Clinical Challenge 2

20 years old female at 21 weeks of gestation by LMP and confirmed by ultrasound, was receiving prenatal care through a clinic. Her pregnancy was complicated by multiple urinary tract infections and she had recently been diagnosed with pyelonephritis. The condition was treated with IV antibiotics at a community hospital, and she was discharged with a prescription for Ampicillin to be taken for 7 days. She felt well untill two days before her second admission to the same community hospital, when she began having sharp, intermittent right upper-quadrant pain that was unrelated to eating.

Patient's apetite was decreased but she did not have nausea or vomiting, dysuria, urgency, frequncy,flank pain or diarrhea. Although she never took her temperature, she said that she "felt warm" at home and had a fever of 104.1 on admission. She was started on IV Ampicillin and Rocephin for presumed recurrence of pyelo. A renal sonogram showed a small stone in the patient's right kidney and a mild bilateral hydronephrosis.

Despite on going antibiotic therapy, her symptoms did not improve. She continued to be febrile, developed hypotension and tachycardia, and her urine output decreased. At this point the patient was transferred to our institution.

The question was: Where shall we begin?

Posted by: chameed Posts: 173 :: 12-03-2005 :: | Reply to this Message

Re: Clinical Challenge 2

look for d cause of hydronephrosis, relieve d obstruction, get c/s of urine and blood done, full supportive treatment.if dere is an obstruction causing hydronephrosis infection will not settle without relieving d obstruction.

Posted by: san_marms Posts: 3 :: 18-03-2005 :: | Reply to this Message

Re: Re: Clinical Challenge 2

quote:

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san_marms wrote:
look for d cause of hydronephrosis, relieve d obstruction, get c/s of urine and blood done, full supportive treatment.if dere is an obstruction causing hydronephrosis infection will not settle without relieving d obstruction.

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Well, here's a little more info:

Upon arrival to our institution, she complained of right upper-quadrant pain, right sided flank pain, fever, chills and decreased apetite but no nausea or vomiting. Her fetus was moving well and she did not have any contractions, leakage of fluid or vaginal bleeding.

Her temp. was 101.1, BP 96/46, pulse 120s and resp. 18. Shaking chills, mild cva tenderness on her right side and right upper- and lower-quadrant pain with rebound and guarding.

She was kept NPO and agressively hydrated with IV fluids. Her white count was 14.5 with 29 bands. Chem, LFT's,amylase and lipase were all normal. Her urine was positive for large leukocyte esterase and large blood.

Posted by: chameed Posts: 173 :: 03-04-2005 :: | Reply to this Message