-IBIS-1.5.0-
tx
urinary system
cystitis
diagnoses

definition and etiology

definition:
An acute inflammation or infection of the urinary bladder.

etiology:
Most bladder infections are due to gram-negative bacteria that invade through the ascending route (vagina or rectum-urethra-bladder). E. coli is the most common infectious agent (80-85% of infections), followed by Klebsiella, Proteus, Enterobacter aerogenes, and Pseudomonas aeruginosa. Occasionally Staph albus/aureus or Strep faecalis, gram-positive organisms, are involved.

Cystitis is very common (accounting for over six million office visits yearly in the US) and occurs in the female 10 times more often than in the male (due to their shorter urethra), except as infants when both sexes are equally affected. Patients may be extremely symptomatic or asymptomatic. The contraceptive diaphragm is implicated in up to 10% of women who suffer from recurrent cystitis.

signs and symptoms

signs and symptoms:
The onset of cystitis may be very sudden (within 1 hour) or may be more gradual, developing within a day or over the course of several days. The typical presentation of cystitis is:
• Burning pain on urination: at the start, during, at the end, or through the whole flow.
• Constant burning in the suprapubital area.
• Frequency, urgency, nocturia.
• Low back pain.
• Fever, chills, and other systemic symptoms are usually absent: if they are present consider a severe infection or spread up to the kidneys.

lab findings:
• UA may show pyuria, hematuria, and bacteriuria.
• The urine may be cloudy, bloody, and malodorous.
• A two-cup urine catch is recommended: the first 10-20 ml examines the urethra, and the next 200 ml would be a clean catch of the bladder.
• Growth of over 100,000 organisms per ml indicates infection, although marked bacteriuria may be absent in some patients with true cystitis, especially in symptomatic patients. If the specimen was garnered with catherization or suprapubic aspiration, bacteriura of 100-1000/ml is sufficient.
• A urine specimen containing > 5 WBC/hpf definitely constitutes pyuria.
• > 2 RBC/hpf is considered abnormal and should lead to more investigation.
• It is recommended for women to also get a swab of vaginal secretions to check for vaginitis to rule out gonorrhea, C. trachomatis, trichomonas, hemophilus, and candida.

course and prognosis

In acute uncomplicated cystitis, the typical conventional response is antibiotics. If there is some sort of urinary anatomic abnormality, neuropathic GU tract lesion, or obstructive uropathy, surgery may be required to correct the situation. If the disease becomes recurrent, conventional treatment is daily doses of medication for long-term use.

differential diagnosis

• Vaginitis.
• Urethritis.
• Pyelonephritis or glomerulonephritis.
• Herpes simplex genital eruptions.


footnotes