CASE PRESENTATION

ON
URINARY TRACT
INFECTION

KRISTINA KARYLLE S. ARAOJO

MEDICAL CLERK
DECEMBER 13, 2010

GENERAL OBJECTIVE:

To present a case of Acute Pyelonephritis

SPECIFIC OBJECTIVES:

To present the clinical manifestations of Acute Pyelonephritis

To present an algorithm of the pathophysiology of Acute Pyelonephritis

To discuss the management for Acute Pyelonephritis according to 2004

Philippine Clinical Practice Guidelines.

Significance of the Presentation:

The incidence of Urinary tract infection persists to be among the top reasons
for consultations nationwide. This case presentation would provide us the
advantage of exploring the causes and approach to urinary tract infections.
Frequently recurring signs and symptoms should prompt us to explore further and
be familiar with the medications needed to treat the different kinds of Urinary Tract
Infections in order to provide quality care to patients.

CASE
This is a case of R. F, a 23 year- old married housewife, a Roman Catholic
from Tolosa, Zamboanga City and admitted in ZCMC for the first time due to
abdominal pain.
History revealed that 6 days prior to admission, patient experienced
abdominal pain with a scale of 5 / 10 radiating to the flank area. This was
associated with on and off moderate grade fever, 3 episodes of loose bowel
movement which was watery, yellowish, and none bloody and four episodes
of vomiting of previously ingested food amounting to 1/ 2 cup. Patient took
Paracetamol 500 mg tablet which provided relief from fever. No consult done.
2 days prior to admission, patient sought consult at Mindanao Central
Sanitarium and was admitted and managed as a case of urinary tract
infection. Patient was referred to Zamboanga City Medical Center for further
work up and management and was subsequently admitted.
Patient has no previous hospitalizations. No heredo- familial diseases
such as diabetes mellitus, hypertension, asthma, cancer and kidney
problems. Patient is a housewife, not a known smoker and alcoholic beverage

drinker. No known allergies to food and medications. She is married with 2

children.
Review of systems revealed no weight loss, no dizziness, no headache, no
blurring of vision, no nasal congestion, no difficulty of breathing, no
palpitations, no chest pain, no polyuria, no vaginal bleeding. There is body
malaise, anorexia, vomiting, abdominal pain, dysuria, urinary frequency and
tea colored urine.
Patient was examined conscious, coherent, febrile and not in respiratory
distress.
Temperature: 37.7 C, Pulse Rate: 85 beats/min, Respiratory Rate: 21
breaths/min, Blood Pressure: 130/70 mmHg
Examined with warm skin, anicteric sclerae, pink palpebral conjunctivae,
pupils reactive to light, dry oral mucosa; Equal chest expansion, no chest
lagging, clear breath sounds, equal tactile fremitus; Adynamic precordium,
regular rate, normal rhythm, PMI at the 5th ICS MCL, no murmurs, no heaves,
no thrills; Flabby abdomen, normoactive bowel sounds, tympanitic, (+)
tenderness on all quadrants, (+) kidney punch; Strong peripheral pulses,
good capillary refill time

Admitting Impression: Acute Pyelonephritis

Upon admission, patient was started on venoclysis with PNSS 1 liter at
30gtts/minute. The following diagnostic work-ups were ordered: CBC, Platelet

Count, Serum Potassium, Sodium, Creatinine, Urinalysis, KUB Ultrasound,

Urine Culture and Sensitivity and Random Blood Sugar
On the 1st hospital day, patient noted to have abdominal and flank pain
associated with febrile episodes. No other pertinent physical findings. Started on
Paracetamol 300 mg IVTT every 4 hours.
On the 2nd hospital day, still with abdominal and flank pain. Patient was
febrile. Urinalysis revealed urine ph at 6, pus cells as well as rbc were numerous to
count. She was started with Ceftriaxone 1 gram every 12 hours. Other diagnostics
were not yet done.
Patient is still admitted.