最新泌尿道感染及损伤GU2h-PPT文档.ppt

Introduction Definition,Pathogen stay and grow in any part of GUT causing inflammation,Defense system in GUT,Normal flora stay in meatal skin and mucosa of urethra, secrete bacteriocin, metabolic products, to suppress the growth of pathogen , compete nutrients Urothelium secrete mucin preventing bacteria adhesion Anti-reflux mechanism,Predisposing factors,Obstructive: as stones, tumor, stricture, BPH Body resistance, hypertension, diabetes, pregnancy, congenital immunodeficiency Iatrogenic: catherterization, cystoscopy Renal parenchyma diseases: renal injury, renal failure, interstitial nephritis Anatomical: female urethra,Pathogen Gram-negative: 85% Bacillus coli Gram-positive: Staphylococcus aureus Chlamydia Mycoplasma,Mode of infection retrograde blood lymph direct,Diagnosis,Clinical features Laboratory investigation Bacterial culture and colony counting: 105/ml,Principles of treatment,Select sensitive antibiotics Use at least two kinds of sensitive antibiotics to avoid production of drug resistant strain Use full dose as early as possible Administer lower nephrotoxin antibiotics,Pyonephrosis,Infection in parenchyma, pelvis or calyces cause broad parenchyma damage, pus accumulated in pelvis and calyces gradually, in the end the kidney becomes a pus containing cyst. It may be caused by bacterial pyelonephritis or specific infection as renal TB,Pyonephrotic kidney:outer surface,Pyonephrosis. The dilated pelvis was filled with pus and abscesses are present in the renal parenchyma and communicate with the pelvis,Diagnosis and treatment,Clinical manifestation are fever, anorexia, anemia, loin mass, tendness in renal region and bladder irritating symptoms when pus goes down along the ureter into the bladder Pus disgorging from ureteral orifice can be seen under cystoscopy when there is no obstruction in upper urinary tract IVU and isotope renogram suggest renal failure Nephrostomy or nephrectomy is needed,Chronic prostatitis,Etiology Bacteria may retrograde into peripheral zone of the prostate when the posterior urethra become infected Non bacterial prostatitis is often related to chlamydia and mycoplasma infection There exists a prostate-blood barrier, it is difficult to control the UTI,Prostatic anatomy,Preprostatic sphincter,Peripheral zone,External sphincter,Transitional zone,trigone,detrusor,urethra,AFMS,Central zone,verumontamun,Symptoms,Irritating symptoms Dysuria Pain in perineum, loin, testis etc. Sexual disorder: premature ejaculation, ED Fever, chill: unusual Neuropsychiatric symptoms,Diagnosis,DRE: a soft and enlarged gland with mild tendness may be felt when prostate is congested Prostatic fluid exam: wbc 10 under high power microscope Prostatic fluid culture Hypoechoic lesion may be seen on TRUS,Treatment,Administer sensitive antibiotics Prostatic massage every week Physical treatment Regular sexuality, abandon alcohol,Acute epididymitis,Etiology Its often complicated with prostatitis, long time catherterization and postoperation of TURP, because pathogen can pass through orifice of ejaculatory duct and result in infection When urine flows retrograde into ejaculatory duct, a chemical epididymitis will occur When there is a repeated epididymitis in children, an ectopic ureteral orifice in seminal vesicle should be suspected,Symptoms and diagnosis,Scrotum ache refers to spermatic cord A rapid epididymis or testis swelling High fever Typical history and symptoms,Treatment,Administer broad spectrum antibiotics Use 33%magnesium sulfate liquid to do wet drssing on scrotum Surgical drainage if abscess developed,TB of the kidney,Introduction Pathology pathological stage clinical stage caseation,Complete destruction of the kidney by tuberculosis,Renal TB. In the bottom right corner of the picture is a granuloma.,Clinical features,Frequency dysuria Hematuria or pyuria Mass Systemic symptoms,Diagnosis,History and clinical features Urine exam Cystoscope X-ray PCR,An advanced middle calyceal lesion, which is shown on retrograde pyelogram,TB cause fibrosis of the calyceal stem, so that the area of the kidney that drains into the diseased calyceal system ceases to function and on urography gives the typical cut-off appearance,Treatment,Medical regimen INH+RFP+EBT Surgical intervention focal cleaning partial nephrectomy nephrectomy ureterocystostomy sigmoid augmentation cystoplasty,Surgical choice,CT scan shows the left kidney is almost destroyed by TB,Nephrectomy,