Pyelonephritis

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍feverflank paindysuria

Symptoms include:

‍fever, up to ‍°, over ‍ ‍hoursdays

‍flank pain

‍dysuria

‍urinary frequency

‍urinary urgency

‍hematuria

‍cloudy urine

‍fatigue

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍chills



Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍sexual activity

‍urinary catheterization

no history of: ‍urinary tract obstruction, ‍urinary tract infections, ‍kidney stones, ‍urinary tract abnormalities, ‍diabetes, ‍pregnancy, ‍immunodeficiency





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Pelvic: external genitalia ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍cervical motion tenderness

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Thoracic

Lumbar spine: ‍tenderness on ‍, range of motion ‍fulllimited





ASSESSMENT:

‍Pyelonephritis ‍likelysuspectedpossible

DDx: acute pyelonephritis, chronic pyelonephritis, urinary tract infection, kidney stones, renal abscess, renal cell carcinoma, tuberculosis of the kidney, renal vein thrombosis, renal infarction, gallstones, appendicitis, diverticulitis, pelvic inflammatory disease, ovarian cyst, ureteral obstruction





PLAN:

Investigations:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍CRP, ‍blood culture

- Urinalysis

- Urine culture

- Abdominal ultrasound

- CT scan of abdomen

- CT pyeloscan

Treatments:

- ‍Antibiotics

- ‍Analgesics

- Increase fluid intake

Further care:

- Referral to urologist

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop such as fever, vomiting, or increased pain

- Referral to ER if severe abdominal pain, severe vomiting, or high fever