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Urinary Tract Infection
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Urinary Tract Infection

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Transcript

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