A pregnant 23 year old female arrives at her doctor\'s office complaining of fev

Question

A pregnant 23 year old female arrives at her doctor's office complaining of fever, headache, abdominal pain on her left side radiating to her back, dysuria, and hematuria. The doctor ordered a urinalysis with a urine culture and a CBC.

The results of the urinalysis are as follows:

Specific gravity: 1.017

pH: 6.4

Protein: Positive

Glucose: Negative

Ketone: Negative

Bilirubin: Negative

Blood: Positive

Nitrites: Positive

Leukocytes: Positive

White Blood cells casts: Positive

Urobilinogen: .2-10. Her U/dL

All values obtained in the CBC were normal witht the exception of white blood cell values which showed leukocytosis. Once these results were reviewed, the doctor admitted the patient to the hospital for IV antibiotic treatment and fluid hydration. The antibiotics chose for the treatment ar ampicillin and gentamicin. The diagnosis was pyelonephritis

Questions:

1. Why did not the doctor order an x-ray of the patient's urinary system? If an X ray would have been ordered what would it be potentially showing?

2. Why did the doctor order a urinalysis witha urine culture?

3. Why are pregnant women are more at risk for developing urinary tract infections and pyelonephritis?

4. Why did the doctor admit the patient to the hospital instead of sending her home with antiobiotics? Why did he order the use of ampicillin and gentamicin instead of the preffered ciprofloxacin route?

5. Should there be protein in the patient's urine?

6. explain the following urinalysis results:

a. presence of nitrites

b.positive leukocytes

c. white blood cell casts

Explanation / Answer

1. X ray is not ordered because, x ray radiation is very harmful fit the baby inside. Pregnant women urinary bladder is hardly visible in the X ray. Because the growing uterus compresses the bladder.

2. Urinalysis gives a complete picture whereas urine culture helps to identify the bacteria specifically.

3. In pregnancy, immune system is weakened by the elevated corticosteroid and women are more prone to infections.

4. Hematuria is a serious complication in pregnancy. Urinary tract infection can potentially ascend and infect the foetus. Bacterial infection can spread to the blood and cause septic shock and death. Ampicillin and gentamicin act by synergy together. Since the bacteria causing the infection is not known, both the drugs are given. Ampicillin acts against gram positive bacteria and gentamicin act on gram negative bacteria.

5. In a normal healthy person urine doesn't contain urine.

6. A. Presence of nitrites indicate bacterial infection. Bacteria reduce nitrates to nitrites.

B. L eukicytosis indicates bacterial infection

C. White blood cell casts are aggregates of WBC which also indicates infection

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