Homeopathic Remedies for Cystitis

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Uti be gone Natural Urinary Tract Infection Cure Summary


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Principle 2 Differential Diagnosis Should Always Include Underlying Medical Illnesses Both Minor and Serious Which

Elderly patients are susceptible to delirium, and patients with dementia have an even greater risk of developing delirium with consequent behavioral disturbance, as a result of even minor medical illnesses, such as a urinary tract infection or viral syndrome. In addition, more serious, potentially life-threatening symptoms could have behavioral concomitants in susceptible patients with dementia. For this reason, it is imperative, in the evaluation of such patients, to thoroughly evaluate for comorbid states. Assuming that acute behavioral changes in a dementia patient are only part of the dementia can often delay diagnosis of comorbid states and can lead to unnecessary interventions for behavior.

Haemorrhagic Cystitis

Chamomile extract decreased the symptoms of haemorrhagic cystitis. Thirty-two patients were randomly assigned to receive either the antibiotic cotrimoxazole (trimethoprim sulfamethoxazole) alone or with a chamomile extract administered on day one as a bladder instillation, followed by daily hipbath use. Symptoms were evaluated after 10 days and indicated that the chamomile group experienced more rapid alleviation of symptoms than the group treated with only cotrimoxazole. The product used was Kamillenextrakt, an ethanolic extract of chamomile flowers (Barsom etal 1993).

Acute uncomplicated cystitis in young women

Sexually active young women have the highest risk for UTIs. Their propensity to develop UTIs is caused by a short urethra, delays in micturition, sexual activity, and the use of diaphragms and spermicides. B. Symptoms of cystitis include dysuria, urgency, and frequency without fever or back pain. Lower tract infections are most common in women in their childbearing years. Fever is absent. C. A microscopic bacterial count of 100 CFU mL of urine has a high positive predictive value for cystitis in symptomatic women. Ninety percent of uncomplicated cystitis episodes are caused by Escherichia coli 10 to 20 percent are caused by coagulase-negative Staphylococcus saprophyticus and 5 percent are caused by other Enterobacteriaceae organisms or enterococci. Up to one-third of uropathogens are resistant to ampicillin, but the majority are susceptible to trimethoprim-sulfamethoxazole (85 to 95 percent) and fluoroquinolones (95 percent). D. Young women with acute uncomplicated cystitis should...

Recurrent cystitis in young women

Up to 20 percent of young women with acute cystitis develop recurrent UTIs. The causative organism should be identified by urine culture. Multiple infections caused by the same organism require longer courses of antibiotics and possibly further diagnostic tests. Women who have more than three UTI recurrences within one year can be managed using one of three preventive strategies 2. Postcoital prophylaxis with one-half of a trimethoprim-sulfa-methoxazole double-strength tablet (40 200 mg) if the UTIs have been clearly related to intercourse.

Urinary tract infection in men

Urinary tract infections most commonly occur in older men with prostatic disease, outlet obstruction or urinary tract instrumentation. In men, a urine culture growing more than 1,000 CFU of a pathogen mL of urine is the best sign of a urinary tract infection, with a sensitivity and specificity of 97 percent. Men with urinary tract infections should receive seven days of antibiotic therapy (trimethoprim-sulfamethoxazole or a fluoroquinolone). B. Urologic evaluation should be performed routinely in adolescents and men with pyelonephritis or recurrent infections. When bacterial prostatitis is the source of a urinary tract infection, eradication usually requires antibiotic therapy for six to 12 weeks.

Urinary tract infection

Urinary tract infection (UTI) is a common problem affecting all ages and accounts for approximately 1 of all attendances in general practice. It is very common in sexually active women but uncommon in men and children. Organisms causing UTI in the community are usually sensitive to most of the commonly used antibiotics. The important decision to make is whether to proceed with further investigation of the urinary tract. The morbidity of urinary infections in both children and adults is well known but it is vital to recognise the potential for progressive renal damage, ending in chronic renal failure. The main task in the prevention of chronic pyelonephritis is the early identification of patients with additional factors, such as reflux or obstruction, which could lead to progressive renal damage.

Recurrent or chronic urinary tract infections

Recurrent infections occur as a relapse of a previously treated infection or because of reinfection, often with differing organisms. Persistent (chronic) UTIs indicate that the organism is resistant to the antimicrobial agents employed or that there is an underlying abnormality such as a renal stone or a In men and children an anatomical abnormality is usual, while recurrent cystitis in women often occurs despite a normal tract. In men, instruction on perineal hygiene, more frequent bladder emptying and postintercourse voiding may assist in the prevention of reinfection.

Urinary tract infection in children

UTI in infants and very young children is often renal in nature and may be associated with generalised symptoms such as fever, vomiting, diarrhoea and failure to thrive. Symptoms of dysuria and frequency appear only after the age of 2 years when the child is able to indicate the source of the discomfort. In a girl or boy (rare presentation) with symptoms of dysuria and frequency an underlying abnormality is likely to be present with a reported incidence of vesicoureteric reflux as high as 40 and scarred kidneys (reflux nephropathy) in 27 . 3 Thus the early detection of children with vesicoureteric reflux and control of recurrent renal infection could prevent the development of scars, hypertension and chronic renal failure. Radiological investigation of children with UTIs shows normal kidneys in approximately 66 and reflux in approximately 33 .

