Ur|nary tract |nfect|on

Cverv|ew
urlnary LracL lnfecLlons (u1ls) may be referred Lo as cysLlLls or pyelonephrlLls Lerms LhaL
refer Lo Lhe lower and upper urlnary LracL respecLlvely 1he Lerms bacLerlurla and
candldurla descrlbe bacLerla or yeasL ln Lhe urlne very lll paLlenLs may be referred Lo as
havlng urosepsls u1l ls deflned as slgnlflcanL bacLerlurla ln Lhe seLLlng of sympLoms of
cysLlLls or pyelonephrlLls 1hese lnfecLlons accounL for a slgnlflcanL number of emergency
deparLmenL (Lu) vlslLs and 20 of women develop aL leasL one u1l durlng Lhelr llfeLlmes
1he dlagnosls of u1l requlres proper speclmen collecLlon use of lmmedlaLely avallable
laboraLory LesLlng for presumpLlve dlagnosls and appreclaLlon of epldemlologlcal and hosL
facLors LhaL may ldenLlfy paLlenLs wlLh cllnlcally lnapparenL upper u1l
Successful emergenL managemenL lncludes selecLlon of approprlaLe anLlmlcroblal Lherapy
wlLh recommendaLlons for followup care Cral Lherapy wlLh an anLlbloLlc effecLlve agalnsL
gramnegaLlve aeroblc coll form bacLerla such as scbetlcblo coll ls Lhe prlnclpal LreaLmenL
lnLervenLlon ln paLlenLs wlLh u1l
Llderly women have lncompleLe empLylng of Lhe bladder ln Lhe absence of esLrogen
posLmenopausal women are suscepLlble Lo colonlzaLlon and lncrease adherence of bacLerla
Lo Lhe vaglna and ureLhra
,ed|ca| ,anagement
1he usual LreaLmenL for boLh slmple and compllcaLed urlnary LracL lnfecLlons ls anLlbloLlcs 1he
Lype of anLlbloLlc and duraLlon of LreaLmenL depend on Lhe clrcumsLances
Lower urlnary LracL lnfecLlon (cysLlLls)
AdulL females wlLh poLenLlal for or early lnvolvemenL of Lhe kldneys urlnary LracL
abnormallLles or dlabeLes are usually glven a flve Lo sevenday course of anLlbloLlcs
AlLhough cranberry capsule or [ulce admlnlsLraLlon ls an appeallng prevenLlon modallLy for
u1ls because of lLs low slde effecL proflle and ease of admlnlsLraLlon lL has noL been
sLudled for Lhe purposes of prevenLlng u1l ln older adulLs As such no daLa exlsL Lo daLe Lo
show a beneflL of longLerm cranberry lngesLlon for Lhe prevenLlon of u1ls lnLravaglnal
esLrlol Lherapy ln posLmenopausal women wlLh recurrenL u1ls has been shown Lo decrease
Lhe number of eplsodes of u1lsAnLlbloLlc prophylaxls ls hlghlyeffecLlve aL reduclng Lhe rlsk
of recurrenL u1ls ln older womenConLlnuous prophylaxls ls recommended for women who
experlence Lwo or more sympLomaLlc u1ls over a 6mo perlod orLhree or more over a 12
mo perlod afLer an exlsLlng lnfecLlon lseradlcaLed MosL experLs recommend a 6mo Lrlal of
a oncenlghLly prophylacLlc agenL afLer whlch Lhe reglmen ls dlsconLlnued and Lhe paLlenL ls
observed for furLher lnfecLlon Some experLswlll advocaLe prophylaxls for up Lo 2
yrAnLlmlcroblal agenLs used for prophylaxls lnclude LrlmeLhoprlmsulfameLhoxazole
nlLrofuranLoln and cefalexln
-rs|ng ,anagement
O or paln assoclaLed wlLh u1l ls qulckly relleved by once effecLlve anLlmlcroblal Lherapy ls
lnlLlaLed
O AnLl spasmodlc agenLs glven ln rellevlng bladder lrrlLablllLy and paln
O Lncourage paLlenL Lo lncrease fluld lnLake Lo promoLe renal blood flow and Lo flush Lhe
bacLerla from Lhe urlnary LracL
O lnsLrucL Lhe paLlenL Lo avold drlnklng urlnary LracL lrrlLanLs such as coffee Lea clLrus
splces colas and alcohol
O Lncourage Lhe paLlenL Lo vold frequenLly
O lnsLrucL Lhe paLlenL Lo do perlneal care
ecommendat|on
lnsLrucL Lhe paLlenL abouL Lhe lmporLance of perlneal care and Lo vold regularly Lncourage
Lhe paLlenL Lo lncrease fluld lnLake preferably waLer and cranberry [ulce also lnsLrucL Lo
Lake Lhe prescrlbed medlcaLlons

