Urinary Tract Infections
Intro
The urinary tract consists of the kidneys, ureter, bladder, and urethra. Its function is to rid the body’s toxic waste and unwanted fluid and regulate metabolic processes. Musculoskeletal symptoms of U-G pain include unilateral costovertebral tenderness, low back, flank, inner thigh, or leg pain, and ipsilateral shoulder pain.
Urinary tract infections (UTI’s): UTI occurs when the introduction of pathogens into this space is associated with adherence to the mucosa of the urinary tract. Colonization may be followed by microbial multiplication and an associated inflammatory response. There are two types of UTI's, upper and lower. Upper UTI's are located in the kidneys or ureter and are more serious than Lower UTI’s because they can be a direct threat to renal tissue itself. Lower UTI's are located in the bladder or urethra and are the more well-known UTI's commonly occurring in women.
S&S
Upper
Referral Pattern
The upper urinary tract refers pain to the ipsilateral shoulder, in addition to flank pain and unilateral costovertebral tenderness. The lower urinary tract refers pain to pelvis or lower abdominal area, in addition to having low back pain.
Special Tests
The Murphy’s percussion test is used to rule in or rule out kidney involvement. It is a highly sensitive (97.2%) test with a high (93.3%) positive predictive value although it is not a very specific test.
Red Flags
Positive Murphy's sign
References
Mandell, G. L., Douglas, R. G., Bennett, J. E., & Dolin, R. (2005). Mandell, Douglas, and Bennett's principles and practice of infectious diseases (6th ed.). New York: Elsevier/Churchill Livingstone.
Singer, A., Mccracken, G., Henry, M., Thodejr, H., & Cabahug, C. (1996). Correlation Among Clinical, Laboratory, And Hepatobiliary Scanning Findings In Patients With Suspected Acute Cholecystitis. Annals of Emergency Medicine, 28(3), 267-272.
Image from https://www.google.com/search?q=urinary%20tract%20infection&psj=1&biw=1366&bih=624&bav=on.2,or.r_cp.r_qf.&um=1&ie=UTF-8&hl=en&tbm=isch&source=og&sa=N&tab=wi&authuser=0&ei=Cn3UUZDqO-quiAKytICYAQ#facrc=_&imgdii=_&imgrc=yVG3pTzpUYISnM%3A%3BsogyGL_Lq22VNM%3Bhttp%253A%252F%252Fmedia.summitmedicalgroup.com%252Fmedia%252Fdb%252Frelayhealth-images%252Furinary_2.jpg%3Bhttp%253A%252F%252Fwww.summitmedicalgroup.com%252Flibrary%252Fpediatric_health%252Fhhg_uti%252F%3B744%3B963
The urinary tract consists of the kidneys, ureter, bladder, and urethra. Its function is to rid the body’s toxic waste and unwanted fluid and regulate metabolic processes. Musculoskeletal symptoms of U-G pain include unilateral costovertebral tenderness, low back, flank, inner thigh, or leg pain, and ipsilateral shoulder pain.
Urinary tract infections (UTI’s): UTI occurs when the introduction of pathogens into this space is associated with adherence to the mucosa of the urinary tract. Colonization may be followed by microbial multiplication and an associated inflammatory response. There are two types of UTI's, upper and lower. Upper UTI's are located in the kidneys or ureter and are more serious than Lower UTI’s because they can be a direct threat to renal tissue itself. Lower UTI's are located in the bladder or urethra and are the more well-known UTI's commonly occurring in women.
S&S
Upper
- lower tract symptoms (frequency, urgency, dysuria)
- fever (sometimes with chills)
- skin paresthesias
- urinary frequency, urinary urgency
- dysuria, hematuria, pyuria, bacteriuria
- dyspareunia
Referral Pattern
The upper urinary tract refers pain to the ipsilateral shoulder, in addition to flank pain and unilateral costovertebral tenderness. The lower urinary tract refers pain to pelvis or lower abdominal area, in addition to having low back pain.
Special Tests
The Murphy’s percussion test is used to rule in or rule out kidney involvement. It is a highly sensitive (97.2%) test with a high (93.3%) positive predictive value although it is not a very specific test.
Red Flags
Positive Murphy's sign
References
Mandell, G. L., Douglas, R. G., Bennett, J. E., & Dolin, R. (2005). Mandell, Douglas, and Bennett's principles and practice of infectious diseases (6th ed.). New York: Elsevier/Churchill Livingstone.
Singer, A., Mccracken, G., Henry, M., Thodejr, H., & Cabahug, C. (1996). Correlation Among Clinical, Laboratory, And Hepatobiliary Scanning Findings In Patients With Suspected Acute Cholecystitis. Annals of Emergency Medicine, 28(3), 267-272.
Image from https://www.google.com/search?q=urinary%20tract%20infection&psj=1&biw=1366&bih=624&bav=on.2,or.r_cp.r_qf.&um=1&ie=UTF-8&hl=en&tbm=isch&source=og&sa=N&tab=wi&authuser=0&ei=Cn3UUZDqO-quiAKytICYAQ#facrc=_&imgdii=_&imgrc=yVG3pTzpUYISnM%3A%3BsogyGL_Lq22VNM%3Bhttp%253A%252F%252Fmedia.summitmedicalgroup.com%252Fmedia%252Fdb%252Frelayhealth-images%252Furinary_2.jpg%3Bhttp%253A%252F%252Fwww.summitmedicalgroup.com%252Flibrary%252Fpediatric_health%252Fhhg_uti%252F%3B744%3B963