尿路感染医疗培训课件.ppt

1、本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。vUrinary tract infection(UTI)is the most common of all bacterial infections,affecting humans throughout their life span.vNot only is UTI common,but the range of clinical effects it can produce is exceptionally broad,from acute pyelonephritis with gram-

2、negtive sepsis to asymtomatic bacteriuria.本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。vUTI upper pelvic 肾盂 calyx 肾盏 ureter 输尿管 lower bladder 膀胱 urethra 尿道 pyelonephritis cystitis urethritisvFemale:male 10:1本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。v UTI:a broad term that encompasses both a

3、symptomatic microbial colonization of the urine and symptomatic infection with microbial invasion and inflammation of urinary tract structures.v Acute pyelonephritis(急性肾盂肾炎):a pyogenic,focal infection of the renal parenchyma accompanied by local and systemic symptoms of infection.v Chronic pyeloneph

4、ritis（慢性肾盂肾炎）:the pathologic and radiologic findings of chronic cortical scarrings,tubulointerstitial damage,and deformity of the underlying calyx.本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。v Gram-negtive enterobacteria is most common 95%E.coli大肠杆菌大肠杆菌 60-80%Proteus mirabilis 变形杆菌 Klebsiella sp

5、克雷伯杆菌 Pseudomonas sp 绿脓杆菌(urinary tract instrumentation)Serratia sp 沙雷杆菌v Gram-positive organisms 5-10%Streptococcus faecalis 粪链球菌 Staphylococcus aureus 金黄色葡萄球菌 Staphylococcus albus 白色葡萄球菌v Fungi 真菌v Yeasts 原虫v Viruses 病毒 本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；

6、如有不当之处，请联系网站或本人删除。v Ascending infection Most UTI are believed to occur by the ascending route.urethrabladderureterpelviscalyx parenchymav Hematogenous infection Relatively rare Staphylococcal bacteremia 金葡菌血症v Intestine to kidney by way of lymphatics 盆腔器官炎症 阑尾炎 结肠炎v Direct infection 外伤 肾周器官感染本文档所提供的

7、信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Ascending infection：urethrabladderureterpelviscalyx parenchymaHematogenous infection：circulation parenchyma calyx pelvis本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。v Valve at the junction of ureter and bladder.v The dilution and removal of bacteria in uri

8、ne which occurs with micturition.v The high concentration of urea and low pH in urine restrict the growth of bacteria.v Antibacterial ability of mucosa:secret IgA,IgG.v Prostatic fluid本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。v Obstruction to the flow of urine anywhere from the kidney to ureth

9、ra is well recognized as the most important predisposing cause.v Congenital abnormalities such as polycystic kidney disease 多囊肾,vesicoureteral reflux 膀胱输尿管返流膀胱输尿管返流.v urinary tract instrumentationv Female urethrav Disturbence of immune capacity such as diabetes,anemia,chronic hepatic disease,chronic

10、 kidney disease,tumor and so on.v Inflammation of near areav Other factors本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Macroscopic examination:Mucosa is edematous and congestive,and contain a variable number of abscesses on the capsular surface and on cut sections of the cortex and medulla.Occasi

11、onally,areas of inflammation extend from the cortex into the medulla in the shape of wedge.本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Histologic changes:Tubular epithelial cells are edematous,necrosis and detach from basement membrane.Some tubules are damaged and others are destroyed,many tubul

12、es contain leukocytes.Acute inflammation with polymorphonuclear leukocyte infiltraton may be found.The glomeruli and blood vessels are relatively free of inflammatory changes.本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Macroscopic examination:Parenchymal scarring and underlying caliceal deformit

13、y.The kidneys are frequently irregular,and reduction in size is often unilateral or asymmetrical.The kidney usually has flat-based or U-shaped scars.本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Chronic pyenephritis.Note the irregularly scared kidney,dilated and blunted calices.本文档所提供的信息仅供参考之用，不能作

14、为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Chronic pyenephritisbroad scars in a patient with chronic VUR.本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Histologic changes:increase in interstitial fibrous tissue tubule atrophy and necrosis periglomerular fibrosis本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Acu

15、te pyelonephritis Systemic symptoms:rigors and high fever,often with fatigue,nausea and vomiting,abdominal pain or diarrhea.Local manifestations:Dysuria frequancy,and nocturia.Back and loin pain(with exquisite tenderness on percussion of the costovertebral angle).Urine:Cloudy urine,pyuria.本文档所提供的信息仅

16、供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Chronic pyelonephritis Asymptomatic bacteriuria,dysuria and frequency,vague complaints of flank or abdominal discomfort,and intermittent low-grade fevers.May be divided into the following five types:Recurrent type;Low-grade fever type;Hematuria type;Insidious ty

17、pe;Hypertension type本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。v clinical characteristic of pyelonephritis v Relapse:If bacteriuria recurs with the same pathogen within a short time following cessation of therapy,the recurrence is defined as a relapse.v Reinfection:infection with new organism.本

18、文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。vPapillary necrosisvPerinephric abscessvSepticemiavRenal stone and obstruction本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。vAn uncommon complication in pyenephritis.vOccurs more often in diabetic patients.vPatients sometimes have renal colic with hem

19、aturia due to passage of papillae down the ureter.vThe IVP may show loss of papillae.本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。vrare complication of pyelonephritis,often associated with obstruction to urine flow or DM.vSymptoms and signs:loin pain accentuated by movement,chills and fever,urina

20、ry frequency and dysuria.vUltra-sound,radiation examination help to diagnosis.本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Urinary routine White cells are frequently observed.Detection of leukocyte cas

21、ts is also an indication of involvement of the kidney.hematuira Proteinuria,100000/ml,can be defined significant result.When bacterial count 2gLow molecular protein,usually 2gRenal function Defect of glomerular function Defect of tubular functionRadiological examinationSizes of kidneys are similar,n

22、o deformity and stricture of pelvis and calicesSizes of kidneys are different,with deformity and stricture of pelvis and calices本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Acute pyelonephritisvGeneral treatment:rest in bed,increase fruid intake and so on.vAntibiotic treatment:should start antibi

23、otic therapy immediately after urine collection.Serious patient should be given combined 2 antibiotic drugs and the drug should be given through intravenous route.The antibiotic course usually is 1014 days.本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Chronic pyelonephritisGeneral treatment:vthe m

24、ost important effort should be made to correct the underlying complicating factors such as urinary tract obstruction,congenital abnormality and so on.vRest,fruid intake to increase urine volume is also needed.本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。Chronic pyelonephritisPrinciples of antibiotic treatment including:vcombined antibiotic therapy is usually need.vtreatment course:24 weeks.vcorrect the underlying complicating factors.vthe treatment of acute phase is similar to acute pyelonephritis本文档所提供的信息仅供参考之用，不能作为科学依据，请勿模仿；如有不当之处，请联系网站或本人删除。