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CLASS 22010 GU > UTIs to include epididymitis, prostatitis, and pyelonephritis > Flashcards

UTIs to include epididymitis, prostatitis, and pyelonephritis Flashcards

1
Q

What are among the most common entities encountered in medical practice?

A

UTIs

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2
Q

What kind of bacteria is responsible for most UTIs?

A

Coliform Bacteria (E. Coli – most common)

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3
Q

What is the most common route for UTIs?

A

Ascending infection from the urethra

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4
Q

What is defined as an infection of the bladder?

A

Acute cystitis

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5
Q

Cystitis is most commonly caused by what?

A
  1. E. Coli (coliform bacteria)

2. Enterococci (gram-positive)

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6
Q

True or False

Uncomplicated cystitis in men is rare and implies a pathologic process such as infected stones, prostatitis, or chronic urinary retention requiring further investigation

A

True

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7
Q

These are all signs and symptoms of what?

  1. Irritative voiding symptoms
    a. frequency
    b. urgency
    c. dysuria
  2. suprapubic discomfort
  3. female hematuria/symptoms after sex
  4. usually afebrile
  5. may have suprapubic tenderness w/ palpation
A

Cystitis

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8
Q

These can all be causes of what?

  1. Pelvic irradiation
  2. Chemotherapy
  3. Bladder carcinoma
  4. Interstitial cystitis
  5. Voiding dysfunction disorders
  6. Psychosomatic disorders
A

Noninfectious cystitis

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9
Q

Lab findings in urinalysis for cystitis may reveal what?

A
  1. Pyuria
  2. Bacteriuria
  3. Various degrees of hematuria
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10
Q

Since uncomplicated cystitis is rare in men what kind of imaging is warranted?

A
  1. Ultrasonography
  2. Cystoscopy
    (or both)
  3. possible CT scan if pyelonephritis, recurrent infections, or autonomic abnormalities suspected
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11
Q

What is the antimicrobial therapy for cystitis?

A
  1. Ciprofloxacin (cipro) 250mg q 12hrs, PO 3 days
  2. Nitrofurantoin (macrobid) 100mg q 12hrs PO 5-7 days
  3. Trimethoprim/Sulfamethoxazole (bactrim) 160mg TMP PO q 12hrs 3 days
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12
Q

What urinary analgesics can be used for cystitis?

A

Phenazopyridine (pyridium) 100-200mg q 8hrs as needed PO max 3 days

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13
Q

Women who have more than how many episodes of cystitis per year can be considered for prophylactic antibiotic therapy?

A

Three episodes per year

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14
Q

What are the three most commonly used oral agents for cystitis prophylaxis?

A
  1. Trimethoprim-Sulfamethoxazole (40mg/200mg) daily
  2. Nitrofurantoin (100mg) daily
  3. Cephalexin (250mg)
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15
Q

What is an infectious inflammatory disease involving the kidney parenchyma and renal pelvis?

A

Pyelonephritis

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16
Q

What are the most common causative agents of pyelonephritis?

A

Gram-negative bacteria

  1. E coli
  2. Proteus
  3. Klebsiella
  4. Enterobacter
  5. Pseudomonas
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17
Q

What are some gram-positive bacteria that are less commonly seen in pyelonephritis?

A
  1. Enterococcus Faecalis

2. Staphylococcus Aureus

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18
Q

Infection in pyelonephritis usually ascends from the lower urinary tract except what bacteria that is usually spread by a hematogenous route (blood stream)?

A

S. aureus

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19
Q

These are all signs and symptoms of what?

  1. Fever
  2. Flank pain
  3. Irritative voiding symptoms
  4. Shaking chills
  5. Associated nausea and vomiting
  6. Diarrhea
  7. Tachycardia
  8. CVA tenderness is usually pronounced
A

Pyelonephritis

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20
Q

What are some lab findings for pyelonephritis?

A
  1. UA: pyuria, bacteriuria, degrees of hematuria, WBCs
  2. Urine culture: heavy growth of offending organism
  3. Blood culture: may be positive
  4. CBC: Leukocytosis and left shift
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21
Q

What imaging should be done for pyelonephritis?

A

Renal ultrasound

1. may show hydronephrosis (stone/obstruction)

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22
Q

What antimicrobial therapy is used for INPATIENT treatment of pyelonephritis?

A

Ampicillin 1g q 6hrs and Gentamicin 1mg/kg q 8hrs IV (14 days)

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23
Q

What antimicrobial therapy is used for OUTPATIENT treatment of pyelonephritis?

A
  1. Ciprofloxacin (Cipro) 750mg q 12hrs PO (7-14 days)

2. Levofloxacin 750mg PO (7-14 days)

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24
Q

True or False

IV antibiotics are continued for 24hrs after the fever resolves in pyelonephritis and oral antibiotics are then given to complete the 14 day course of therapy

25
Q

Fever in pyelonephritis may persist for up to how long even with appropriate antibiotics?

26
Q

Associated factors such as those listed below all warrant what disposition in a patient with pyelonephritis?

  1. Complicating factors
    a. urolithiasis
    b. obstruction
  2. severe infection
  3. evidence of sepsis
  4. need for parenteral antibiotics
  5. no clinical improvement in 48hrs with PO antibiotics
  6. need for imaging
  7. need for draining of urinary tract obstruction
27
Q

What is inflammation and infection of the prostate gland?

A

Acute prostatitis

28
Q

What usually causes prostatitis?

A
  1. Gram-negative rods
    a. E coli
    b. Pseudomonas
29
Q

Prostatitis is less commonly caused by what gram-positive organism?

A

Enterococci

30
Q

What are the most likely routes of infection in prostatitis?

