Pathophysiology of Upper and Lower Urinary Tract Infections

Lower urinary tract infections (UTIs) involve the urethra and the  bladder; upper urinary tract infections include the ureters and the  kidneys.  Upper UTIs are rarer than lower UTIs but typically are more  severe (Healthline, 2019).  Microorganisms are the most common agent  resulting in UTI infection.  Microorganisms can include Escherichia coli  (E. Coli) and staphylococcus saprophyticus.   Less common  mircroorganisms are proteus, klebsiella, pseudomonas, viruses, fungi,  tubercular bacilli, and parasites.  Gram-negative bacilli move into the  urethra, next to bladder, then on to the ureter, and kidney.  Infection  begins as an inflammatory response producing edema within the bladder  wall.  The bladder feels full with only small amounts of urine present,  but the urgency of needing to urinate is present and appears more often  than usual (Huether & McCance, 2017).  Signs and symptoms of lower  UTIs might include frequency, nocturia, dysuria, urgency, and hematuria  (in some cases).  Signs and symptoms of upper UTIs might include nausea,  vomiting, fever, chills, low back, flank pain, abdominal pain and  mental status changes in the elderly population (Barkley, 2018).

Pathophysiology Impact and Patient Factors

Women are more prone than men to experience UTIs, possibly because of  urethral irritation during sexual intercourse or because they have a  shorter urethra, making it easy for microorganism transmission  (Berkowitz, 2007).  Microorganisms mostly associated with a female  diagnosis would be E.Coli and microorganisms primarily related to a male  diagnosis would be proteus species.  Disorders with lower UTIs might  be, urethritis/dysuria, and cystitis. Diseases with upper UTIs might be,  renal, pyelonephritis, and renal abscess (Barkley, 2018).  Contributing  patient factors might be age, prior UTI history, pregnancy,  immunocompromised patients, urinary catheter usage, and poorly  controlled diabetes (Healthline, 2019).

Diagnosis and Treatment

Diagnostic test for lower UTIs are urinalysis, esterase detection on  dipstick, and presence of nitrate by dipstick.  Treatment for lower UTIs  are ciprofloxacin, augmentin, bactrim (commonly), additionally  amoxicillin, macrobid, levaquin, monurol, and primsol maybe prescribed.   The preferred treatment course is 3-days instead of 7-day  to maximize  benefits and minimize treatment drawbacks (Barkley, 2018).

Diagnostic test for upper UTIs are ESR elevation, and white blood cell  casts appearing on urinalysis.  Treatment for upper UTIs is Bactrim,  Augmentin, Cipro, tobramycin, or gentamicin.  For patients with upper  UTIs experiencing nausea and vomiting, hospitalization may be necessary  (Barkley, 2018).

References

Barkley, T.  (2018).  Adult-gerontology primary care nurse practitioner.  West Hollywood, CA:  Barkley & Associates.

Berkowitz, A. (2007).  Clinical pathophysiology made ridiculously simple. Miami, FL:  MedMaster, Inc.

Healthline.  (2019).  Everything you need to know about urinary tract infection.  Retrieved from https://www.healthline.com/health/urinary-tract-infection-adults#symptoms

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

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