Urinary infections in pregnancy

UTI in pregnant women requires careful surveillance. Asymptomatic bacteriuria should always be excluded during early pregnancy because it tends to develop into a full-blown infection. Acute cystitis is treated for 10 to 14 days with any of the following antimicrobials cephalexin, amoxycillin potassium clavulanate or nitrofurantoin (if a beta-lactam antibiotic is contraindicated). The dosages are the same as for other groups. Asymptomatic bacteriuria should be treated with a week-long course.

Pyelonephritis and Urinary Tract Infection

History of the Present Illness Dysuria, frequency (repeated voiding of small amounts), urgency suprapubic discomfort or pain, hematuria, fever, chills, (pyelonephritis) back pain, nausea, vomiting. History of urinary infections, renal stones or colicky pain. Recent antibiotic use, prostate enlargement. Diaphragm use.

Why Prevent Urinary Tract Infections in Children

There are two main reasons for trying to actively prevent UTIs a. To prevent morbidity mortality associated with acute cystitis & pyelonephritis. Young children are especially at risk of severe infections, with 6 of UTIs in the first year of life associated with bacteraemia, 2 requiring fluid resuscitation at diagnosis, and 1 requiring ventilatory support (Craig et al., 1998). The incidence of death from urinary sepsis was as high as 11 during the 1960s, but is now rare. Because UTIs often recur -12 to 30 of children with their first UTI have another infection during the ensuing 12 months (Winberg et al., 1974) - these occasional severe outcomes may justify offering preventive interventions to young children with UTI. The combination of vesicoureteric reflux (VUR) and renal damage from recurrent UTIs has traditionally been thought to lead to end-stage renal disease (ESRD) (Bailey, 2000). In recent years, however, evidence has emerged that hypertension (HT), renal impairment, and...

Which Children are at Risk of Recurrent UTI

Data from a prospective hospital based cohort study in children less than 5 years of age who were identified following their first symptomatic UTI implicates young age and presence of high grade VUR as risk factors for recurrence of UTI (Panaretto et al., 1999). Vesico-ureteric reflux of grade 3 to 5 is an independent risk factor for recurrence (odds ratio 3.5), as is age less than 6 months (OR 2.9). Recurrence of UTI is also a predictor of future recurrence. After 2 UTIs, the risk of recurrence within one year is 60 , and after 3 UTIs the risk of recurrence within one year is 75 (Hellerstein, 1982).

Can Recurrent Urinary Tract Infections be Prevented

A Cochrane meta-analysis of studies comparing antibiotic prophylaxis with antibiotic prophylaxis combined with surgical re-implantation of ureters demonstrated that there may be a small reduction in recurrent UTIs in the surgery plus antibiotic group (Wheeler et al., 2004). However, the effect size was such that nine re-implantations would be needed to prevent one febrile UTI after 5 years. No difference in GFR or abnormalities on DMSA scan was demonstrated between groups. Importantly, none of the studies included a control group that received no treatment. Williams et al. performed a meta-analysis of 5 existing randomised controlled trials of antibiotic prophylaxis in the prevention of recurrent UTIs (Williams et al., 2001). Three trials (n 392) examined long-term antibiotic treatment (2-6 months) and subsequent off-treatment development of UTI. These trials included patients with asymptomatic bacteriuria. Two trials (n 72) examined antibiotic prophylaxis for prevention of recurrent...

Do Nonantibiotic Interventions Have a Role in Preventing Recurrent Urinary Tract Infections

Cranberry juice has been examined as a UTI prophylactic in a Cochrane meta-analysis. No difference in incidence of bacteriuria between treatment and control groups was found, although small numbers may have underestimated any treatment effect (Jepson et al., 2004). The authors concluded that this safe intervention requires larger trials to evaluate its efficacy. Addressing voiding dysfunction with bladder training programs with or without the additional use of anticholinergic agents may be an alternative to prophylactic chemotherapy. The anticholinergic oxyphenomium bromide was found to be effective at decreasing detrusor contractility and the degree of reflux in children with these conditions (Scholtmeijer and Van Mastrigt, 1991), although it has not been proven to decrease the incidence of UTI. Circumcision has been demonstrated to reduce the incidence of UTI in boys 10-fold in a retrospective cohort study (Schoen et al., 2000). This intervention may not be appealing as a first-line...

Antepartum Urinary Tract Infection

Four to 8 of pregnant women will develop asymptomatic bacteriuria, and 13 will develop symptomatic cystitis with dysuria. Pyelonephritis develops in 25-30 of women with untreated bacteriuria. I. Asymptomatic bacteriuria is diagnosed by prenatal urine culture screening, and it is defined as a colony count 105 organisms per milliliter. Patients with symptomatic cystitis should be treated with oral antibiotics without waiting for urine culture results.

Urinary infections in the elderly

The typical settings in which UTIs occur in the elderly are in the frail, those who are immobilised, and those with faecal incontinence and inadequate bladder emptying. The presenting symptoms may be atypical, especially with upper UTI where fever of undetermined origin and behaviour disturbances may be a feature. In men obstructive uropathy from prostatism should be excluded by ultrasound. Uncomplicated infections should be treated the same way as for other age groups but no antimicrobial treatment is recommended for asymptomatic bacteriuria.

