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LN, a 26-year-old married woman, complains of dysuria, frequency, and urgency lasting two days. She also has a three-year medical history of "bladder infections," implying recurrent urinary tract infection (UTI) with probable underlying disease. In accordance with this, I would seek more information on other related symptoms such as hematuria, incontinence, or obstructive symptoms such as intermittent pee flow. I would inquire further about her past medical history, particularly the indication for the IV pyelography and cystogram performed 5 years ago, as well as whether she had a history of renal calculi or previous admissions during childhood years related with renal abnormalities. I would also enquire about the possibility of pregnancy and do a urine dipstick test. Family history would also be important keeping in mind that some renal structural abnormalities are inherited.
The working diagnosis for LN is acute recurrent urinary tract infection. The supporting symptoms include dysuria, frequency and urgency. She also has a history of previous “bladder infections” that was treated with antibiotics. The absence of gynecology symptoms is important to rule in urinary tract infection. (Dason, Dason, & Kapoor, 2011).
Her treatment plan includes advice on attention to female hygiene, post-coital micturition and adequate fluid intake. First line antibiotics such as trimetroprim and nitrofurantoin can be started as treatment. (Colgan & Williams, 2011). Prophylactic treatment such as post-coital or self start antibiotics prophylaxis can also be recommended if LN experiences UTI symptoms and is confident with her self-diagnosis. (Dason et al, 2011).
I would recommend follow up with a few diagnostic options to find the cause of LN’s recurrent UTI such as cystoscopy to look for anatomic abnormalities such as cystocoele and diverticulum. Following the outcome of this, a CT urography can be discussed to look for further abnormalities up the ureter and kidneys such as renal scarring. (Michels & Sands, 2015). If the patient is found pregnant, a specialist referral is indicated for LN.
Colgan, R., & Williams, M. (2011). Diagnosis and Treatment of Acute Uncomplicated Cystitis. American Family Physician, 84(7), 771-776.
Dason, S., Dason, J.T., & Kapoor, A. (2011). Guidelines for the Diagnosis and Management of Recurrent Urinary Tract Infection in Women. Canadian Urological Association Journal, 5(5), 316-322.
Michels, T.C., & Sands, J.E. (2015). Dysuria: Evaluation and Differential Diagnosis in Adults. American Family Physician, 92(9), 778-788.
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