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Dysuria
Urgency
Frequency
Low back pain
No hematuria
No hypogastric pain
No suprapubic pain
No fever
No consult
No medications
Review of Systems
No vaginal discharge
No vaginal irritation
No cough/ cold
No fever
No loose stools
No chest pain
No dizziness
No palpitations
Family History
OB-Gyne History
PHYSICAL EXAMINATION
Vitals
64.5 kg 168 cm
(BMI: 22.9, normal weight)
BP: 110/70
PR: 60 beats/min
RR: 18 breaths/min
Temp: 36.8 C
HEENNT
Anicteric sclerae
Pink conjunctivae
No TPC, No CLAD
Neck veins not dilated
Dry lips, moist buccal mucosa
Nonhyperemic pharynx
Chest/Lungs
Symmetrical chest expansion
Resonant on percussion
Equal tactile and vocal fremiti
No retractions
No rales
No wheezes
Heart
Adynamic precordium
No heaves or thrills
Apex beat is at 5th ICS MCL
Normal rate, regular rhythm
No murmurs
Abdomen
Flat, soft abdomen
No tenderness
No organomegaly
No masses
Normoactive bowel sounds
Urinary
No CVA tenderness
Extremities
Full pulses
No edema, no cyanosis
Good turgor
No rashes, no lesions
Equally distributed hair
No clubbing
CRT <2sec
31 female
Painful urination
Acute presentation of:
Dysuria
Urgency
Frequency
Low back pain
No hematuria
No hypogastric pain
No suprapubic pain
No fever
Afebrile
Soft, non-tender abdomen
No CVA tenderness
Sexual history?
Salient Features
CLINICAL IMPRESSION
Urinary Tract Infection
Etiology
Escherichia coli
Proteus
Klebsiella
Enterobacter
Serratia
Pseudomonas
Gram-positive cocci
play a lesser role in
UTIs.
Etiology
Staphylococcus
saprophyticus
Enterococci
Staphylococcus
aureus
Pathogenesis
Why females?
proximity to the anus, its short length (~4 cm), and its
termination beneath the labia
Found in 2-8% of pregnant women
decreased ureteral tone, decreased ureteral peristalsis, and
temporary incompetence of the vesicoureteral valves
Pathogenesis
Obstruction?
Any impediment to the free flow of urine (tumor, stricture,
stone, or prostatic hypertrophy) results in hydronephrosis
Dysfunction?
Interference with bladder enervation, as in spinal cord
injury, tabes dorsalis, multiple sclerosis, diabetes, and other
diseases
Reflux?
common among children with anatomic abnormalities of the
urinary tract as well as among children with anatomically
normal but infected urinary tracts
Pathogenesis
Cystitis
Pyelonephritis
History
dysuria, frequency,
urgency, and suprapubic
pain
PE
Laboratory
Clinical Presentation
Urethritis
30% of women with acute dysuria, frequency, and pyuria
have midstream urine cultures that show either no growth or
insignificant bacterial growth
Distinguish between sexually-transmitted pathogens and
low count E.coli or staphylococcal infection
Chlamydial or gonococcal infection
E.coli UTI
Clinical Presentation
Infectious
Physical
Cervicitis
Urethretis
Vulvovaginitis
Urethral strictures
Tumor
Differential diagnosis
Pre-treatment urine
culture and sensitivity
is not recommended
Standard urine
microscopy and
dipstick leukocyte
esterase (LE) and nitrite
tests are not
prerequisites for
treatment
Diagnostics
The Philippine Clinical Practice Guidelines on the Diagnosis and
Management of Urinary Tract Infections in Adults, 2004
Urinalysis
Light yellow
Turbid
pH 7.0
SG 1.015
RBC +3 (39/hpf)
Protein +1
WBC +3 (260/hpf)
Epithelial 3/hpf
Casts 0/hpf
Bacteria 251/hpf
Therapy
The Philippine Clinical Practice Guidelines on the Diagnosis and
Management of Urinary Tract Infections in Adults, 2004
Prognosis
PUBLIC HEALTH
References