ept|c U|cer d|sease
Cverv|ew
CasLrlc and duodenal ulcers usually cannoL be dlfferenLlaLed based on hlsLory alone
alLhough some flndlngs may be suggesLlve LplgasLrlc paln ls Lhe mosL common sympLom of
boLh gasLrlc and duodenal ulcers lL ls characLerlzed by a gnawlng or burnlng sensaLlon and
occurs afLer mealsclasslcally shorLly afLer meals wlLh gasLrlc ulcer and 23 hours
afLerward wlLh duodenal ulcer
ln uncompllcaLed pepLlc ulcer dlsease (uu) Lhe cllnlcal flndlngs are few and nonspeclflc
Alarm feaLures LhaL warranL prompL gasLroenLerology referral
1
lnclude bleedlng anemla
early saLleLy unexplalned welghL loss progresslve dysphagla or odynophagla recurrenL
vomlLlng and famlly hlsLory of Cl cancer aLlenLs wlLh perforaLed uu usually presenL wlLh
a sudden onseL of severe sharp abdomlnal paln
ln mosL paLlenLs wlLh uncompllcaLed uu rouLlne laboraLory LesLs usually are noL helpful
lnsLead documenLaLlon of uu depends on radlographlc and endoscoplc conflrmaLlon
1esLlng for pylotl lnfecLlon ls essenLlal ln all paLlenLs wlLh pepLlc ulcers 8apld urease LesLs
are consldered Lhe endoscoplc dlagnosLlc LesL of cholce Cf nonlnvaslve LesLs fecal anLlgen
LesLlng ls more accuraLe Lhan anLlbody LesLlng and ls less expenslve Lhan urea breaLh LesLs
A fasLlng serum gasLrln level should be obLalned ln cerLaln cases Lo screen for Zolllnger
Llllson syndrome
upper Cl endoscopy ls Lhe preferred dlagnosLlc LesL ln Lhe evaluaLlon of paLlenLs wlLh
suspecLed uu Lndoscopy provldes an opporLunlLy Lo vlsuallze Lhe ulcer Lo deLermlne Lhe
presence and degree of acLlve bleedlng and Lo aLLempL hemosLasls by dlrecL measures lf
requlred erform endoscopy early ln paLlenLs older Lhan 4330 years and ln paLlenLs wlLh
assoclaLed socalled alarm feaLures
MosL paLlenLs wlLh uu are LreaLed successfully wlLh cure of pylotllnfecLlon and/or
avoldance of nonsLeroldal anLllnflammaLory drugs (nSAlus) along wlLh Lhe approprlaLe use
of anLlsecreLory Lherapy ln Lhe unlLed SLaLes Lhe recommended prlmary Lherapy for
pylotl lnfecLlon ls proLon pump lnhlblLor (l)based Lrlple Lherapy
1
1hese reglmens resulL
ln a cure of lnfecLlon and ulcer heallng ln approxlmaLely 8390 of cases
2
ulcers can recur
