Urinary Tract Infection


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Urinary Tract Infection

  1. 1. Disorders of Urinary System
  2. 2. Organs of Urinary Tract <ul><li>Upper urinary tract </li></ul><ul><li>Male urethra </li></ul><ul><li>Female Urethra </li></ul>
  3. 3. Aetiology <ul><li>UTI is most common reason patients seek health care </li></ul><ul><li>Occur mainly in women – 1 in 5 will develop a UTI in a lifetime </li></ul><ul><li>Urinary tract most common site of nosocomial infection (instrumentation of urinary tract or catheterization </li></ul><ul><li>Urinary tract calculi and bladder cancer more common in non-Maori </li></ul>
  4. 4. Classification of UTIs according to Location <ul><li>Lower UTI </li></ul><ul><li>Cystitis, prostatitis, urethritis </li></ul><ul><li>Upper UTI </li></ul><ul><li>Acute pyelonephritis, chronic pyelonephritis, renal abscess, perineal abscess </li></ul>
  5. 5. Sites of Infectious Processes in Urinary Tract
  6. 6. Common Micro-organisms Causing UTI <ul><li>Escherichia coli – most common pathogen (80% of cases in persons who do not have urinary tract structural abnormalities or calculi) </li></ul><ul><li>Fungal and parasitic infections uncommon but can occur in the immunosuppressed, diabetics or those undergoing multiple courses of antibiotics </li></ul>
  7. 7. Lower UTIs <ul><li>Several mechanisms maintain sterility of bladder </li></ul><ul><li>physical barrier of urethra </li></ul><ul><li>urine flow </li></ul><ul><li>Uretero-vesical junction competence various </li></ul><ul><li>antibacterial enzymes </li></ul><ul><li>antibodies </li></ul>
  8. 8. Predisposing Factors <ul><li>Factors increasing urinary stasis </li></ul><ul><li>Foreign bodies </li></ul><ul><li>Anatomical factors </li></ul><ul><li>Factors compromising immune response </li></ul><ul><li>Functional disorders </li></ul>
  9. 9. Factors Increasing Urinary Stasis <ul><li>Intrinsic obstruction (stone, tumour of urinary tract) </li></ul><ul><li>Extrinsic obstruction (tumour, fibrosis compressing urinary tract) </li></ul><ul><li>Urinary retention (including neuro-genic bladder and low bladder wall compliance) </li></ul>
  10. 10. Foreign Bodies <ul><li>Urinary calculi </li></ul><ul><li>Indwelling catheter </li></ul><ul><li>Ureteral stent </li></ul>
  11. 11. Urinary Tract Calculi <ul><li>Calculu s – stone </li></ul><ul><li>Lithiasis – stone formation </li></ul><ul><li>Occur more frequently in men </li></ul><ul><li>Incidence higher in persons with family history of stone formation </li></ul><ul><li>Occur more frequently in summer months (associated with dehydration) </li></ul>
  12. 12. Pathophysiology <ul><li>Many theories as to cause </li></ul><ul><li>Crystals, when in supersaturated concentration, can precipitate & unite to form a stone </li></ul><ul><li>Some genetic factors </li></ul>
  13. 13. Risk Factors <ul><li>Abnormalities that result in ↑ urine levels of calcium, oxaluric acid, uric acid or citris acid </li></ul><ul><li>Warm climate that causes ↑ fluid loss, low urine volume & increased solute concentration in urine </li></ul><ul><li>Large amts dietary proteins -> ↑ uric acid secretion </li></ul><ul><li>Excessive amts tea or fruit juices (elevate urinary oxalate level) </li></ul><ul><li>Low fluid intake that ↑ urinary concentration </li></ul><ul><li>Family history of stones or gout </li></ul><ul><li>Sedentary lifestyle or immobility </li></ul>
  14. 14. Urinary Calculi
  15. 15. Clinical Manifestations <ul><li>Apparent when urinary flow obstructed </li></ul><ul><li>Severe abdominal or flank pain (pain usually determined by location of stone) </li></ul><ul><li>Haematuria </li></ul><ul><li>Renal colic </li></ul><ul><li>Nausea & vomiting </li></ul>
  16. 16. Location of Calculi in Urinary Tract
  17. 17. Ureteric Stent
  18. 18. Anatomical Factors <ul><li>Congenital defects leading to obstruction or urinary stasis </li></ul><ul><li>Ectopia (abnormal opening) exposing urinary stream to skin, vagina, or faecal stream </li></ul><ul><li>Shorter female urethra </li></ul>
  19. 19. Factors Compromising Immune Response <ul><li>HIV </li></ul><ul><li>Diabetes mellitus </li></ul>
  20. 20. Functional Disorders <ul><li>Constipation </li></ul><ul><li>Voiding dysfunction with detrusor sphincter dyssynergia </li></ul>
  21. 21. Urinary Tract Infections <ul><li>Organisms are usually introduced via the ascending route from the urethra </li></ul><ul><li>May be introduced via bloodstream or lymphatic system </li></ul><ul><li>Most infections due to Gram-negative bacilli normally found in the GI tract </li></ul><ul><li>Common factor contributing to ascending infection is urological instrumentation </li></ul><ul><li>Sexual intercourse allows bacteria to travel from vagina to the perineum & may cause minor urethral trauma </li></ul>
  22. 22. Clinical Manifestations <ul><li>Dysuria </li></ul><ul><li>Frequent urination (more often than every 2 hrs) </li></ul><ul><li>Urgency </li></ul><ul><li>Suprapubic discomfort or pressure </li></ul><ul><li>Haematuria </li></ul><ul><li>Cloudy urine (sediment) </li></ul><ul><li>Flank pain, chills & fever indicate upper UTI - pyelonephritis </li></ul>