Differential diagnosis

Acute uncomplicated Pyelonephritis Acute pyelonephritis is a urinary tract infection that has progressed from the lower urinary tract to the upper urinary tract. Most episodes of acute pyelonephritis are uncomplicated but hospitalization may be required. Acute uncomplicated pyelonephritis typically occurs in healthy, young women. http://www.utdonline.com/home/content/topic.do?topicKey=uti_infe/6922

Differential Diagnosis Patient Acute Uncomplicated Pyelonephritis Subjective: Left flank pain (+) Urinary frequency Fever and chills Vomiting (-) dysuria (-) gross hematuria (-) urgency Objective: Temp.= 38.6°C (+) CVA tenderness Dysuria Urgency Frequency Suprapubic pain/tenderness Fever, chills, and malaise Maybe accompanied by flank pain and CVA tenderness

Differential Diagnosis Patient Nephrolithiasis Subjective 21 y/o, female Left flank pain Urinary frequency Low fluid intake Objective (+) CVA tenderness Flank pain Renal colic Hematuria Urinary frequency, urgency, dysuria Costovertebral angle tenderness

Differential Diagnosis Patient Complicated Urinary Tract Infection Subjective: 21 y/o, Female Left flank pain Urinary frequency Fever and chills Vomiting (-) dysuria (-) gross hematuria (-) urgency (-) suprapubic pain/tenderness Objective: Temp.= 38.6°C (+) CVA tenderness Dysuria with accompanying urgency and frequency Suprapubic pain/tenderness Fever, chills, and malaise Maybe accompanied by flank pain and CVA tenderness

Complicated Urinary Tract Infection Significant bacteriuria which occurs in the setting of functional or anatomic abnormalities of the urinary tract or kidneys. Conditions that define complicated UTI: the presence of an indwelling urinary catheter or use of intermittent catheterization incomplete emptying of the bladder with more than 100 ml of urine retained postvoiding obstructive uropathy due to obstruction of the bladder outlet, a calculus or other causes vesicoureteral reflux or other forms of urologic abnormalities including surgically created abnormalities azotemia due to intrinsic renal disease renal transplantation

Urinary Tract Infection Conditions affecting Pathogenesis Gender and Sexual activity Pregnancy Obstruction Neurogenic Bladder dysfunction Vesicoureteral Reflux Bacterial Virulence factors Genetic Factors Gender and Sexual Activity- females are more prone due to the proximity of the anus to the urethra, the short length of the urethra, and its termination beneath the labia. Sexual intercourse introduces bacteria into the bladder which may cause cystitis. Pregnancy- during pregnancy, there is reduced ureteral tone, decreased ureteral peristalsis, and temporary incompetence of the vesicoureteral valves. Obstruction- any impedement to the flow of urine results in hydornephrosis and this greatly increases frequency of UTI. Neurogenic bladder dysfunction- infection may be initiated by the use of catheters for bladder drainage and is favored by the prolonged stasis of urine in the bladder. VR reflux- allows for the reflux of bacteria and thus upper tract infection.

Genitourinary Tuberculosis Genitourinary tuberculosis (GUTB) may involve the kidneys, ureter, bladder, or genital organs The infection almost always affects the kidneys during the primary exposure to infection but does not present clinically. The spread to the kidneys from the lungs, bone, or a GI tract focus usually is hematogenous.

Genitourinary tuberculosis Patient Genitourinary tuberculosis Subjective 21 y/o Female (+) PTB (2005) (+) flank pain (+) urinary frequency (-) dysuria (-) gross hematuria (-) weight loss (+) easy fatigability Objective (+) CVA tenderness (+) fever 38.6 C 30-45 years M:F = 5:3 History of pulmonary tuberculosis flank pain Urinary frequency dysuria gross hematuria weight loss fatigue anorexia CVA tenderness low-grade fever http://emedicine.medscape.com/article/450651-overview http://www.merck.com/mkgr/mmg/sec10/ch76/ch76b.jsp

Differential Diagnosis Patient Pneumonia Subjective 21 y/o, female Fever & chills Dyspnea Chronic cough Easy fatigability Objective Tachypneic, on respiratory distress Tachycardia (+) palpable cervical lymph nodes ↑tactile & vocal fremiti Dullness to percussion (+) fine crackles (+) egophony, bronchophony & whispered pectoriloquy Fever, Cough, Dyspnea Chest pain Egophony, whispered pectoriloquy Crackles or rales, bronchial breath sounds Increase tactile/ vocal fremiti

Pulmonary tuberculosis Tuberculosis is an infectious disease caused by mycobacteria, usually Mycobacterium tuberculosis transmitted by airborne droplet nuclei, which may contain fewer than 10 bacilli When inhaled, droplet nuclei are deposited within the terminal airspaces of the lung.

Differential Diagnosis Patient Pulmonary tuberculosis Subjective (+) fever (-) weight loss (+) chronic cough (nonproductive) (-) hemoptysis Objective Trachea situated midline Increased tactile fremiti Dullness on percussion Increased vocal fremiti (+) Bronchophony, egophony, Whispered pectoriloquy Fever Weight loss Cough (productive cough) Hemoptysis Trachea midline Bronchophony, egophony, whispered pectoriloquy

Lung Malignancy Tumors arising from the respiratory epithelium. It is the leading cause of cancer deaths in men and women. Major cell types: Adenocarcinoma Squamous cell carcinoma Small cell carcinoma Large cell carcinoma

Differential Diagnosis Patient Lung Malignancy Subjective 21 y/o, female (-) weight loss (+) chronic cough (-) hemoptysis Father is a smoker Objective Trachea situated midline Increased tactile fremiti Dullness on percussion Increased vocal fremiti (+) Bronchophony, egophony, Whispered pectoriloquy 55-65 y/o, males Weight loss Cough Hemoptysis Associated with smoking Trachea midline Bronchophony, egophony, whispered pectoriloquy