Management of UTI and obstructive jaundice. Diagnosis. Treatment. Patient counseling.

1. CASE STUDY ON
UTI &OBSTRUCTIVE
JAUNDICE
PREPARED BY
RAJESH KUMAR DUTTA
PHARMD IV YEAR

2. DEFINATION
 A urinary tract infection (UTI) is an infection in any part of your
urinary system — your kidneys, ureters, bladder and urethra. Most
infections involve the lower urinary tract — the bladder and the
urethra
 Obstructive jaundice is a condition in which there is blockage of
the flow of bile out of the liver. This results in redirection of excess
bile and its by-products into the blood, and bile excretion from the
body is incomplete

4. PATIENT DEMOGRAPHIC DETAILS
 Name : XX
 Age :63yrs
 Sex :Female
 DOA :2-03-20
 Height :159cm
 Weight :55kg

5. CHIEF COMPLAINTS
C/O Abdominal pain at right hypochondriac x 3 days
region
c/o yellowish discoloration of urine
C/O Burning micturition x 4 DAYS
Past medical history
K/C/O Diabetes mellitus x 3 years
Past medication history
Tab. Metformin 500mg 1-0-1

6. OBJECTIVE
VITALS SIGNS

7. PHYSICAL EXAMINATION
 EYE :Normal
 CVS :S1S2 +
 RS :NVBS
 CNS :NFND

8. LABORATORY INVESTIGATION
parameter Observed value Normal value
Total WBC
count(cells/cm)
17,100 4500-11000
PCV 36.6% 38-45%
MCH (pg) 23.3 27-32
NEUTROPHILLS 81% 40-65%
LYMPHOCYTES 14% 30-50%
ESR 1 hr (mm) 44 2-15
Department of hematology

9. Parameter Observed value Normal value
RBS (mg/dl) 196 100-146
FBS (mg/dl) 235 70-110
Post prandial blood sugar
(mg/dl)
294 100-140
Pre lunch (mg/dl) 156 100-140
Pre dinner (mg/dl) 267 100-140

10.  Department of biochemistry
parameter Observed value Normal value
Blood glucose (mg/dl) 239 70-150
Amylase (u/l) 210.8 25-110
Lipase (u/l) 155.3 Up to 64

11. parameter Observed value Normal value
Bilirubin direct (mg/dl) 0.61 0.1-0.4
Bilirubin indirect (mg/dl) 1.68 0.1-0.9
SGOT (U/L) 108.81 5-40
SGPT (U/L) 91.71 5-40
S Alkaline phosphatase (U/L) 195.01 53-128

12. Department of clinical pathology
Urine examination
Physical examination
Colour : pale yellow
Appearance :slightly turbid
PH :5.5
Reaction : acidic
Chemical examination
Albumin : present
Sugar : present
Bile salt : absent

13. Bile pigment : absent
Microscopical examination
Pus cells : plenty
Epithelial cells : 3-4 cells
Bacteria : present
URINE CULTURE
Organism isolated e coli

14.  M.R CHOLANGIO PANCREATOGRAPHY
 Dilated common bile duct
 Calculus 6-7mm in the distal common bile duct, smaller calculi proximal to
this calculus in the distal duct
 Small calculi with in the gall bladder.

15. ASSESMENT
 Urinary tract infection
 Obstructive Jaundice
 Calculi with in the gall bladder

16. TREATMENT PLAN
Sl
no.
GENERIC NAME DOSE FREQUENC
Y
1 2 3 4
1 Pantaprazole 40 mg 1-0-0-1 * * * *
2 Cefotaxime 1g 1-1-1 * * * *
3 Norfloxacin 400mg 1-0-1 * * * *
4 Butylscopolamine 1 amp 1-1-1 * * * *
5 Ondansetron 4mg 1-1-1 * * * *

17. PATIENT COUNSELLING
 Follow low fat diet
 Reduce the intake of carbohydrates
 Don’t be panic due to yellow colour deposition on skin , it is due to
jaundice .
 Take the medication regularly
 If you are feeling any discomfort , just inform to your doctor.
 Drink plenty of water.
 Take pantoprazole half an hour before food.
 Reduce dairy products.

18. SOAP NOTES
Subjective data
 A 63 years old female patient was admitted to the female medicine ward
 Complaint of abdominal pain at right hypochondriac x 3 days
 Yellowish discoloration of urine
 Burning micturition x 4 days

19. Objective data
 She was good couscious and oriented and stable vitals on admission BP
was elevated.
 EYE :Normal
 CVS :S1S2 +
 RS :NVBS
 CNS :NFND

20. ASSESMENT
 Based on objective and subjective data the patients was diagnosed with
UTI, Obstructive jaundice and calculi with in the gall bladder.
PLAN
 The patient was started on antibiotic therapy like cefotaxime 1mg and
norfloxacin 400 mg for the treatment of UTI
 Pantoprazole 40 mg it is to reduce the Gastric acid.
 Butylascopolamine is act on the smooth muscle of gastrointestinal biliary
and genitourinary tract
 Ondansetron 4 mg it is a antiemetics drug