Clinical Presentation

Angiodysplasia usually presents with persistent occult bleeding or repeated small bleeds. In colonic ischaemia infarction there may be a history of arrhythmia or cardiac failure, and it may present acutely with abdominal pain and bloody diarrhoea or less acutely with stricturing and symptoms of obstruction. Infective conditions usually lead to diarrhoea, crampy abdominal pain and fever. A careful drug history should be obtained if pseudomembranous colitis is suspected. Inflammatory bowel disease may have an indolent presentation with lethargy, anorexia and weight loss. However, more characteristic symptoms of ulcerative colitis include bloody diarrhoea (> 10 stools day), urgency and abdominal pain. Peritonitis and systemic sepsis may occur with toxic megacolon and perforation. Colorectal Crohn's disease characteristically presents with diarrhoea. Obstruction due to stricturing may occur and fistulae leading to specific symptoms (e.g., colovesical - pneumaturia and recurrent urinary...

Complications And Prognosis

Prognosis has dramatically improved since the combination of CYC and GC has been utilized for severe disease presentations. Milder forms of WG, in which critical organ systems are not involved, may be effectively treated with weekly MTX or daily AZA. Recent studies have demonstrated that in severe disease, making a transition from CYC to MTX or AZA after approximately three months spares, or markedly reduces, CYC toxicities. These include cystitis, bladder cancer, lymphoma, myelodysplasia, and sterility. Almost all patients will achieve remission with these approaches to therapy. Because relapses are very common, patients should be closely monitored for early signs and symptoms of disease, so that treatment may be instituted or changed without delay.

Presenting a history and examination

The priorities are to communicate the patient's name, gender and age, to describe in detail the presenting com-plaint(s), to describe the significant past medical history, family history, medication and allergies, any relevant positive findings in functional enquiry and place the current presentation in the context of the patients social circumstances. The presentation of the history should be complaint or problem led. Then, if possible, use the patient's words to describe the presenting complaint. Avoid the use of medical terms, such as dysuria, or medical jargon. In a complex case with several complaints these should be listed and then each presented in detail. A common mistake is insufficient emphasis on the presenting complaint.

Role of Prophylactic Intravenous Immunoglobulin Infusions in the Prevention of Neonatal Sepsis

Would the prophylactic administration of pooled human immunoglobulin help to preterm or low birth-weight infants help prevent systemic infection A Cochrane Review has analysed 19 trials that randomised 5000 preterm or low birth weight infants to prophylactic intravenous immunoglobulin infusions or placebo (Ohlsson and Lacy, 2004b). Eight different IVIG preparations were used and there were 7 dosage variables. In 4 trials, infants received a single dose of intravenous immuno-globulin, and in the remaining 15 multiple doses were given. The meta-analysis of 10 of the trials comprising 3975 infants, showed a significant decrease in clinical and culture proven septic episodes in those infants who received immunoglobulin (p 0.02). The prevention of 1 or more episodes of serious infection comprising sepsis, meningitis or urinary tract infection was studied in 16 studies comprising of 4986 infants and a combined analysis showed a significant decrease in serious infection in infants receiving...

Abdominal Pain and the Acute Abdomen

Associated Symptoms Fever, chills, nausea, vomiting (bilious, feculent, blood, coffee ground-colored material) vomiting before or after onset of pain jaundice, constipation, change in bowel habits or stool caliber, obstipation (inability to pass gas) chest pain, diarrhea, hematochezia (rectal bleeding), melena (black, tarry stools) dysuria, hematuria, anorexia, weight loss, dysphagia, odynophagia (painful swallowing) early satiety, trauma.

What conditions are often missed

This question refers to the common 'pitfalls' so often encountered in general practice. This area is definitely related to the experience factor and includes rather simple non-life-threatening problems that can be so easily overlooked unless doctors are prepared to include them in their diagnostic framework. Classic examples include smoking or dental caries as a cause of abdominal pain allergies to a whole variety of unsuspected everyday contacts foreign bodies occupational or environmental hazards as a cause of headache, respiratory discomfort or malaise and faecal impaction as a cause of diarrhoea. We have all experienced the 'red face syndrome' from a urinary tract infection whether it is the cause of fever in a child, lumbar pain in a pregnant woman or malaise in an older person. The dermatomal pain pattern caused by herpes zoster prior to the eruption of the rash (or if only a few sparse vesicles erupt) is a real trap. Lead poisoning Malnutrition (unsuspected) Menopause syndrome...

Clinical Manifestations

Most studies report that 25 of men and 70 of women infected with C. trachomatis are asymptomatic or minimally symptomatic. The National Longitudinal Study of Adolescent Health Study collected data prospectively from 14,322 U.S adolescents and followed them into adulthood (Miller et al., 2004). Of the participants that tested positive for chlamydial infection, 95 did not report symptoms in the 24 hours preceding specimen collection. Among men with chlamydial infection, the prevalences of urethral discharge and dysuria were only 3.3 and 1.9 , respectively. Among women with chlamydial infection, the prevalences of vaginal discharge and dysuria were 0.3 and 4.2 , respectively. Among the small number of young men reporting urethral discharge (n 17), the prevalence of chlamydial infection was high (38.5 ), whereas the prevalence of chlamydial infection was only 6.0 among the women reporting dysuria (n 232) and 0.9 among those reporting vaginal discharge (n 98) (Miller et al., 2004).

Second Malignancies

Like radiation, chemotherapy is associated with second malignancies. The most common iatrogenic cancers attributable to systemic treatment are myelodysplasia and acute leukemia. These are usually associated with drugs that have alkylation as at least one of their mechanisms of action. Classic alkylators like cyclophosphamide contain an electorphilic alkyl group with an affinity for the N7 position on guanine. As a result, it intercolates itself between DNA strands causing mispairing of neu-cleotides and single and double strand breaks. Other drugs, such as the platinums, anthracyclines, and epipodophyllotoxins, have a nonclassical alkylating mechanism that achieves similar effects on DNA through electrostatic means. This DNA damage, if it activates an oncogene or inactivates a tumor suppressor, can lead to transformation of cells and neoplasia. There are other examples of secondary cancers resulting from primary systemic cancer therapy. For example, tamoxifen can cause uterine cancer...