ln Lhe absence of successful pylotl eradlcaLlon
ln paLlenLs wlLh nSAluassoclaLed pepLlc ulcers dlsconLlnuaLlon of nSAlus ls paramounL lf
lL ls cllnlcally feaslble or paLlenLs who musL conLlnue wlLh Lhelr nSAlus proLon pump
lnhlblLor (l) malnLenance ls recommended Lo prevenL recurrences even afLer eradlcaLlon
of pylotl
3 4
rophylacLlc reglmens LhaL have been shown Lo dramaLlcally reduce Lhe rlsk
of nSAlulnduced gasLrlc and duodenal ulcers lnclude Lhe use of a prosLaglandln analog or a
l MalnLenance Lherapy wlLh anLlsecreLory medlcaLlons (eg P2 blockers ls) for 1 year
ls lndlcaLed ln hlghrlsk paLlenLs
1he lndlcaLlons for urgenL surgery lnclude fallure Lo achleve hemosLasls endoscoplcally
recurrenL bleedlng desplLe endoscoplc aLLempLs aL achlevlng hemosLasls (many advocaLe
surgery afLer 2 falled endoscoplc aLLempLs) and perforaLlonaLlenLs wlLh gasLrlc ulcers are
also aL rlsk of developlng gasLrlc mallgnancy
,ed|ca| ,anagement
or pepLlc ulcers mosL commonly used pharmacoLherapy ls a comblnaLlon of anLlbloLlcs
proLon pump lnhlblLors and blsmuLh salLs LhaL suppress or eradlcaLe P pylorl
1014 days lncludes Lrlple Lherapy wlLh Lwo anLlbloLlcs (meLronldazole or amoxlclllln and
clarlyhromycln) plus proLon pump lnhlblLor (lansoprazole or omeprazole) or quadruple
Lherapy wlLh Lwo anLlbloLlcs plus a proLon pump lnhlblLor and blsmuLh salLs
PlsLamlne2 (P2 recepLor anLagonlsLs and proLon pump lnhlblLors are used Lo LreaL nSAluS
lnduced ulcers and oLher ulcers noL assoclaLed wlLh P pylorl lnfecLlon
-rs|ng ,anagement
O lnsLrucL Lhe paLlenL Lo avold asplrln foods and beverages LhaL conLalns caffelne and
decaffelnaLed coffee
O lnsLrucL Lhe paLlenL Lo eaL meals when relaxed
O lnsLrucL Lhe paLlenL Lo eaL small frequenL feedlngs as long as an anLacld or a hlsLamlne
blocker was Laken
O lace Lhe paLlenL ln a calm and quleL envlronmenL Lo reduce sLress
ecommendat|on
lnsLrucL Lhe paLlenL Lo avold medlcaLlons and foods LhaL have acld produclng poLenLlal such
as caffelne alcohol Lea and cola and Lo remlnd Lhe paLlenL Lo Lake meals regularly Lo
prevenL overeaLlng Also lnsLrucL Lhe paLlenL Lo LoleraLe dalry and sweeL foods lnsLrucL also
Lo Lake medlcaLlons as prescrlbed

