Tag: pyelonephritis

Person holding abdomen, appearing in pain, wearing grey sweatshirt

What’s Causing My Abdominal Pain? Common Causes Explained

On By Dr. Scott RennieIn GastrointestinalLeave a comment
shutterstock_152569646Patients who present to the clinic or urgent care with abdominal pain can be some of the most challenging, because of the many different causes.  The job of your primary care or urgent care provider is to determine whether the pain is requiring immediate surgical evaluation. Medical providers must try to determine which patients can safely be observed and their symptoms treated and which patients require further investigation by a specialist such as a surgeon.  This is difficult because abdominal pain is often non-specific and presents with other symptoms very commonly. Triage:  We must urgently investigate abdominal pain in many patients.  Some patients require assessment of their airway, breathing and circulation followed by appropriate resuscitation.   Patients who may need surgery must be transferred to a facility where they can receive that care where appropriate nursing care, laboratory, surgical consultation, and radiology facilities are available. Patients who are having less severe pain or signs on exam may require consultation or referral for further management. Helpful information from patients: 1)   Time course of pain 2)   Location of pain 3)   Radiation of pain 4)   Factors that make the pain worse or better (such as foods or antacids) 5)   Associated symptoms including fever, chills, weight loss, nausea, vomiting, diarrhea, constipation, blood in the stools, jaundice, change in stool or urine color or diameter of the stools. 6)   Past medical history, including history of abdominal surgeries 7)   Family history of bowl disorders 8)   Alcohol intake 9)   Medications – including Tylenol, aspirin, and ibuprofen/aleve 10)  Menstral and contraceptive history in women Surgical abdomen:  Usually defined as a condition with rapidly worsening course without surgical intervention.  Obstructions of the intestines and peritonitis (inflammation/irritation of the inner wall of the abdomen that covers most abdominal organs) are reasons for referral to a surgeon. Sometimes tests will be ordered such as an abdominal radiograph,  CBC, comprehensive metabolic panel with liver enzymes, lipase, a urine analysis and pregnancy test (in women of childbearing potential). Other things we consider in determining the cause of the abdominal pain are the location of the pain and changes in where the pain radiates as well as how rapidly the pain gets worse. Some possible causes of abdominal pain are many – gallstones or gallbladder dysfunction, peptic ulcer, hiatal hernia, pneumonia, heart attack,  pancreatitis, heartburn, lactose intolerance, celiac sprue, pregnancy (including ectopic), endometriosis, sickle cell disease,  appendicitis, ovarian cyst or torsion, UTI, kidney stones, constipation, colitis, diverticulitis, pelvic inflammatory disease, gastroenteritis, intestinal ischemia (decreased blood flow to the intestines), diabetic ketoacidosis, kidney infection, abdominal aortic aneurism, or even trauma. Treatment:  Is tailored to address the cause of the pain.  If no cause can be found at your doctor’s office, the goal is to determine whether it is safe for you to go home with medications to help with the pain, and testing done as an outpatient or whether you need to be transferred to the hospital where further workup can be done immediately.   I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Detailed anatomical diagram of human urinary system with kidneys, ureters, bladder, renal arteries and veins labeled

UTI (Bladder Infection): Common Questions Answered

On By Dr. Scott RennieIn Other Diseases and ConditionsLeave a comment
shutterstock_41100079Patients often come into the urgent care after trying to treat themselves at home for a urinary tract infection (UTI).  Determining if you are having the symptoms of a UTI yourself at home can be confusing and quite challenging.  If the wrong decision is made, and you are not treated appropriately and within the correct time period, complications can result such as progression of the UTI to kidney infection (pyelonephritis) and even to urosepsis which is when bacteria can enter your bloodstream and cause you to become very sick. Bladder infection (also known as cystitis, or UTI) is inflammation of the bladder.  They are common in women, but are very rare in men.  About 20% of all women get at least one bladder infection at some point in their lives.  A man’s chances of getting a UTI increases as he ages due to an increase in prostate size. In elderly patients, bladder infections can be particularly difficult to diagnose.  The symptoms are less specific (such as urinary incontinence or fatigue) and are frequently blamed on aging. Symptoms of bladder infection:  For some patients some or all of these symptoms may be present, and for others, none of these symptoms are present and they still have a UTI.  Symptoms can include urgent need to urinate on a frequent basis, painful urination, burning sensation with urinating, urinary incontinence (uncontrollable loss of urine), low back pain, pain above pubic bone, cloudy colored urine, bloody urine. Causes of bladder infection:  Most are caused by a bacteria called E. coli which usually lives in the intestines.  Women sometimes get bladder infections after sex.  Vaginal intercourse makes it easier for bacteria to reach the bladder through the urethra.  Some women contract the infection – dubbed “honeymoon cystitis” almost always after having sex.  Pregnant women are also more prone to infection due to the bladder being compressed by the growing fetus.  Children who get urinary tract infections should be evaluated for urinary reflux (vesicoureteral reflux or VUR). The bacteria then multiply in the bladder and cause inflammation in the walls of the bladder that may lead to the symptoms described above.  In men, a UTI may be a sign of an obstruction in the urinary tract  which may need investigation. Symptoms of kidney infection (aka pyelonephritis):  Fever, flank pain, nausea, along with the symptoms of UTI. Vesicoureteral reflux (VUR):  In normal kidney-bladder function, urine flows from the kidneys to the bladder.  In children with VUR, the urine also flows backwards, from the bladder up toward the kidneys.  As a result, children with CUR are at risk for kidney infections and may develop kidney damage.  VUR affects about 1 percent of children.  Many children will grow out of their VUR as they get older.  To determine whether your child has VUR, you should ask your doctor.  Testing such as kidney ultrasound other radiological tests may be ordered to evaluate for VUR. Common questions that I get asked:
 I often get asked, “Will my bladder infection go away on it’s own if I drink lots of water/cranberry juice and take over the counter AZO?”  The answer is probably no.  As I mentioned above, there is a risk of developing a kidney infection if the bladder infection is not treated appropriately with antibiotics.
What’s the difference between over the counter AZO and Pyridium that is prescribed by your doctor?  Both contain phenazopyridine, however the prescription comes in a higher strength that is more than double the concentration of the active ingredient. Can taking cranberry juice or extract cure my UTI?  No.  Cranberry has not been shown effective as a treatment for a documented UTI.   There is some human evidence supporting the use of cranberry juice and supplements to PREVENT a UTI, although most available studies are of such poor quality that no clear dosing guidelines are available. Can I get pregnant while taking antibiotics for a UTI?  Yes, many antibiotics interfere with hormone birth control pills or medication.  You should use a backup form of birth control if you are taking antibiotics.   I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.