Monday, January 26, 1998: (Day 9 Continued)
End Exam I material first half of class and begin Exam II Material:
Prostatitis is one form of urinary tract infection.
Defined as swelling of the prostate
Common etiologies are complications of chlamydia and gonococcal, acute and chronic bacterial infections.
There is some opportunity for chemical, occupational an viral causes also.
We will deal mostly with acute and chronic bacterial and lump the rest together.
Acute Bacterial
 Seen in young males with surgical intervention or instrumentation.
 Can acquire ascending infection, produces bladder that is large, tender and achy
 May have Dysuria, incomplete voiding
 Ideal patient to do triple catch test.
 Patients will be sick with fever & chills, flue like symptoms.
 Urgency and frequency
 Oliguria is a protective mechanism.
 Lab findings in action notes.
 Contraindication for treatment is prostatic massage. Do not want to drive organism and bacteria into
blood stream. This may increase risk of septicemia.
Tuesday, January 27, 1998: (Day 10)
Prostatitis
Acute Bacterial Prostatitis
Chronic Bacterial Prostatitis:
 Older patients
 S/S much less impressive. Mild urgency and dysuria, discharge but not much
 Triple catch urine test is positive but patient may not feel any symptoms.
 Rectal/prostate exam may drive organisms deeper during acute prostatitis and causes chronic prostatitis
Non-Bacteria Prostatitis:
 Culture negative
 Viral infections are more frequently occuring than bacterial.
 Pain relates to size and bogginess of prostate
 Voiding symptoms such as hesitancy and oligura. This is good environment for stone formation
General Complications
 Progression of involvment of epididymus
 Can go uphill to bladder via reflux mechanism.
 Main cautions are acute prostatitis, avoid massage and instrumentation.
Erythritis:
 Ascending infections mainly
 E. Coli is main culprite (80-85%)
 STD group can cause this: Gonococcal & non-gonococcal urethritis
 Voiding symptoms are common in the male population. Females may have no symptoms.
 S&S may be urgency and frequency. This is probably an irritation phenomenon and just doesn’t
take as much stretch on bladder.
 May or may not have fever. Does have ability to go systemic.
 Gonococcal erythritis: must worry about complications such as endocarditis. Meningitis may also
be a complication.
 Arthritis is a synovial based process. Can be unilateral or bilateral and the knees are the most
likely infected.
 Diagnosis can largely be done via history: does not hurt until urea passes through tube.
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Urinalysis is helpful. Triple catch test would find WBC, RBC and bacteria in cup 1 mainly.
Treatment is going to be penicillin. Some Asian strains are resistant to penicillin.
Another complication in women is development of PID at a rate of 15%.
Non-gonococcal urethritis:
 Related to chlamydia (fungi 15%)
 Very common for women to have no symptoms and men have less prominent symptoms.
 Has no opprotunity to produce complications.
 Diagnosis is typically paneling discharge. It should be E. Coli or Chlamydia.
 Chlamydia in particular, sulfa drugs will work well. Remember sulfa drugs from tri 5, they may
form crystals and if person is not drinking enough water they may produce stones.
Asymptomatic Bactururia:
 Male patients with instrumentation (foley catheter)
 Female patients with catheter.
 Might get UA or do a culture and find more than 100,000 colonies. Basically satisfy lab definition
of bacturia but patient does not have symptoms
 This should be cause for watchful waiting and recommend lots of fluids. At this point they do not
need antibiotic theory. They may want the therapy if they start to become symptomatic. If they
do go an antibiotic therapy, use the shortest duration possible. There was a study that showed the
same results were the same for a three day and a ten day course of antibiotics.
 Just because they meet lab definition, they do not need antibiotics.
 Yellow Dock Herb is used to make a tea or drink and it may be helpful
 Use vinegar as soap and a drink.
Cystitis
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Inflammation of urinary bladder
Inflammaton of membrane of inner most lining of bladder
Petetchiae can be formed
Tissue can break down and ulcerate. Capillary bleeding occurs producing hematuria frequently
There are no casts but blood clots may show up in urine.
UA microscopically may show bladder cells in greater quantity than normal. Not typical
desquamation process we expect to see.
Bacterial infections often play a role. E. Coli is culprit.