Infections in Females

Symptoms in females include mild abdominal pain, intermittent bleeding, vaginal discharge, or dysuria-pyuria syndrome. The cervix can appear normal or exhibit edema, erythema, friability, or mucopurulent discharge. In prepubertal girls, vaginitis can occur secondary to infection of transitional cell epithelium by C. trachomatis. In contrast, the squamous epithelium of the adult vagina is not susceptible to chlamydiae, and vaginal discharge generally reflects endocervical infection. The definition of pelvic inflammatory disease is a sexually transmitted infection that ascends from the vagina and cervix to involve the uterus, ovaries, and peritoneal tissues as well as the fallopian tubes. Lower abdominal pain, usually bilateral, is the most common presenting symptom. Pain may be associated with an abnormal vaginal discharge, abnormal uterine bleeding, dysuria, dyspareunia, nausea, vomiting, fever, or other constitutional symptoms. It is more commonly present in a subclinical form that...

Miscellaneous Effects of Systemic Treatment

A series of other long-term and late effects are associated with specific systemic cancer drugs. For example, bleomycin causes pulmonary fibrosis at doses above 450 mg m2, especially in the elderly and those on supplemental oxygen,66 and the acrolein metabolite of cyclophosphamide and ifosfamide causes a hemorrhagic cystitis that in a small proportion of unfortunate patients can become chronic after a severe acute episode. Cisplatin can affect renal function, which can be either acute or of delayed-onset. Vinca alkyloids like vincristine cause sensory neuropathy, as do platinum drugs (cisplatin, oxaliplatin) and taxanes (paclitaxel, docetaxel). Many of these can reverse to some extent but take many months or even years to do so. Cisplatin's ototoxicity is often permanent.67

Sequelae and Limitations of Chemoradiotherapy for Squamous Cell Anal Cancer

Late complications associated with radiation and chemotherapy can adversely affect the QOL of patients. Grade 3-4 complications occur in 10 to 19 of patients (17,20,27,29,45,46). Frequent late effects of chemoradiotherapy include chronic diarrhea, dysuria due to proctitis, chronic pelvic pain, fractures and sexual dysfunction (27,45,47). Complications of the anal canal occur in 15 to 30 of patients and include anal necrosis, stenosis, fistulae or ulceration, and anal incontinence (particularly if there was sphincter involvement by tumor). The incidence of radionecrosis in patients treated with BRT is 2 to 9 (48-50). In general, treatment-related anorectal complications require APR or colostomy in 3 to 6 of patients (39,40,44). In a retrospective study of 144 patients treated with radiation and chemotherapy, factors contributing to late toxicity included anatomical tumor extent and delivered dose of radiation. Patients receiving < 39.6 Gy had a 7 complication rate, while those...

Management of spinal injury

A holistic approach to the prevention of complications should be considered essential at all hospital levels of care and during all phases of management, from the acute phase to the rehabilitation phase (39). The most common complications, which increase morbidity and mortality, are pressure sores, urinary retention, urinary infection and deep venous thrombosis. To prevent pressure sores, patients should be log-rolled every two hours. These items are also desirable at basic levels. It is anticipated that patients with spinal injuries or suspicion thereof would be rapidly referred to the next highest level in the health care system, where they could be more adequately managed, in terms of diagnosis and treatment. Ideally, patients should arrive at tertiary care centres within two hours of injury. Appropriate handling of patients, with the use of simple techniques such as log-rolling and the avoidance of undue movement during transport, is likewise essential at all levels of the health...

Clinical Investigations

Urinalysis a dipstick test will detect microscopic haematuria (not visible grossly) which can indicate bladder disease, or pick up other substances such as protein or sugar in the urine which may flag up bladder infection or an underlying medical condition such as diabetes mellitus.

Nonneoplastic Conditions

Bacterial cystitis this, the most common cause of cystitis, is usually due to coliform organisms (e.g., E. coli) ascending the urethra. Underlying structural (diverticula, fistulae, malformations, stones) or medical (diabetes mellitus, chronic renal failure, immunosuppression) conditions predispose. Recurrent infections, especially in men, should trigger investigation for an underlying cause. Polypoid papillary cystitis these closely related conditions describe localised non-specific inflammation and oedema of the bladder mucosa commonly seen in association with indwelling urinary catheters and less often with vesical fistulae. They may be difficult to differentiate endo-scopically and microscopically from papillary urothelial carcinoma, which tends to have finer stromal papillary cores, more urothelial atypia and less associated inflammation. Interstitial cystitis usually in middle-aged women, the aetiology is obscure and the diagnosis essentially one of exclusion. Symptoms may be...

Neoplastic Conditions

Urothelial carcinoma in situ occurs rarely in the absence of invasive tumour, when it can closely mimic interstitial cystitis both clinically and cystoscopically, presenting with irritative bladder symptoms and appearing as multifocal red, velvety patches. More often seen in association with prior or synchronous invasive malignancy which can be multifocal. Diagnosis is made by urine cytology and bladder biopsy, which shows severe (often, but not necessarily, full-thickness) dysplasia of the surface urothelium. Papillary architecture is lacking. Lesser grades of atypia may merit the term urothelial dysplasia. Careful distinction should be made from superficial carcinoma, which is used by urologists to describe tumours that have not invaded into the muscularis propria, regardless of histological type and grade. Carcinoma in situ is usually treated with intravesical chemotherapy (e.g., mitomycin) or immunotherapy (BCG vaccine), although localised disease may be controlled by...

