1. Differential diagnosis

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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.

8. 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.

9. 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

10. 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

11. 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.

12. 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

13. 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

14. 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