A
  1. ascent up urethra
  2. reflux of infected urine into the prostatic ducts
  3. lymphatic and hematogenous routes are rare
31
Q

These are all signs and symptoms of what?

  1. Perineal, sacral, or suprapubic pain
  2. High fever
  3. Irritative voiding symptoms
  4. Varying degrees of obstructive symptoms may occur as acutely inflamed prostate swells (urinary retention)
  5. warm, tender prostate detected on exam
A

Prostatitis

32
Q

What are some common lab findings in prostatitis?

A
  1. CBC: leukocytosis and left shift
  2. UA: pyuria, bacteruria, degrees of hematuria
  3. Urine culture: offending pathogen
33
Q

What antimicrobial therapy is used for INPATIENT treatment of patients with prostatitis?

A
  1. Ampicillin 1g q 6hrs and Gentamicin 1mg/kg q 8hrs IV
34
Q

If antibiotics are continued for _____ after the fever resolves in prostatitis and oral antibiotics are then given to complete the 4-6 week course of therapy.

35
Q

What antimicrobial therapy is used for OUTPATIENT treatment of patients with prostatitis?

A
  1. Ciprofloxacin (cipro) 750mg q 12hrs PO (4-6 weeks)
  2. Levofloxacin (Levaquin) 750mg PO (4-6 weeks)
  3. Trimethoprim-Sulfamethoxazole (Bactrim DS) 160/800mg q 12hrs PO 4-6 weeks
36
Q

True or False

You can use Tylenol and NSAIDS for pain control with prostatitis

37
Q

True or False

If urinary retention in prostatitis persists, a percutaneous suprapubic tube is required but urethral catheterization is CONTRAINDICATED

A

True

Urethral Catheterization is CONTRAINDICATED

38
Q

What is the disposition of patients with prostatitis?

A

MEDEVAC

  1. evidence of urine retention
  2. signs of sepsis
  3. need for surgical drainage of bladder prostatic abscess
  4. chronic prostatitis
  5. absence of clinical improvement in 48hrs with PO antibiotics
39
Q

What may evolve from acute bacterial prostatitis?

A

Chronic bacterial prostatitis

40
Q

What is the most common etiologic agents in chronic bacterial prostatitis?

A

Gram-negative rods

41
Q

What is the ONLY gram-positive organism that’s associated with chronic bacterial prostatitis?

A

Enterococcus

42
Q

Can chronic bacterial prostatitis be managed by the IDC alone?

A

NNNNOOOOPPPPPEEEE

43
Q

What are these signs and symptoms of?

  1. Variable degree of irritative voiding symptoms
  2. Low back and perineal pain
  3. Suprapubic discomfort
  4. History of UTIs
  5. PE usually unremarkable
A

Chronic bacterial prostatitis

44
Q

Upon examination the how would the prostate feel in chronic bacterial prostatitis?

A
  1. normal
  2. boggy
  3. indurate
45
Q

Imaging in chronic bacterial prostatitis may not be necessary but pelvic radiographs or transrectal ultrasounds may show what?

A

Prostatic Calculi

46
Q

What antimicrobials would be used for chronic bacterial prostatitis?

A
  1. Trimethoprim-Sulfamethoxazole (Bactrim DS) 160/800mg q 12hrs PO
    a. associated w/ best cure rates
  2. Ciprofloxacin (cipro) 250-500mg q 12hrs PO
  3. Levofloxacin (levaquin) 750mg daily PO
47
Q

Where should you refer suspected chronic bacterial prostatitis patients?

48
Q

What is the inflammation and/or infection of the epididymis?

A

Epididymitis

49
Q

What are the two categories that epididymitis can be divided into?

A
  1. Sexually transmitted

2. Non-sexually transmitted forms

50
Q

What category of epididymitis typically occurs in men under 40 years of age, associated with urethritis, and can result from chlamydia trachomatis or Neisseria gonorrhoea?

A

Sexually transmitted

51
Q

What category of epididymitis typically occurs in older men, associated with UTIs and prostatitis, and can be caused by gram-negative rods (E-coli, Klebsiella)

A

Non-sexually transmitted

52
Q

What is the route of infection for epididymitis?

A

urethra to the ejaculatory duct

53
Q

These are signs and symptoms of what?

  1. may follow heavy lifting, trauma, sex
  2. urethritis or cystitis
  3. pain in scrotum and may radiate along spermatic cord or to the flank
  4. fever
  5. scrotal swelling
  6. early in the course
    a. epididymis may be distinguishable from testis
  7. later
    a. the two may appear as one large, tender mass
  8. Prehn sign
A

Epididymitis

54
Q

What is Prehn sign?

A

elevation of the scrotum above the pubic symphysis improves pain from epididymitis

55
Q

What kind of imaging should you use for epididymitis?

A

Scrotal ultrasound

56
Q

What antimicrobial therapy would you use for sexually transmitted epididymitis?

A
  1. Ceftriaxone (Rocephin) 500mg IM x1 dose
    PLUS
  2. Doxycycline 100mg BID for 10 days
57
Q

What antimicrobial therapy would you use for non-sexually transmitted epididymitis?

A
  1. Trimethoprim/sulfamethoxazole (Bactrim) 160mg TMP PO q 12hrs for 3 weeks
  2. Ciprofloxacin (cipro) 250-500mg PO BID for 3 weeks
  3. Levofloxacin (Levaquin) 750mg PO (3 weeks)
58
Q

What are some good methods for symptomatic relief of epididymitis?

A
  1. Bed rest
  2. scrotal support
  3. ice packs
  4. Anti-inflammatory analgesics (NSAIDS)
59
Q

Delayed or inadequate treatment of epididymitis may result in what?

A
  1. Epididymo-orchitis
  2. Decreased fertility
  3. Abscess formation

CLASS 22010 GU (41 decks)

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