Jessica Peyton, age 4, began wetting her bed again after being dry at night for

Question

Jessica Peyton, age 4, began wetting her bed again after being dry at night for the past 3 months. She cried when she urinated and was crabby and lethargic. Jessica’s mother had seen these signs before and recognized them as manifestations of yet another urinary tract infection. She took Jessica to a pediatric nurse practitioner who had just opened an office nearby. After taking a thorough health history, the nurse practitioner obtained a urine sample, diagnosed cystitis, and prescribed an antibiotic. She also referred Jessica to a urologist, who discovered that Jessica has vesicoureteral reflux.

Answer the questions about Jessica in the Case Example Activity.

What findings in the urine sample would be characteristic of cystitis

Why would a urinary tract infection cause Jessica to develop nocturnal enuresis?

Why did the nurse practitioner suspect that Jessica had vesicoureteral reflux?

Explain what is vesicoureteral reflux.

Why does vesicoureteral reflux predispose to urinary tract infection?

Explanation / Answer

Cystitis is a disorder that leads to the inflammation of the bladder. The urinary tract infection is the major cause for occurrence of cystitis. One of the most common ways to inspect or find out about cystitis is determining and analyzing the urine sample. The doctor determines if the urine sample has bacteria, blood or pus which helps in detecting the occurrence of cystitis. The determination and presence of leukocytes in the urine is also one of the alarming factors for presence of the cystitis.

Nocturnal Enuresis is urination that occurs at night while sleeping after an age when the person is able to control his or her bladder. An urinary tract infection cause bed wetting sometimes due to high incidence of detrusor instability. UTI is responsible for frequent urination even if the bladder is full. UTI can cause unstable bladder which might lead to involuntary bed wetting.

The urologist detected vesicoureteral reflux as it was found that valve that normally prevents urine from flowing backward from bladder to uterus has a defect. This is the primary vesicoureteral reflux. In the secondary vesicoureteral reflux, due to high pressure generation inside the bladder, it leads to urinary tract malfunction. The bed wetting and the lethargy might be related with the same. It was suggested that she has vesicoureteral reflux as there is frequent passage of urination. It might be a untreated case of vesicoureteral reflux which leads to bed wetting.

Vesicoureteral reflux is majorly a condition or reflux of abnormal flow of urine from the bladder back to the uterus which connects the kidneys to the bladder. This happens due to a defect in the valve that prevents the back flow. It increases the risk of UTI and might lead to eventual damage to the kidney.

The vesicoureteral reflux predispose to urinary tract infection due to defect in the valve which allows the urine to move back to urethra from the bladder. It is because of the bacterial virulence factors and the lack of proper host defense mechanism that leads to the disposal of UTI.

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