Resection Specimens

Simple cystectomy is quite a rare operation, typically performed for benign conditions such as interstitial cystitis or neurogenic bladder complicated by chronic infection. It involves bladder removal with maintenance of the urethra in women or the prostate and seminal vesicles in men.

Open Simple Prostatectomy

This operation is reserved for BPH where the prostate weighs over 50-75 g. It is also appropriate where there is concomitant benign bladder disease requiring treatment such as a symptomatic diverticulum or a large stone. Potential risks are urinary incontinence, erectile dysfunction, retrograde ejaculation and urinary tract infection. The advantages over TURP are complete removal of the gland (therefore no recurrence) and no risk of dilutional hyponatraemia. However, there is an increased risk of intraoperative haemorrhage and a longer hospital stay. Previous prostatectomy, prior pelvic surgery and prostate cancer are contraindications to the operation.

History of present pregnancy

Medical problems during this pregnancy should be reviewed, including urinary tract infections, diabetes, or hypertension. 7. Review of systems. Severe headaches, scotomas, hand and facial edema, or epigastric pain (preeclampsia) should be sought. Dysuria, urinary frequency or flank pain may indicate cystitis or pyelonephritis.

Urogenital Infections

Probiotics are widely used to decrease the frequency of recurrent bacterial vaginosis and candidal vulvovaginitis, and have undergone clinical testing that supports this use. They are administered both orally and intravaginally. Additionally, lactobacilli play a significant role in the prevention of UTIs. One study using intravaginal administration of probiotics such as Lactobacillus GR-1 and B-54 or RC-14 strains twice weekly for 2 weeks and then monthly for 2 months demonstrated that treatment resulted in 45 less UTIs than placebo and improved the maintenance of normal flora (Reid & Burton 2002). A significant reduction in UTI rate was also reported in a randomised double-blind study involving 55 premenopausal women (Reid 2001 b). The study investigated the effectiveness of treatment for 1 year with a weekly suppository containing either 0.5 g L. rhamnosus GR-1 and L. fermentum B-54 or a Lactobacillus growth factor. Treatment resulted in the UTI rate decreasing by 73 and 79 ,...

Products Available

In the various studies and consumer references, many dosages and dosing regimens have been reported for the use of cranberry in prevention of renal calculi, prevention of urinary odor, and prevention and treatment of urinary tract infections. Prevention of urinary tract infection 8 oz of cranberry juice four times a day for several days, then twice daily (7) 300 mL day as cranberry juice cocktail (11). Treatment of urinary tract infection 6 oz cranberry juice of daily for 21 days (12) cranberry juice 6 oz twice daily (13).

Dementia delirium and other organic brain syndromes

A woman of 83 had been diagnosed as suffering from moderate to severe dementia of Alzheimer's type, but was able to remain at home because of the devoted care of her 62-year-old daughter. Her behaviour became much more agitated and confused over a period of 2 days, alternating with periods of drowsiness her urine had become foul-smelling over this time. The GP and community psychiatric nurse diagnosed acute-on-chronic confusion due to urinary tract infection, and continued to look after the patient at home, for her daughter wished to avoid hospital admission. With antibiotics, a change of catheter, and some sedation with small doses of chlorpromazine, the patient's condition returned to normal over a few days. Her daughter nevertheless appeared exhausted, and regular respite care admissions were arranged to ease her burden.

Seven masquerades checklist

Depression, diabetes, drugs, spinal dysfunction and urinary tract infection can all cause abdominal pain although the pain may be more subacute or chronic. Abdominal pain and even tenderness can accompany diabetic ketoacidosis. Drugs that can cause abdominal pain are listed in Table 30.4 . Spinal dysfunction of the lower thoracic spine and thoracolumbar junction can cause referred pain to the abdomen (Fig 30.1). The pain is invariably unilateral, radicular in distribution, and related to activity. It can be confused with intra-abdominal problems such as biliary disease (right-sided), appendicitis and Crohn's disease (right side), diverticular disease (left-sided) and pyelonephritis.

Physical Examination

Differential Diagnosis Nephrolithiasis, appendicitis, cystitis, pyelonephritis, diverticulitis, salpingitis, torsion of hernia, ovarian torsion, ovarian cyst rupture or hemorrhage, bladder obstruction, prostatitis, prostate cancer, endometriosis, ectopic pregnancy, colonic obstruction, carcinoma (colon, prostrate, cervix, bladder). Causes of Nephrolithiasis Hypercalcemia, hyperuricosuria, hyperoxaluria, cystinuria, renal tubular acidosis, Proteus mirabilis urinary tract infection (stag-horn calculi).

Bladder Bowel and Sexual Disturbances

Sphincter dyssynergia, may then lead to retention of urine and, particularly in males, to vesicoureteral reflux, with the threat of hydronephrosis and progressive renal failure (138). Retention of urine also increases the risk of urinary tract infection which, in turn, may suddenly precipitate urinary symptoms.

