

Fluoroquinolones (if resistance then have IV dose of ceftriaxone first)
If susceptible to bactrim then do that for 7-10 days

36
Q

When must a pt with acute pyelonephritis f/u?

A

24-48 hrs!

37
Q

Indications for hospitalization with acute pyelonephritis

A 
Critically ill/hemodynamic instability
Persistently high fever
Persistent pain/ marked debility
Suspected or documented obstruction
Metabolic derangements 
Unable to take liquids by mouth
Concerns about compliance for f/u
38
Q

Tx of acute pyelonephritis for complicated/severe illness

A 
Fluroquinolone
Extended spectrum cephalosporin
Extended spectrum penicillin
Carbapenem
Aminoglycoside (plazomycin)
*support (analgesics, anti-emetic, IVF)
39
Q

Complications that might be associated with acute pyelonephritis

A

Sepsis with shock
Renal failure
Scarring or chronic pyelonephritis (kidney disease also)
Renal abscess formation (inadequate therapy)

40
Q

What is interstitial cystitis?

A

Bladder pain syndrome
Chronic debilitating condition characterized by bladder pain and voiding sxs for over 6 wks in absence of infection or other causes
*impacts psychosocial and quality of life

41
Q

What often coexists with interstitial cystitis?

A

Chronic pain conditions (fibromyalgia, irritable bowel syndrome)

42
Q

What is the pathophysiology of interstitial cystitis?

A

Altered urothelium due to combo of disruption of glycosaminoglycan layer, bladder urothelial injury, secretion of proinflammatory substances, neural hypersensitivity and neuropathic pain/voiding dysfunction

43
Q

Presentation of interstitial cystitis

A

Suprapubic/bladder pain (worse with filling and relieved with voiding)
+/- urinary urgency, frequency, nocturia
+/- pain in pelvis, perineum, urethra, ABD, back
+/- dyspareunia, vaginal burning
Men: pelvic pain with sexual dysfunction

44
Q

Why is a UA with microscopy and urine culture used in interstitial cystitis?

A

Diagnosis of exclusion
Done to exclude infection and hematuria
If + hematuria then urine cytology and cystoscopy (also this for +smoking history)

45
Q

Why is postvoid residual urine volume used for interstitial cystitis?

A

R/O bladder outlet obstruction or neuro disorder

46
Q

Why is cystoscopy used for interstitial cystitis?

A

If in doubt

Bladder hydrodistention done to detect glomerulation (submucosal hemorrhage)

47
Q

What can be seen on a cystoscopy for interstitial cystitis?

A

ID altered urothelium (glomerulations, hunner lesions)

48
Q

First line tx for interstitial cystitis

A 
Self care and behavior modifications
Diet
Bladder retraining by increasing voiding intervals)
Low impact exercise
Psychotherapy
Analgesics (pyridium)
49
Q

Second line tx for interstitial cystitis

A 
Oral meds (tricyclic antidepressant-amitriptyline, pentosan polysulfate-elmiron or antihistamines-hydroxyzine)
Intravesical meds like lidocaine
Pelvic PT
50
Q

Third line tx for interstitial cystitis

A

Cystoscopy with short duration, low pressure bladder hydrodistention (anesthesia)
Intravesical instillation of glycosaminoglycans
Intravesical dimethyl sulfoxide
*urology from here on

51
Q

Fourth line tx for interstitial cystitis

A

Intradetrusor botulinum toxin

Sacral neuromodulation

52
Q

Fifth line tx for interstitial cystitis

A

Cyclosporine

53
Q

Sixth line tx for interstitial cystitis

A

Surgery (urinary diversion)

54
Q

Indications for referral for interstitial nephritis

A 
Hematuria
Complex sxs (pain with incontinence)
Incomplete bladder emptying
Neurologic disorder that affects bladder function
Prior pelvic radiation
Prior pelvic surgery
Not responded to initial tx

X Clin Med II Exam 3 (6 decks)

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