Women's Health Flashcards
What is cystitis?
Inflammation of the bladder and urethra.
Why is cystitis more common in women than men?
Men have a longer urethra providing a greater barrier to bacteria entering the bladder. Fluid from the prostate also provides some antibacterial property (particularly in men under 50).
When does cystitis become more common in men? Why?
Over the age of 50 due to prostate enlargement.
What is recurrent cystits?
Defined as 3 episodes in the past 12 months, or 2 episode in the past 6 months.
What is usually the cause of cystitis?
Infection caused by bowel flora ascending the urethra from the perineal and perianal areas. Bacteria are transferred to the bladder where they proliferate.
What are the most common bacterial organisms implicated in cystitis?
1 - E. coli - indicated >80% cases.
2 - Staphylococcus - up to 10% cases.
What are the clinical symptoms of uncomplicated cystitis?
- Pain when passing urine
- Increases urinary frequency and urgency
- Haematuria
Patients may also report only passing small amounts of urine with pain worsening at the end of voiding urine.
Symptoms start suddenly.
What conditions are considered in the differential diagnosis for cystitis?
- Pyelonephritis - patient will show signs of systemic infection, N&V and flank+/loin pain.
- STI’s - symptoms will tend to be more gradual in onset and last for longer. Considered most common in 18-25 category.
Specific questions to ask patients presenting with cystitis symptoms.
Duration - symptoms over 5-7 days should be referred.
Age - unusual in children. Females >70- have a higher risk of complications and should be referred.
Presence of fever - referral is needed if fevere is present.
Vaginal discharge - any reports of vaginal discharge indicate an alternative diagnosis.
Location of pain - pain experienced in the loin area requires referral.
When should patients presenting with cystitis symptoms be referred?
- Male
- Age under 16
- Sings of upper UTI
- Vaginal discharge
- Onset gradual
- Risk of complications
- Not managed with OTC medication
- Symptoms over 7 days
- Haematuria
What can be bought OTC for management of cystitis?
Alkalinising agents - given 1 sachet TDS for 2-3 days.
Should be cautioned in patients with HTN.
What non-pharmacological advice should be given to patients with cystitis?
Increase fluid intake to 5L daily to help promote bladder voiding (flushes out the bacteria).
What specific questions should you ask a patient presenting with abnormal discharge / thrush symptoms?
Discharge - does it have any smell? What colour is it? Thrush presents as which ‘curd-like’ discharge with no odour.
Age - thrush is rare over the age of 60.
Pruritus - itching is prominent in thrush.
Onset - thrush symptoms develop suddenly.
What are the main symptoms of thrush?
- Abnormal discharge - no odour and curd-like.
- Vulval itching.
What conditions are considered in the differential diagnosis for thrush / abnormal discharge?
Bacterial Vaginosis (BV) - thin white discharge with a fishy odour. Odour is worse after sex and during menses. Itching and soreness not usually present.
Trichomoniasis - presents as profuse, frothy, green-yellow fishy smelling discharge accompanied by vulvar itching and soreness. Vaginal spotting, dysuria and urgency may also be experienced.
