HYPERTENSION AND DIABETES2
Pathophysiology Synthesis of Shadow Health Patient: Urinary Tract Infection
Shadow Health Patient: Makayla
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Pathophysiology
This Shadow Health patient presented with a urinary tract infection (UTI). A UTI is an
infection anywhere along the urinary tract; this could be the kidneys, ureters, bladder, or urethra.
Usually, this occurs in the lower portion, like the bladder or urethra. Our body has natural defense
mechanisms to prevent bacteria from invading our bladder. These defense mechanisms include
urination, which washes away bacteria, mucous secreting cells in our urethra, and a low pH of urea.
We are not always successful. Sometimes, bacteria succeed in colonizing the urinary epithelium, or
lining. As women, we are often more prone to infection because our urethra is shorter, and bacteria
have less of a way to climb to the bladder! The usual bacteria that cause UTIs is Escherichia coli,
which is present in fecal matter. When someone does not wipe properly after a bowel movement, this
bacterium can get into the urethra and cause an infection. Other bacteria might be Staphylococcus
saprophyticus, which is present on the skin.
Clinical Manifestations
The most common signs of a UTI are lower back or flank pain, having to go to the bathroom
(urinate) more frequently and urgently, pain with urination (also called dysuria), and occasionally
blood in the urine (also called hematuria). Sometimes, urine will be cloudy and smell bad as well. If
the UTI progresses up the urinary tract to the kidneys or renal tubules, pyelonephritis and symptoms
might be fever, chills, flank pain, and very purulent urine.
Diagnostic Treatments
UTIs are diagnosed based on a clinical assessment. The physician or clinician will observe
the patient, evaluate symptoms, and identify any risk factors (like being a woman, having diabetes,
being pregnant or sexually active, or immunocompromised). Diagnosis is also based on a urinalysis
to examine the urine and nitrites and white blood cells' appearance, which can indicate an infection.
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HYPERTENSION AND DIABETES3
Additionally, this urinalysis can be cultured to determine which bacteria are present and which
antibiotic will best target the condition.
Common Medications and Interactions
Luckily, UTIs are relatively easy to treat, especially when caught early. Commonly, UTIs are
treated with a broad-spectrum antibiotic. If a urine culture is performed to identify the bacteria
causing the infection during a urinalysis, a targeted antibiotic can be chosen to treat the condition.
The most common antibiotic for treating UTIs is Bactrim. Bactrim is a
trimethoprim/sulfamethoxazole antibiotic that kills the bacteria colonizing the urinary tract to restore
the natural flora and stop it. Another antibiotic used if the bacteria is resistant to other antibiotics is
Keflex, a cephalexin, is a potent antibiotic used to kill the bacteria.
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