An Algorithm For Determining The Underlying Causes Of Behavioral Problems

Behavior problems among individuals with dementia residing in long-term care settings (see Figure 13.1). This model highlights four decision modules to assist clinicians (and caregivers) in the identification of causes of an individual's behavior problem. Before entering into the decision modules, it must first be determined whether the behavior has a somatic cause. At this point, an assessment should be made to determine if sensory deficits may be a factor in the problematic behavior (e.g., Is the person's hearing aid working or should the battery be replaced Has his or her vision worsened ). Infections (e.g., UTIs), poor hydration, pain (e.g., Do poorly fitting dentures result in problematic behaviors at meals ), and so on also should be ruled out before proceeding to the first module and attempting to create interventions for functional causes. Of course, communication problems associated with dementia and or cultural differences use of a foreign language can exacerbate problems of...

Vulvar Vestibulitis Syndrome

Vulvar Vestibulitis Treatment

Other factors Many other physically based etiological theories of vulvar vestibulitis exist however, they are based on uncontrolled studies and should be interpreted with caution. These include human papillomavirus infection (57), faulty immune system functioning allergies (6,58), urethral conditions (e.g., interstitial cystitis) (59), vaginismus (46), sexual abuse (44,60), and psychological factors (e.g., somatization disorder) (46). It is important to note that controlled studies of sexual abuse (10,12) show no difference between affected and non-affected women, although a history of depression and physical abuse has been linked to vulvar vestibulitis (8). Furthermore, an increase in pelvic floor muscle tension (61,62) has also been associated with vulvar vestibulitis. Although the tensing of pelvic floor musculature may represent a protective reaction against, or a conditioned response to vulvar pain, this increase in tension is likely to only exacerbate the pain.

Recommendations for the Use of Antibiotic Prophylaxis

Current clinical guidelines regarding the use of antimicrobial prophylaxis for recurrent UTIs in children highlight the uncertainty that surrounds their efficacy. For example, the American Academy of Pediatrics currently recommends the use of prophylactic antibiotics for all children with UTIs in whom documented VUR exists (American Academy of Pediatrics, 1999), whereas Swedish guidelines limit prophylaxis to high grades of reflux (4-5) only (Jodal and Lindburg, 1999). We know that UTIs may be severe, particularly in infants, and that frequent recurrent UTIs are associated with, but not necessarily the cause of, permanent renal damage in a small percentage of cases. There is a limited amount of poor-quality evidence that recurrent UTIs may be prevented by long-term prophylactic antibiotics, although it is not known if the benefits of this approach (if any) outweigh the risks. It is very difficult to determine if antibiotic prophylaxis can prevent the development of long-term renal...

Postpartum Fever Workup

History Postpartum fever is 100.4 F (38 degrees C) on 2 occasions > 6h apart after the first postpartum day (during the first 10 days postpartum), or 101 on the first postpartum day. Dysuria, abdominal pain, distention, breast pain, calf pain. Differential Diagnosis UTI, upper respiratory infection, atelectasis, pneumonia, wound infection, mastitis, episiotomy abscess uterine infection, deep vein thrombosis, pyelonephritis, pelvic abscess.

Description of Chief Complaint Data Used in Biosurveillance

Table 23.1 is a sample of chief complaints from a registration computer in an ED. The chief complaints are more terse (four or five words) than those recorded in physician notes. They also contain misspellings, unconventional abbreviations, and unorthodox punctuation. Only two of these chief complaints contain diagnoses (finger lac and uti, which are abbreviations Uti for finger laceration and urinary tract infection, respectively). The rest describe the patient's symptoms. The second column of the table shows the syndromes that a human expert assigned to the patient for purposes of training a Bayesian natural language processor. We will discuss syndromes shortly.

Tumourlike Conditions

Miscellaneous other causes of cystitis include pelvic radiotherapy, intravesical BCG immunotherapy (granulomatous) or chemotherapy, oral drugs (cyclophosphamide), viral infection (CMV, HSV) and parasite infestation (schistosomiasis). Amyloidosis may present as a localised, nodular bladder mass (amyloid tumour).

Case Study III Psychological Perspectives

This case, which began as a seemingly straightforward case of progressive dementia, demonstrates the influence of multiple comorbidities (depression and delirium) that are integral to dementia care. As Mrs. Walker experienced significant loss ( her best friend) and stress ( her husband's illness and daughter's divorce), she became depressed. It is interesting to note that along with Mrs. Walker's overt vegetative symptoms of depression (e.g., not eating, losing weight, not bathing), she was also reporting mood problems as indicated in her statement I'm not worth a damn. In addition to the anti-depressant medication, there was some implicit behavioral treatment as well. Mrs. Walker began socializing more at the senior center and was likely engaging again in more day-to-day pleasant events than she had been before depression treatment. This, in addition to a focus on increasing her functional activity, would be psychological complements to the medication treatment. In addition, perhaps...


Ad infections occur worldwide as epidemic, endemic, and sporadic infections. Of the 51 human Ad serotypes currently known, the most common in clinical materials are the respiratory types of subgenus C (Ad1, Ad2, Ad5) and subgenus B (Ad3 and Ad7) (102,103). Along with being an important cause of respiratory tract infections, Ad can also cause conjunctivitis and gastrointestinal disease. Ads have been implicated in aseptic meningitis, encephalitis, hepatitis, and hemorrhagic cystitis and may cause severe disseminated infections in immunocompromised patients of all ages (104). In humans, the majority of Ad infections in immunocompetent hosts are subclinical, meaning that no apparent symptoms are present. This feature has made Ad an attractive platform for numerous gene therapy applications, including cancer. However, like most human virus pathogens, Ads possess a substantial genetic armamentarium to interfere with the immune system of the host to ensure their evolutionary survival...

