Differential Diagnosis for 70-year-old Female with Urostomy and Recent Stent Removal
Single Most Likely Diagnosis
- Urinary Tract Infection (UTI): Given the recent removal of a stent and the presence of a urostomy, the patient is at high risk for developing a UTI. Symptoms such as feeling unwell and nausea, along with a significantly elevated white blood cell count (WBC) of 21, support this diagnosis. The proximity to the stent removal also points towards a possible infection related to the procedure.
Other Likely Diagnoses
- Pyelonephritis: An infection of the kidney, which could be a complication of the UTI, especially if the infection has ascended to the kidneys. The symptoms and elevated WBC count could also be indicative of pyelonephritis.
- Sepsis: Although not exclusively an infection, sepsis could be a consequence of an untreated or severe UTI, especially in an elderly patient with potential comorbidities. The high WBC count and symptoms of feeling unwell could be early signs of sepsis.
- Urostomy Site Infection: Given the presence of a urostomy, there's a risk of infection at the site of the stoma. However, this might present with more localized signs of infection such as redness, swelling, and discharge at the stoma site.
Do Not Miss Diagnoses
- Peritonitis: Although less likely, peritonitis (inflammation of the peritoneum, the thin layer of tissue that lines the abdominal cavity) could occur, especially if there's a leak from the urostomy site or another abdominal source. This condition is life-threatening and requires immediate attention.
- Septic Shock: A severe form of sepsis that can lead to organ failure and death if not promptly treated. Early recognition and intervention are critical.
Rare Diagnoses
- Fungal Infection: While less common than bacterial infections, fungal infections can occur, especially in patients with certain risk factors such as immunosuppression or prolonged use of antibiotics.
- Tuberculosis (TB) of the Urinary Tract: Although rare, TB can affect the urinary tract and might present with similar symptoms. However, this diagnosis would be less likely without specific risk factors or exposure history.
For the management of the most likely diagnosis, Urinary Tract Infection (UTI), IV antibiotics would be the best option. The choice of antibiotic should be guided by local resistance patterns and the patient's specific risk factors. Commonly used IV antibiotics for UTIs include:
- Ceftriaxone: A third-generation cephalosporin effective against a wide range of gram-negative bacteria.
- Cefepime: A fourth-generation cephalosporin with broad-spectrum activity.
- Piperacillin-Tazobactam: A broad-spectrum penicillin combination that covers many gram-negative and some gram-positive bacteria.
- Meropenem: A carbapenem antibiotic with a very broad spectrum of activity, often reserved for more complicated infections or when other options are not suitable.
It's crucial to obtain urine cultures to guide antibiotic therapy and adjust as necessary based on culture and sensitivity results.