Friday, September 11, 2009

Helen Sipuel Huggins had surgery 8-30-09

Tana visited with her Dr.... who saw her at Mercy from a distance. Asked about mother... Urosepsis (Any doubt I Love Learning Medicine!) see below. . . . .

Pyelonephritis is an ascending urinary tract infection that has reached the pyelum (pelvis) of the kidney (nephros in Greek). If the infection is severe, the term "urosepsis" is used interchangeably - - - - sepsis being a systemic inflammatory response syndrome due to infection aka SIRS is recognized as the first event in a cascade to multi-organ failure. Mortality is considerably increased when severe sepsis or septic shock are present, though the prognosis of urosepsis is globally better than sepsis due to other infectious sites.

/uro·sep·sis/ (u″ro-sep´sis) Urosepsis accounts for approximately 25% of all sepsis cases and may develop from a community or nosocomial acquired urinary tract infection

It requires antibiotics as therapy, and treatment of any underlying causes to prevent recurrence. It is a form of nephritis

SYMPTOMS: dysuria (painful voiding of urine), abdominal pain (radiating to the back on the affected side) and tenderness of the bladder area and the side of the involved kidney

CAUSES: Most cases of "community-acquired" pyelonephritis are due to bowel organisms that enter the urinary tract. Common organisms are E. coli (70-80%) and Enterococcus faecalis. Hospital-acquired infections may be due to coliforms and enterococci, as well as other organisms uncommon in the community (e.g. Klebsiella spp., Pseudomonas aeruginosa).

Most cases of pyelonephritis start off as lower urinary tract infections, mainly cystitis and prostatitis.

TREATMENT: All acute cases with spiking fevers and leukocytosis should be admitted to the hospital for IV fluids hydration and IV antibiotic treatment immediately. ciprofloxacin IV 400mg every 12 hours is the first line treatment of choice. Alternatively, ampicillin IV 2g every 6 hours plus gentamicin IV 1mg/kg every 8 hours also provide excellent coverage.

If the patient is unwell and septic, intravenous fluids may be administered to compensate for the reduced oral intake, insensible losses (due to the raised temperature) and vasodilation and to maximize urine output.

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