Outbreak Detection

2 We note that clinicians and especially veterinarians working in agribusiness do not always work-up a case to the highest level of diagnostic precision due to cost-benefit considerations. For example, medical practice guidelines suggest that a clinician treating a woman with uncomplicated urinary tract infection may treat this relatively imprecise diagnosis without obtaining a urine culture (to establish a more precise bacteriological diagnosis) because the probability of curing the condition with a broad-spectrum antibiotic is high.

Chest Radiation

Pelvic radiation can cause long-term radiation proctitis in a minority of patients. Analogous to the symptoms of a bladder infection, the inflamed rectum seeks to immediately discharge any small amount of stool that enters it. As a result, these patients can have severe fecal urgency and frequency, with each movement consisting of a disappointingly small amount of stool. Antispasmodics like Levsin or Anusol suppositories can help, and symptoms usually improve over the course of a couple of years. However, some patients with persistent debilitating symptoms eventually elect colostomy.


A Acute uncomplicated pyelonephritis presents with a mild cystitis-like illness and accompanying flank pain fever, chills, nausea, vomiting, leukocytosis and abdominal pain or a serious gram-negative bacteremia. The microbiologic features of acute uncomplicated pyelonephritis are the same as cystitis, except that S. saprophyticus is a rare cause.

Laboratory diagnosis

The laboratory diagnosis of UTI depends on careful collection, examination and culture of urine. Collection of urine 1 Suprapubic aspirate of urine (SPA). This is an extremely reliable way to detect bacteriuria in neonates and in patients where UTI is suspected but cannot be confirmed because of low colony counts or contamination in an MSU. Under local anaesthetic, a needle (lumbar puncture needle in adults) is inserted into the very full bladder about 1 cm above the pubic symphysis, and 20 mL is collected by a syringe. Any organisms in an SPA specimen indicate UTI.

Culture of the urine

The nature and number of organisms present in the urine are the most useful indicators of UTI. 1 Most common are enteric organisms. Escherichia coli is responsible for about 90 of UTIs with other Gram-negative organisms (Klebsiella sp and Proteus sp) and Gram-positive cocci (Streptococcus faecalis and staphylococci) also occurring. If > 10 5 colony forming units (cfu) per mL of bacteria are present in an MSU, it is highly likely that the patient has a UTI. On the other hand, it is most important to realise that up to 30 of women with acute bacterial cystitis have less than 10 5 cfu mL in the MSU. For this reason, it is reasonable to treat women with dysuria and frequency even if they have < 10 5 cfu mL of organisms in an MSU.

Biopsy Specimens

Rigid or flexible cystoscopy allows direct visualisation of macroscopic bladder pathology for evaluation and biopsy of small lesions using either cold cup forceps or a small diathermy loop. The latter may cause significant heat artefact, reducing the value of histologic assessment. Rigid cystoscopy employs a larger lumen allowing superior visualisation (better optics and water flow), greater versatility in the passage of accessory instruments and easier manipulation. It also provides suitable access for transurethral resection of superficial bladder tumours with diathermy (TURB). Flexible cystoscopy is more comfortable for the patient, may be easier to pass and allows a range of angles of visualisation within the bladder. Cystoscopy should be avoided during active urinary tract infection as instrumentation can exacerbate the condition. Carcinoma in situ may be invisible to the endoscopist and necessitate random biopsies to make the diagnosis. Distinction from interstitial cystitis may...

Clinical Summary

The patient was a 52 year old woman with past medical history significant for morbid obesity (205 kg), cigarette smoking with chronic obstructive pulmonary disease (COPD), and cor pulmonale. She was on oxygen therapy at home for the past 7 months. She presented to the hospital with complaints of increasing weight gain, abdominal and lower extremity edema with pruritus and skin ulcers. She had no fever, chills, cough, dysuria, chest pain or palpitations. She denied any trauma to her legs. Her breathing was at baseline and she denied any acute shortness of breath.

Timothy S Tracy

It appears that cranberry juice may be effective in preventing the recurrence of urinary tract infections, but not in treating urinary tract infections. It is generally well tolerated and relatively free of adverse effects. There have been case reports of coadministration of cranberry juice and warfarin resulting in bleeding events, but this potential interaction remains to be conclusively established. Key Words Vaccinium macrocarpon prophylaxis urinary tract infection kidney stones.


Another important maternal infection that has consequences for the developing fetus is urinary tract infection. Urinary tract infections represent the most common medical complication of pregnancy, occurring in approximately 4-7 of all pregnancies. When all potentially offending genitourinary pathogens are included, and when the spectrum of asymptomatic bacteriuria is considered, these factors may increase the frequency of maternal bacteriuria to 25 . Recent research using an inception cohort design with Medicaid maternal and infant-linked records and Vital Records for 41,090 pregnancies during 1995-1998 found the relative risk (RR) for MR or developmental delay among children of mothers with urinary tract infection without an antibiotic (i.e., based on Medicaid pharmacy reimbursement claims) was significantly elevated compared to the group without an urinary tract infection and compared to children of mothers with urinary tract infection and an antibiotic claim. Similar analyses of...


History of the Present Illness Quantity of RBCs found on urinalysis. Repeat testing. Color, timing, pattern of hematuria Initial hematuria (anterior urethral lesion) terminal hematuria (bladder neck or prostate lesion) hematuria throughout voiding (bladder or upper urinary tract). Frequency, dysuria, suprapubic pain, flank pain (renal colic), perineal pain fever. Recent exercise, menstruation bleeding between voidings.


