URINARY TRACT

INFECTION
ARNAIZ, NEPTALY P.
 OBJECTIVES
• Identify risk factors predisposing to UTI
• Discuss the difference between
complicated and uncomplicated UTI as
well as lower and upper UTI
• Discuss different sign and symptoms of
UTI
• Identify Types and etiology of UTI
• Discuss diagnostics of UTI
• Discuss treatment regimen of UTI
 CASE
• R.D
• 42/F
• Married, separated (2008)
• Filipino
• Roman catholic
• May 15, 1976 (Rizal)
• Rodriguez, Rizal
• November 20, 2018
 Chief complaint
• Urinary frequency
 HPI
1 week prior to consult:
(+) frequent urination
(+) incomplete voiding
(+) straining
(+) urgency

(-) hypogastric pain

(-) flank pain
(-) fever
(-) dysuria
(-) vaginal discharge
(-) hematuria

(-) no consult
(-) no medication taken

Day of consult:
Still with above symptoms, hence consulted at our
institution
PMH: FMH
• (-) Hypertension • (+) Hypertension – mother
• (-) Diabetes Mellitus
• (-) Diabetes Mellitus
• (-) Heart diseases
• (-) Kidney disease • (-) Stroke
• (-) Bronchial Asthma • (-) Kidney disease
• (-) Thyroid disorders
• (-) Tuberculosis
• (+) Bronchial asthma – father
• (-) Previous hospital • (+) Tuberculosis – father
admissions • (-) Skin diseases
• (+) BTL – 2007 (QMMC) • (-) Cancer
• (+) Peptic ulcer diseases -
• (+) allergy to “daing”
mother
AGUILAR-CONJE FAMILY
NOV. 20, 2018
EAMC FMCH

?
OBSTETRICAL HISTORY
• G3P3 (3003)
GYNECOLOGICAL HISTORY
• LMP: October 15, 2018
• PMP: September 2018
• Menarche: 12 y.o
• Interval: regular (monthly)
• Duration: 7 days
• Amount: 3 pads/day,
moderately soaked
• Symptoms:
(-) dysmenorrhea
SEXUAL HISTORY
• Coitarche: 19 y.o
• No. of sexual partner: 1
• Sexuality: Male
• (-) Dyspareunia
• (-) Discharges
• (-) Previous STI
• (+) Contaceptive use:
OCP (6 mos)
 ROS
• General: unremarkable
• Skin: unremarkable
• HEENT: unremarkable
• Pulmonary: unremarkable
• Cardiac: unremarkable
• GI: unremarkable
• GUT: (+) urinary frequency, (+) weak/slow stream, (+) urgency, (+)
incomplete voiding, (+) straining
• Hematologic: unremarkable
• PVS: unremarkable
• Endocrine: unremarkable
• Neurologic: unremarkable
• Psychiatric: unremarkable
• MSK: unremarkable
 PHYSICAL EXAMS
• BP – 120/80 mmHg
• HR – 88 bpm
• RR – 20 cpm
• Temp – 37.2 °C
• O2 sat – 98 %
• Ht. – 156 cm
• Wt. – 60 cm
• BMI – 24.6 (overweight)
• IBW – 50.4 kg
• Waist – 85 cm
• Hip – 90 cm
• W/H ratio – 0.94
 PHYSICAL EXAMS
Conscious, coherent and not in cardiorespiratory
distress

HEENT: unremarkable
LUNGS: unremarkable
HEART: unremarkable
ABDOMEN: unremarkable
EXTREMETIES: Unremarkable

ST: (-) KPT

 ASSESSMENT
• Acute Uncomplicated Cystitis
 SALIENT FEATURES
Positive pertinent Negative pertinent
(+) frequent urination (-) hypogastric pain
(+) incomplete voiding (-) flank pain
(+) straining (-) fever
(+) urgency (-) dysuria
(-) vaginal discharge
(-) hematuria
 DIFFERENTIAL DIAGNOSIS
Rule in Rule out
Acute uncomplictated (+) urinary symptoms (-)fever
pyelonephritis (-) flank pain
(-) KPT
(-) nausea and vomiting
(-) vaginal discharges
Complicated UTI (+) urinary symptoms No presence of underlying
disease
Urethritis (+) urinary symptoms (-) sexual contact
(-) urethral discharges
(-) dysuria
(-)fever
DISCUSSION
URINARY TRACT INFECTION
• Presence of microorganism in the
kidney and urinary tract

• It occurs as the interaction between

bacterial virulence and host biologic
and behavioral factors
 PATHOGENESIS
Routes:

• Ascending – most common

perineal area  urethra  bladder  kidney

• Hematogenous – kidney receives 25% of total

cardiac output

• Lymphatics
 Factors Predisposing to UTI
• Gender and sexual activity
• Pregnancy
• Obstruction
• Neurogenic bladder dysfunction
• Vesicourethral reflux
• Urinary tract instrumentation
• Diabetes mellitus
• Immunosuppresion
• Urinary tract abnormalities
 LOWER UTI UPPER UTI

• Superficial or mucosal invasion • Tissue invasion

• Cystitis • Acute Pyelonephritis
• Urethritis • Intrarenal and perinephric abscess
• Prostatitis

CLINICAL SYNDROMES CLINICAL SYNDROMES

• Dysuria, frequency, urgency and gross • With or without signs and symptoms of
hematuria lower UTI
• (-) fever • (+) fever, chills, flank pain, nausea and
• Mild hypogastric tenderness vomiting
• (-) KPT • (+) KPT
• In prostatitis, (+) prostatic tenderness on
rectal examination
 UNCOMPLICATED COMPLICATED
• Infection in structurally and • Infection in urinary tract with functional
neurologically normal urinary tract and structural abnormalities including
calculi and indwelling catheter

• Infecting microorganisms are more

likely resistant to antimicrobial agents
 THANK YOU FOR LISTENING!!!
• REFERENCES:
– DOH National Antibiotic guidelines 2017
– Phil CPG on the Diagnosis and Management of UTI
in Adults 2013 Update (Part 1) and 2015 Update
(Part 2)