Unit Three Past Paper (Urinary Tract Infection & More) - PDF

**UNIT THREE** ​**[Urinary Tract Infection ]** **Overview:** - UTIs in men occur when bacteria enter the urinary tract, causing infection in the urethra, bladder, or kidneys. - Less common in men than in women but can be more complicated. **Causes:** - Blockage: Enlarged prostate, ki...

**UNIT THREE** ​**[Urinary Tract Infection ]** **Overview:** - UTIs in men occur when bacteria enter the urinary tract, causing infection in the urethra, bladder, or kidneys. - Less common in men than in women but can be more complicated. **Causes:** - Blockage: Enlarged prostate, kidney stones. - Catheter use: Increases risk of infection. **Unprotected sex:** Risk of sexually transmitted infections. Rule out gonorrhea and chlamydia if sexually active, particularly in adolescent and young adult males. **Chronic Conditions:** Diabetes, urinary retention. **[Diverticulitis:]** Inflammation or infection of diverticula (small pouches) in the intestinal wall, typically in the colon. **Diagnosis of Diverticulitis:** The diagnosis of diverticulitis relies on: - Patient history (LLQ pain, fever, bowel changes). - Physical exam (LLQ tenderness). - Imaging, such as a CT scan, which is the gold standard for confirming diverticulitis. Can be life threatening: Sepsis, small-bowel obstruction, hemorrhage, perforation, ileus and abscess. **Patient History:** - Previous episodes of diverticulitis or known diverticulosis. - Recent changes in bowel habits (constipation or diarrhea). - Diet low in fiber or history of low physical activity. **Symptoms:** - Left lower quadrant (LLQ) pain (most common), can be constant and severe. - Fever, nausea, or vomiting. - Possible bloating, tenderness, or abdominal distension. - Changes in bowel movements (constipation or diarrhea). **Physical Examination:** - LLQ tenderness upon palpation. - Fever or elevated heart rate indicating systemic infection. - Look for signs of peritonitis (rigid abdomen, rebound tenderness) in severe cases. **Diverticulitis Diagnostics** - Laboratory Tests: - CBC: Elevated WBC count suggests infection. - CRP (C-reactive protein) may be elevated. Imaging: - CT scan of the abdomen and pelvis with contrast: - Gold standard for confirming diverticulitis. - Detects inflammation, abscesses, or perforation. **Diverticulitis Management** Uncomplicated Cases: - Oral antibiotics, clear liquid diet, and follow-up. Complicated Cases (e.g., abscess, perforation): - Hospitalization, IV antibiotics, and possible surgical intervention. Prevention Tips - High-fiber diet, regular physical activity, and proper hydration to prevent diverticulosis. **[​Cholecystitis ]** - Inflammation of the gallbladder, often due to gallstones blocking the cystic duct. **Symptoms** - Right Upper Quadrant (RUQ) Pain: - Steady and severe, may radiate to the right shoulder or back. - Worsens after eating fatty foods. - Fever, nausea, and vomiting. - Positive Murphy's sign: Pain upon palpation of the RUQ during deep inspiration - Classic presentation is a patient complaining of sever right upper quadrant pain that occurs within 1 hour or more after eating a fatty meal. Pain may radiate to epigastric or right shoulder areas. Frequent nausea and vomiting. **Diagnosis and Treatment** Laboratory Tests: - Elevated WBC count (indicates infection/inflammation). - Elevated liver enzymes (AST, ALT) and bilirubin in some cases. Imaging: - Ultrasound: First-line imaging; shows gallstones, thickened gallbladder wall, or pericholecystic fluid. - HIDA Scan: Used if diagnosis is unclear after ultrasound. Treatment - Cholecystectomy (surgical removal of the gallbladder):Laparoscopic (most common) or open procedure for severe cases. **[Urinalysis Interpretation ]** Normal values are as follows: - - - - - - - - - - - - - - - - - - - - **Yellow**: Normal color, ranging from light to deep amber - **Dark yellow**: May indicate dehydration or exercise - **Green or blue**: May indicate a pseudomonal UTI or other conditions - **Orange**: May indicate bile pigments, carrots, or other conditions - **Pink or red**: May indicate hematuria, menstrual contamination, or other conditions Chemical composition - **pH**: A pH below 5 may indicate an increased risk of kidney stones, while a pH above 7 may indicate a bacterial UTI  - **Protein**: Small increases in protein are usually not a cause for concern, but larger amounts may indicate kidney problems  - **Sugar**: The presence of sugar in urine may indicate diabetes or liver or pancreas disease  - **Ketones**: The presence of ketones in urine may indicate diabetes or illness  - **Bilirubin**: The presence of bilirubin in urine may indicate liver damage or disease  - **Blood**: The presence of blood in urine may indicate kidney damage, infection, or other conditions  - **Nitrites**: The presence of nitrites in urine may indicate a bacterial infection  - **Leukocyte esterase**: The presence of leukocyte esterase in urine may indicate inflammation or infection  **[​Pancreatitis ]** Inflammation of the pancreas, which can be acute or chronic. - Acute Pancreatitis: Sudden inflammation that can be mild or life-threatening. - Chronic Pancreatitis: Long-term inflammation leading to permanent damage. - Causes: - Gallstones (most common cause). - Alcohol abuse (second most common). - Hypertriglyceridemia or hypercalcemia. - Certain medications, infections, trauma, or post-ERCP (Endoscopic Retrograde Cholangiopancreatography). **Pancreatitis Assessment** Symptoms - Severe epigastric pain: - Often radiates to the back. - Worsens after eating, especially fatty meals. - Nausea and vomiting. - Fever and tachycardia. - Abdominal tenderness and guarding. **Pancreatitis Diagnosis** - Laboratory Tests: - Elevated serum amylase and lipase (lipase is more specific). - Elevated WBC count, liver enzymes (if associated with gallstones). - Imaging: - CT scan: Confirms diagnosis and assesses severity. - Ultrasound: Evaluates gallstones or biliary obstruction. - MRCP (Magnetic Resonance Cholangiopancreatography) for detailed biliary imaging. **Treatment** - NPO (nothing by mouth) to rest the pancreas. - Refer to the emergency department for V fluids and electrolyte management for hydration. - Pain control: Analgesics. - Antibiotics: Only if infection or necrosis is suspected. - ERCP: For gallstone-related pancreatitis to remove obstruction **[​]** **[Nephrolithiasis]** Renal calculi are a common cause of blood in the urine (hematuria) and pain in the abdomen, flank, or groin. They occur in 1 of every 11 people in the United States at some time in their lifetimes, with men affected 2 to 1 over women.[\[1\]](https://www.ncbi.nlm.nih.gov/books/NBK442014/) Development of the stones is related to decreased urine volume or increased excretion of stone-forming components such as calcium, oxalate, uric acid, cystine, xanthine, and phosphate. Calculi may also be caused by low urinary citrate levels (an inhibitor of stone formation) or excessive urinary acidity. Renal calculi may present with excruciating pain, and most patients present to the emergency department in agony. A single event does not cause kidney failure, but recurrent renal calculi can damage the tubular epithelial cells, leading to functional loss of the renal parenchyma. he 4 major types and causes of renal calculi include: - Calcium stones: due to hyperparathyroidism, renal calcium leak, absorptive or idiopathic hypercalciuria, hyperoxaluria, hypomagnesemia, and hypocitraturia  - Uric acid stones: associated with a pH of less than 5.5, a high intake of purine-rich foods (fish, legumes, meat), or cancer; may also be associated with gout  - Struvite stones: caused by Gram-negative, urease-producing organisms that break down urea into ammonia   - - Common organisms include *Pseudomonas, Proteus,* and *Klebsiella.* However,* E coli* does not produce urease and is not associated with struvite stones. - Cystine stones: due to an intrinsic metabolic defect causing the failure of the renal tubules to reabsorb cystine, lysine, ornithine, and arginine;[\[15\]](https://www.ncbi.nlm.nih.gov/books/NBK442014/) visually opaque and amber  Of these, uric acid and cystine are the most likely stone types that develop recurrences.[\[16\]](https://www.ncbi.nlm.nih.gov/books/NBK442014/) Many drugs are known to cause renal stones, including the following: - Atazanavir - Guaifenesin - Indinavir - Silicate overuse - Sulfonamide - Triamterene  **Ultrasound** may be useful for assessing obstruction and resultant hydronephrosis, especially in pregnancy, where x-ray studies are discouraged. Ultrasound can also identify uric acid and other non-calcific renal stones if they are large enough (usually greater than 4 mm), but it can also miss the presence of stones less than 5 mm in size and cannot easily identify ureteral stones ( **A non-contrast abdominal and pelvic computed tomography** scan is considered the \"gold standard\" as it is the most sensitive and reliable test to diagnose urolithiasis and will also provide information regarding obstruction with resultant hydronephrosis. Renal calculi can be extremely painful when they cause a ureteropelvic junction or ureteral obstruction or they become infected. Pain control may require opioids, but intravenous (IV) nonsteroidal anti-inflammatory drugs can also be quite effective while avoiding narcotic side effects. As patients with renal colic will often experience nausea and vomiting, IV hydration and antiemetics may be required acutely. Many stones may be watched conservatively, with intervention planned as an outpatient. Smaller stones (\