NU 621 Unit 7 Discussion – Pathophysiologic Diagnosis

Case #1

Definition of Bacteriuria

Bacteriuria refers to the presence of bacteria in the urine. There are two subtypes of this condition: asymptomatic and symptomatic. In asymptomatic bacteriuria, organisms in the urine are colonized, yet there are no signs of an infection or any symptoms. Aside from patients requiring surgery on the urinary system or those who are pregnant, this does not do any damage to the urinary tract infection (Rn & Rn, 2018). Swelling and pain in the lower urinary tract are signs of an infection and need treatment.

What additional history do you need to make a diagnosis?

Details on her urine symptoms, such as how often she relies on the restroom and the severity of her incontinence, are essential. It would also be helpful to know whether or not she has recently been treated with an antibiotic or whether she is presently taking medicine for comorbidity such as diabetes.

What diagnostic studies would you order and why?

Additionally, ordering urine culture and sensitivity tests can assist detect the microorganism and antibiotics it is susceptible or resistant to, which will aid in determining the appropriate treatment strategy for the patient.

Case #2

What are possible reasons for this woman's pain? List possible differential diagnoses and explain each?

Acute Cystitis – The bladder is inflamed in acute cystitis. A moderate, reddish mucosa, to advanced instances where widespread bleeding, pus, or suppurative exudates, are examples of the many types of inflammation (Rn & Rn, 2018). A long-term infection may cause the mucosa to peel off, ulcers to develop, and necrosis of the bladder wall. E. coli and Staphylococcus aureus are the most prevalent culprits. Frequent urination may be accompanied by urgency, dysuria, and discomfort in the suprapubic and lower back (Rn & Rn, 2018).

Recurrent UTI – A recurrent urinary tract infection (UTI) is three or more in 12 months or two or more in six months (Klein, 2016). An infection that returns more than two weeks following treatment for the first illness or another UTI caused by the same bacterium might be classified as a "relapse" (Rn & Rn, 2018). Fever, frequent urination, urgency, dysuria, and back discomfort are possible symptoms.

Acute Pyelonephritis – Urinary tract infections in the upper urinary tract (ureters, renal pelvises, and kidney interstitium) may cause acute pyelonephritis (Rn & Rn, 2018). In addition to kidney stones and vesicoureteral reflux, other risk factors include being pregnant and having a neurogenic bladder (Rn & Rn, 2018). Acute symptoms include fever, chills, and soreness in the flank or groin (Rn & Rn, 2018). Systemic signs and symptoms of a urinary tract infection (UTI) may be preceded by urinary tract symptoms such as frequency, dysuria, and costovertebral discomfort (Rn & Rn, 2018). It might be difficult to distinguish between the symptoms of pyelonephritis and cystitis based just on clinical examination.

What diagnostic tests should you order to confirm the diagnosis?

A urinalysis and a culture and sensitivity would be requested as diagnostic testing. A urinary tract infection may be ruled out, and the bacteria that cause it can be identified and treated. Blood cultures and imaging of the urinary system, such as a CT scan or a cystoscopy, may be necessary if white blood cell casts are seen.

What are the possible causes of recurrent lower UTIs?

When the same pathogen causes a second UTI within two weeks after the initial therapy, or when reinfection occurs more than two weeks after the treatment for the first infection, a relapse may develop (Rn & Rn, 2018). These include urinary tract abnormalities, sexual intercourse, menopause, and the inherent risk of kidney or bladder stones (Hannan et al., 2019).

What are the differences when comparing prerenal acute renal failure, intrarenal acute renal failure, and postrenal acute renal failure? Give examples of each.

The most prevalent cause of acute kidney damage is prerenal acute renal failure, caused by a lack of kidney perfusion (Rn & Rn, 2018). NSAIDs, bleeding, loss of fluids, sepsis, insufficient cardiac output, renal vasoconstriction due to NSAIDS, kidney stenosis, and kidney oedema may contribute to this condition (Rn & Rn, 2018). Arteriolar dilatation and efferent arteriolar vasoconstriction keep the GFR constant in the early stages. GFR decreases as filtration pressure decreases. Following cardiac surgery, cardiogenic shock and septic shock are the leading causes of acute renal damage (Rn & Rn, 2018).

Allograft rejection, interstitial illness, and ischemic acute tubular necrosis (ATN) are some of the causes of intrarenal acute renal failure (Rn & Rn, 2018). ATN necrosis is the most prevalent cause. Surgery, severe sepsis, problems after childbirth, and severe trauma are the most common causes (Rn & Rn, 2018).

An extremely uncommon illness, postrenal acute renal failure, occurs when the urinary system becomes obstructed, causing both kidneys to shut down (Rn & Rn, 2018). Because of this, the GFR decreases with time due to a higher intraluminal pressure above the blockage. Anuria and flank discomfort, followed by polyuria, lasted many hours (Rn & Rn, 2018). Diagnostic catheterization in the ureters may cause oedema and occlusion of the tubular lumen, resulting in severe kidney damage (Rn & Rn, 2018).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Rn, K. M. L., PhD, & Rn, S. H. E., PhD. (2018). Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th ed.). Mosby.

Hannan, T. J., Totsika, M., Mansfield, K. J., Moore, K. H., Schembri, M. A., & Hultgren, S. J. (2019). In persistent and intracellular uropathogenic Escherichia coli bladder infection, host-pathogen checkpoints and population bottlenecks. FEMS microbiology reviews, 36(3), 616-648.

Klein, H. A. J. J. E. A. (2016, April 1). Common Questions About Recurrent Urinary Tract Infections in Women. American Family Physician. https://www.aafp.org/afp/2016/0401/p560.html#: %7E:text=Recurrent%20UTI%20is%20typically%20defined,is%20typically%20responsible%20for %20recurrences.