1 UTI Simple uncomplicated cystitis Acute pyelonephritis Urinary tract infections in patients with a pre existing structural renal abnormalities such as polycystic kidneys reflux nephropathy and obstructive uropathy
2 Simple uncomplicated cystitis Recurrent urinary tract infections (UTIs) are common in young women,there is no evidence that recurrent UTI leads to health problems such as hypertension or renal disease, in the absence of anatomic or functional abnormalities of the urinary tract.
3 Simple uncomplicated cystitis These infections are generally caused by the same organisms and share clinical features, diagnostic testing, and treatmentRecurrent uncomplicated UTIs are common among young, healthy women even though they generally have anatomically and physiologically normal urinary tracts
4 cystitisEscherichia coli is the causative pathogen in approximately 70 to 95 percent of episodes of acute uncomplicated cystitis; Staphylococcus saprophyticus is responsible for most other episodes. Proteus mirabilis, Klebsiella species, enterococci or other uropathogens are isolated from a small proportion of patients
5 Cystitis pathogenesis Urinary tract infections in women develop when uropathogens from the fecal flora colonize the vaginal introitus, enter the urethra and bladder, and stimulate a host response. Migration of the organisms from the introitus into the bladder is facilitated by other factors such as sexual intercourse.
6 Cystitis FeaturesAcute uncomplicated cystitis is manifested primarily by dysuria, usually in combination with frequency, urgency, suprapubic pain, and/or hematuriaFever (>38°C), flank pain, costovertebral angle tenderness, and nausea or vomiting suggest upper tract infection and warrant more aggressive diagnostic and therapeutic measures .
7 Cystitis DiagnosisA directed history and physical examination provide sufficient data to make an accurate diagnosis in most cases of acute dysuria. The examination should include temperature, abdominal examination, and assessment of the costovertebral angle examination for tenderness
9 Case presentationA 23 year old lady c/o dysurea frequency and dark urine there wasno fever but shehad lower abdominal discomfortUrinalysis showed 30—40 pus cells and few red cellsbut no protein and no casts1 what investigation is needed2 is u/s needed3 what is the best treatment4 is prophylactic antibiotic needed
10 Acute pyelonephritisAssociated more with abnormal renal tract or renal stonesMainly Gram negative bacteria and enterococcusD M is a predisposing factorObstructive uropathy with prostatichypertrophy is a factor in old males
11 pyelonephritis Fever Loin pain Occasionally septic shock and DIC Dysuria and hematuriaMay be complicated by perinephric abscess
12 Pyelonephritis investigation Urinalysis cultureCBC renal functionUltrasound kidneys to role out obstruction or abnormal tractHospitalization is usually required
13 pyelonephritis Intravenous antibiotics are required I V fluids are essentialUrinalysis culture and renal function are importantUltrasound abdomen is indicated
14 Case presentationA 35 year old lady known to have DM for the last five years maintained on insulin presented with high grade fever dysurea and loin pain on examination she looked ill temp BP 110/60 with bilateral loin tendernesswhat investigation is required for this lady
15 Case presentation What therapy should be given Appropriate was given and fever subsided within 48 hours but came back 5 days laterWhat would be the cause of her fever
16 UTI in pregnancyThe homodynamic changes in pregnancy predispose to UTIThe attacks can be sever and prolongedLonger antibiotic therapy is requiredAmoxycillin and ceftrixone are save