Therapeutic Uses and Folklore horseradish was traditionally used by Europeans to treat gout, kidney stones, asthma, and bladder infections. It was used in Europe to prevent scurvy before vitamin C was discovered. Grated horseradish mixed into a paste is a home remedy for chest congestion and stiff muscles because it brings blood to the surface of the skin and warms the skin.


History of the Present Illness Severe, colicky, intermittent,, lower abdominal pain flank pain, hematuria, fever, dysuria prior history of renal stones. Abdominal pain may radiate laterally around abdomen to groin, testicles or labia. History of low fluid intake, urinary tract infection, parenteral nutrition. Excessive calcium administration, immobilization, furosemide.

Bladder Obstruction

Receptor expression may also be affected following obstruction. Increased expression of a-adrenoceptors has been observed in human bladder strips from patients with prostatic bladder obstruction and NA can cause contraction of the muscle, a response that does not usually occur in unobstructed bladder (243). Similarly, under normal conditions, the contractile response to nerve stimulation in human bladder does not contain a significant purinergic component indicated by atropine resistance. However, increased purinergic transmission can be demonstrated in patients with unstable obstructed bladders (244,245 see also Ref. 246). Upregulation of purinergic receptors appears to occur in hyperreflexia whether this is due to obstruction (244,245), interstitial cystitis (247), or neurogenic bladders (248).

Bladder Inflammation

Inflammatory conditions of the bladder such as chronic cystitis and interstitial cystitis are characterized by symptoms of urgency and increased frequency of voiding, both associated with pain (249,250). The association with pain has implicated the involvement of bladder afferents in the process, although both sensory and autonomic nerves may be involved in abnormal detrusor muscle responses in inflammation. The two conditions should be distinguished in that chronic cystitis results from chronic inflammation due to persistent infection, whereas in intersti tial cystitis it has been proposed that neurogenic inflammation in the absence of infection may be a primary mechanism in its pathogenesis (249,251). Proliferation of nerve fibers in both the suburothelium and smooth muscle has been reported in the bladder from patients with interstitial cystitis but not chronic cystitis (252,253). The suburothelium contains predominantly sensory nerve fibers. Experimental inflammation in rats has...

Infection Viral

Adenovirus is the most common cause of viral pharyngitis. It is a double-stranded DNA virus. Serotypes 3,4, and 7 are frequently associated with viral pharyngitis. It is transmitted by either respiratory droplets or direct contact. School-aged children are most commonly affected. The classic presentation includes fever, sore throat, coryza, and red eyes. Adenovirus is cytolytic to the epithelial cells it invades and induces a localized inflammatory response in the surrounding tissues. Nasopharyngeal swabs can be obtained for viral cultures and a negative monospot test should be confirmed. It is usually self-limiting and lasts five to seven days. Treatment is supportive. Severe morbidity and mortality are rare and only seen in patients with altered immune function. Complications of adenovirus infection include keratoconjunctivitis (pink eye), acute hemorrhagic cystitis nephritis, and gastroenteritis. Ribavirin has been advocated in several case reports when systemic...

Primary infection

Systemic symptoms (malaise, myalgia, and fever) may occur with primary herpetic infections. Local symptoms of pain, dysuria, and soreness of the vulva and vagina are common in both primary and recurrent infections. The lesions of primary infection tends to resolve within 3 weeks without therapy.


Downstream from the kidneys, ifosfamide is well known to cause hemorrhagic cystitis.23 Once established, hemorrhagic cystitis is difficult to treat thus, prevention is important. Aggressive hydration, continuous infusion schedules, and the use of mesna (a sulfhydryl compound that binds the degradation products of ifosfamide within the bladder) have

Invasive Therapy

Celiac Ganglion Level

Sympathetic plexus or ganglion blocks are indicated if pain is predominantly visceral.46 Blocks of the superior hypogastric plexus are intended to relieve pelvic pain due to malignancy or radiation-induced cystitis or enteritis.4748 A network of sympathetic nerves lies anterior to the fifth lumbar vertebral body (Figure 26-2). At that level, it is a retroperitoneal bilateral structure that innervates the pelvic viscera via the hypogastric nerves. The block is performed with the patient in the prone position, and needles are inserted 5 to 7 cm from the midline bilaterally at the level of the L4-L5 spinous interspace. The needles are directed under computed tomography (CT) or fluoroscopic guidance until they reach the position of the plexus (see Figure 26-2, B). A diagnostic or prognostic block can be performed with 6 to 8 mL of 0.25 bupivacaine whereas injection of a neurolytic agent such as alcohol or phenol will give a prolonged block. The sacrococcygeal plexus or ganglion impar can...

Baical skullcap

Historical note Baical skullcap is a TCM herb used to clear 'heat and dry dampness'. Diseases with heat are associated with symptoms such as fever, irritability, thirst, cough and expectoration of thick, yellow sputum. Damp diseases may be associated with diarrhoea, a feeling of heaviness of the chest and painful urination (Bensky & Gamble 1 986). From a modern perspective this suggests that baical may be useful for infection and inflammation of the respiratory, digestive and urinary systems. Scientific investigations have indeed shown that baical skullcap and its constituents have antibacterial, antiviral, antiinflammatory, hepatoprotective and diuretic actions (Zhang etal 2001).