cystitis 1. cystitis describes a clinical syndrome of dysuria, frequency, urgency, and occasionally...
TRANSCRIPT
Cystitis
1
• Cystitis describes a clinical syndrome of dysuria, frequency, urgency, and occasionally suprapubic pain
2
3
Reduced Urine Flow Outflow obstruction, prostatic hyperplasia, prostatic carcinoma, urethral stricture, foreign body (calculus)
Neurogenic bladder Inadequate fluid uptake (dehydration)
Promote Colonization Sexual activity—increased inoculation
Antimicrobial agents—decreased indigenous flora
Facilitate Ascent Catheterization Urinary incontinence Fecal incontinence Residual urine with ischemia of bladder wall
Risk Factors for UTIs
Laboratory Diagnosis
• The presumptive laboratory diagnosis of acute cystitis is based on microscopic urinalysis, which indicates microscopic pyuria, bacteriuria, and hematuria
• presence of 102 cfu/mL or more of urine usually indicates infection
4
Tubercular cystitis
• Never primary
Treatment– Medical: ATT– Surgical:
• failure of medical treatment• Nephroureterectomy to remove the source of infection
5
Abacterial cystitis
• Presence of pus in urine but without any accompanying bacteria
Aetiology• Mycoplasma• Chlamydia• Adenovirus
6
Pathology
• Inflammation of the bladder
7
Clinical features
• Urethral discharge
• Abrupt onset features of cystitis
8
Investigations
• All investigations should be done to exclude tuberculous cystitis
9
Treatment
• Spontaneous resolution
• Analgesics, antispasmodic & bladder sedatives
• Antibiotics: tetracycline, chloramphenicol
10
Interstitial cystitis
11
Interstitial cystitis
• Painful bladder syndrome
Epidemiology• prevalence: ~20/100,000• 90% of cases are in females• mean age at onset is 40 years• higher prevalence in Jews
12
Etiology: unknown
• theories: increased epithelial permeability; autoimmune; neurogenic• associations: severe allergies; IBS, fibromyalgia
13
14
Hypothesis for etiologic cascade of painful bladder syndrome/interstitial cystitis
❏ Classification
• non-ulcerative (more common) - younger to middle-aged• ulcerative – middle-aged to older
15
16
Hunner's ulcer in interstitial cystitis nonulcerative interstitial cystitis
17
❏ diagnosis (not usually adhered to)• NIDDK required criteria
1) glomerulations (submucosal petechiae) or Hunner’s ulcers on cystoscopic examination, AND
2) pain associated with the bladder or urinary urgency
18
19
❏ differential diagnoses• UTI• vaginitis• bladder tumour• radiation/ chemical cystitis• eosinophilic/TB cystitis
20
❏ treatment• symptomatic only (no cure)• bladder hydrodistension (also diagnostic)• intravesical dimethylsulfoxide (DMSO)• intravesical hyaluronic acid or heparin• amitriptyline• pentosan polysulfate (Elmiron)• surgery is last resort
21
22
23
24
Complicated Cystitis
• Complicated UTIs are those that occur in a patient with a compromised urinary tract or that are caused by a very resistant pathogen
25
26
Functional/structural abnormalities of urinary tract Recent urinary tract instrumentation
Recent antimicrobial agent use
Diabetes mellitus Immunosuppression Pregnancy Hospital-acquired infection
Complicating Host Factors
27
Common Pathogens
Mitigating Circumstances
Recommended Empirical Treatment
E. coli, Proteus species, Klebsiella species, Pseudomonas species,
Mild-to-moderate illness, no nausea or vomiting—outpatient therapy
Oral norfloxacin, ciprofloxacin, or ofloxacin for 10-14 days
Serratia species, enterococci, staphylococci
Severe illness or possible urosepsis—hospitalization required
Parenteral ampicillin and gentamicin, ciprofloxacin, levofloxacin, ceftriaxone, aztreonam, ticarcillin-clavulanate or imipenem-cilastin until fever gone; then oral trimethoprim-sulfamethoxazole, norfloxacin, ciprofloxacin, or levofloxacin for 14-21 days
Treatment of Complicated UTIs trimethoprim-sulfamethoxazole, 160 to 800 mg 12h; norfloxacin, 400 mg 12h; ciprofloxacin, 500 mg 12h; levofloxacin, 500 mg/day.
ciprofloxacin, 400 mg 12h; levofloxacin, 500 mg/day; gentamicin, 1 mg/kg 8h; ceftriaxone, 1 to 2 g/day; ampicillin, 1 g 6h; imipenem-cilastin, 250 to 500 mg 6-8h; ticarcillin-clavulanate, 3.1 g 6h; and aztreonam, 1 g 8-12h
28