Hematologic spread can happen
Direct irritation can be a cause if urine is left to stand in bladder too long. Concentration of urine
increases and bacterial can increase in number.
Chemotheraputic agents can cause cystitis. Patients must drink lots to move chemo through
Radiation therapy in pelvic area can change or damage bladder wall.
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Signs of cystitis:
 Can present in children as an acute abdomen with lots of pain “cramping pain”.
 Burning pain during urination related ot contraction
 Often have cystitis and urethritis
 Post void ache because of stretching and squeezing on bladder
 Pain can radiate to groin and pelvic floor. Pain can also be suprapubic.
 RBC, WBC and bacteria can be found along with bladder cells
 This can turn systemic with a low grade fever
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Treatment:
 Hydration with water and cranberry Juice (not drink)
 Hydration means water. Cannot get this out of a can of soda. Water mixed with other things
does not do the job of pure water.
Friday, January 30, 1998: (Day 11)
First hour Dr. Atherton went over slides, second hour skipped Class.
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Monday, February 02, 1998: (Day 12)
AVE: 73 on Exam I.
DO NOT EVER MISS THESE QUESTIONS AGAIN:
Which of the following is inconsistent with early chronic renal failure:
 Early chronic you see polyurea, hyponatremia, dehydration. Azotemia is not see here.
Which of the following if completely normally virtually excludes kidney problems:
 Impossible to have serious renal disease if concentration/dilution test is normal.
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Normally glomerulus produces completely protein free urine, small amounts are resorbed by proximal
convoluted tubule. This question is talking about albumin.
KUB/IVP
Reviewing things from Friday with Dr. Atherton.
KUB can stand alone as a scout film.
ACTION NOTES PAGE 37
Pyelonephritis:
Infection of basement tissue where tubules are embedded into.
Perenchyma infection.
Several types:
Acute pyelonephritis:
Ascending infection
Ravishes RBC and WBC and they have great difficulty perfeorming their job and if organisms get that high
it is a big problem.
Perencymal tissue leaves behind scar and tubules will no longer work at theat site.
Once there is enough damage, usually two or more attachs they move to chronic.
Chronic pyelonephritis
Lumpy, bumpy kidney
Any time kidney is affected and not completely repaired you are left with scar tissue.
Tuesday, February 03, 1998: (Day 13)
Page 39 ACTION NOTES:
D.
E.
F.
G.
H.
I.
SLE:
Scleroderma:
Sickle Cell Anemia:
Pregnancy:
Diabetic Kidney
Tropical Diseases:
ACTION NOTES PAGE 41:
NEPHROTIC SYNDROME:
A. Four Major characteristics
1. massive proteninuria
2. hypoalbuminemia
3. edema
4. hyperlipidemia
B. Causes of nephrotic syndrome
 Glomerular (75%)
 Systemic (25%)
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C. Etiology of nephrotic syndrome
Friday, February 06, 1998: (Day 14)
Missed 1 hour before lunch
Took notes in action notes for 2 hours in the afternoon.
Monday, February 09, 1998: (Day 15)
Urinary incontinence Categorization. ACTION NOTES PAGE 51.
Nocturnal enuresis
Two categories of nocturnal enuresis.
1. Have never had control
 Underdevelopment
 Congenital anomaly:
2.
Had control and lost it
 Allergies: food allergies play a prominent role.
 Home situations: regression
Realistic goals for parents: training
 12-18 months is very early to get control
 18-years is still on target for occasional accidents
 over 2 years old, it is probably getting to be abnormal.
 5-6 years old, intervention may be needed. They should not have any genitourinary maturation taking
place at this age.
Breneman:
Followed group of patients for 20 years.
 60% of food allergies, cow’s milk was the major culprit. Strict elimination of milk would stop
incontinence. When introduced to cows milk, enuresis would ensue.
Triad of findings:
Enuretic Triad
1. Male patient who lost control at night
2. Chvostek Reflex: tap face and eye twitches
3. Milk allergy: takes a long time.
Expect kid to feel like:
Wet bed at night
Tuesday, February 10, 1998:
Continue with nocturnal enuresis:
There is not one best way to treat enuretics.
ACTION NOTES: Page 55 and 56
Carcinoma of the GU tract.
Friday, February 13, 1998:
UTI’s are on this test in more detail.
Start Exam III Notes today.
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