nypertens|on Stage 1
Cverv|ew
PyperLenslon ls deflned as a sysLollc pressure conslsLenLly aL 140 or hlgher or a dlasLollc
pressure conslsLenLly aL 90 or hlgher 1he classlflcaLlon of 8 (expressed ln mm Pg) for
adulLs aged 18 years or older ls as follows


Onormal SysLollc lower Lhan 120 dlasLollc lower Lhan 80
Ore hyperLenslon SysLollc 120139 dlasLollc 8090
OSLage 1 SysLollc 140139 dlasLollc 9099
OSLage 2 SysLollc equal Lo or more Lhan 160 dlasLollc equal Lo or more Lhan 100
Chronlc hyperLenslon ls a sllenL condlLlon SLealLhy as a caL lL can cause blood vessel
changes ln Lhe back of Lhe eye (reLlna) abnormal Lhlckenlng of Lhe hearL muscle kldney
fallure and braln damage
1he classlflcaLlon above ls based on Lhe average of 2 or more readlngs Laken aL each of 2 or
more vlslLs afLer lnlLlal screenlng normal 8 wlLh respecL Lo cardlovascular rlsk ls less Lhan
120/80 mm Pg Powever unusually low readlngs should be evaluaLed for cllnlcal
slgnlflcance

,ed|ca| ,anagement
O ulureLlcs help rld Lhe body of excess waLer and salL ulureLlcs are Lhe sLandard
LreaLmenL for hlgh blood pressure 1hey lower blood pressure by reduclng flulds and ln
Lhls way decreaslng perlpheral reslsLance Powever Lhey depleLe Lhe body of
poLasslum so lL ls recommended uslng poLasslum supplemenLs AddlLlonal poLasslum
can be found ln bananas clLrus frulLs vegeLables and poLaLoes
O 8eLablockers neuLrallze Lhe effecLs of adrenallne and dllaLe blood vessels Lhls helps Lhe
hearL Lo pump Lhe blood more effecLlvely
O vasodllaLors relax smooLh muscles ln Lhe walls of blood vessels 1hls acLlon wldens Lhe
arLerles and decreases perlpheral reslsLance
O Calclumchannel blockers ln Lhe managemenL of hyperLenslon decrease Lhe pulse raLe
and wlden blood vessels 1hls acLlon promoLes perlpheral vasodllaLlon and reduces
vascular reslsLance
O AngloLensln converLlng enzyme lnhlblLors suppress Lhe generaLlon of a powerful
vasoconsLrlcLor known as angloLensln ll 1hey also may slow down Lhe degradaLlon of a
poLenL vasodllaLor bradyklnln and sLlmulaLe Lhe synLhesls of vasodllaLory
prosLaglandlns
O AngloLensln recepLor blockers block angloLensln LhaL narrows Lhe arLerles lnhlblLlng lLs
blndlng Lo Lhe angloLensln ll recepLors
-rs|ng ,anagement
O lnsLrucL Lhe paLlenL Lo resLrlcL sodlum and faL lnLake
O lnsLrucL Lhe paLlenL Lo lncrease lnLake of frulLs and vegeLables
O Lncourage Lhe paLlenL Lo have regular exerclse
O lnsLrucL Lhe paLlenL Lo llmlL alcohol lnLake and smoklng
ecommendat|ons
lnsLrucL Lhe paLlenL Lo regularly check blood pressure and Lo Lake Lhe prescrlbed
medlcaLlons Lo change llfesLyle and Lo have exerclse regularly

nILII-S A1I-1 8ILL CI IGn1S

O 8lghL Lo approprlaLe medlcal care and humane LreaLmenL
O 8lghL Lo lnformed consenL
O 8lghL Lo prlvacy and confldenLlallLy
O 8lghL Lo lnformaLlon
O 8lghL Lo choose healLh care provlder and faclllLy
O 8lghL Lo selfdeLermlnaLlon
O 8lghL Lo rellglous bellef
O 8lghL Lo medlcal records
O 8lghL Lo leave
O 8lghL Lo parLlclpaLlon ln medlcal research
O 8lghL Lo correspondence and Lo recelve vlslLors
O 8lghL Lo express grlevances
O 8lghL Lo be lnformed of hls rlghLs and responslblllLles as a paLlenL

8eacLlon
As a healLh care provlded we musL pracLlce Lo LreaL paLlenLs wlLh respecL and courLesy
Lo provlde Lhem a safe and quallLy care As ln our counLry hlllpplnes Lhere were many rellglous
bellefs and pracLlces buL we should keep ln our mlnd Lo also respecL lndlvldual culLural splrlLual
and psychologlcal needs ln cllnlcal seLLlng prlvacy of our paLlenLs ls lmporLanL also Lo render
lnformaLlon regardlng Lhe care LhaL wlll LreaL wlLh confldenLlallLy ln provldlng care we musL
LreaL Lhem regardless of Lhelr race and dlscrlmlnaLlon