UTI

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍urinary tract symptomsdysuriaurinary frequency

Symptoms include:

‍dysuria

‍urinary frequency

‍urgency

‍suprapubic pain

‍flank pain

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍hematuria

‍pyuria

‍malodorous urine

‍changes in urine color



Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍sexual activity

‍poor personal hygiene

‍postmenopausal status

‍recent use of spermicides

‍urinary catheterization

no history of: ‍recurrent UTIs, ‍kidney stones, ‍urological anomalies, ‍neurogenic bladder, ‍prior urological surgery, ‍diabetes

no use of: ‍antibiotic, ‍immunosuppressant drugs, ‍SGLT-2





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 ‍

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

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





ASSESSMENT:

‍UTI ‍likelysuspectedpossible

DDx: UTI, cystitis, pyelonephritis, irritant urethritis, asymptomatic bacteriuria, interstitial cystitis, sexually transmitted infections, vaginitis, prostatitis, kidney stones, bladder stones, urinary retention, neurogenic bladder, benign prostatic hyperplasia, urinary tract obstruction, diabetes mellitus, constipation, diverticulitis, appendicitis, pelvic inflammatory disease, endometritis, cervicitis, vaginal atrophy





PLAN:

Investigations:

- Urinalysis

- Urine culture

- Blood work: ‍CBC, ‍creatinine, ‍CRP

- Abdominal ultrasound

- CT scan of the abdomen and pelvis

Treatments:

- ‍Antibiotics

- Increase fluid intake

- Urinary tract infection prevention: voiding after intercourse, wiping front to back, avoiding irritants, avoiding retention

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