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Uti project
1. RAJASTHAN VIDYAPEETH HOMOEOPATHIC MEDICAL
COLLEGE AND HOSPITAL,DABOK
DEPARTMENT OF MEDICINE
Session – 2017-2018
Topic – Urinary tract infection
Submitted to:- DR.AEJAZ HUSSAIN SIR
2. DEFINATION
A urinary tract infection is multiplication of
organisms in any part of the urinary tract which
includes the ureters ,bladder , kidney or urethra.
3. TYPES
Complicated
Systemic disorders that
predispose to UTI e.g..
Diabetes ,AIDS.
Abnormal urinary tract
e.g.. Obstruction, calculus
vesicouretic reflex , cystic
kidney, benign prostrate
hypertrophy , neurological
abnormality.
Uncomplicated
Urinary tract is normal
anatomically and
functionally.
Normal renal function
No associated disorder
which impairs defense
mechanism.
5. SOURCE OF INFECTION
Most common – E coli
Community acquired
-E. coli
-Enterobacter
Hospital acquired
-Klebsiella
-S. aureus
-Pseudomonas
6. ROUTES OF SPREAD
Haematogenous
Lymphatic
By direct extension e.g. from vesicocolic fistula.
By ascending transurethral route.
7. PATHOGENESIS
Bacteria enters bladder through urethra. From bladder it
may reach o parenchyma resulting in parenchymal
infections.
Females are more prone to cystitis due to
- Short urethra i.e. 4cms
- Enteric organisms residing near anal region colonize in
periurethral region
- Absence of bactericidal secretions
- Sexual intercourse
Injuries to spinal cord
Associated disorders like diabetic mellitus
8. Susceptibility factor – uroepithelial of these patients have
more surface receptors which adhere to strains of e.coli
become attached.
Pregnancy
-urethral tone is decreased
- urethral peristalsis is decreased
-incompetence of vesicourethral valve
Any blockage to free flow of urine as in stricture, calculus,
BPH etc.
Instrumentation of urinary tract cauterization ,cystosopy,
urethral dilatation.
Vesicoureteric reflex – reflux of urine from bladder to
ureters. There is retro gate spread of bacteria
9.
10. SOME OTHER CAUSES OF UTI
Menopause Estrogen has a protective effect in the
urinary tract, but levels of this hormone drop off
significantly during menopause. Lowest estrogen
levels can make it easier for bacteria to thrive in the
vagina or urethra.
Elders – due to weakening of bladder muscles
-weakened immune system
Diabetes – high blood sugar can spill in urine and
encourage the growth of bacteria.
Also , nerve damage to diabetes can prevent
improper bladder emptying
11. CLINICAL PRESENTATION
•Lower urinary tract infection (affects bladder and/or
urethra):
Fever with chills and rigor
Cloudy urine
The urine may have an unpleasant smell
Hematuria
STRANGURY
Increased frequency and urgency
Discomfort and sometimes pain when urinating
Abdominal pain
Back pain
General malaise; generally feeling unwell
Tenderness around the pelvic area
12. •Upper urinary tract infection (affects kidneys and/or
ureters):
Fever , usually high(atleast38Cor100.4F)
Shivering
Vomiting
Nausea
Diarrhea
Pain on the side(flank),upper back or groin-this may
become more uncomfortable when urinating
13. INVESTIGATIONS
Dip stick test – To detect nitrates and leukocyte esterase.
Culture and sensitivity
Gram staining and bacterial colony count
Rectal examination to assess the prostrate
Cystosopy in suspect bladder lesion
Rectal ultrasonography to identify obstruction , cyst and
calculi.
IVU – intravenous urography
14. TREATMENT
Fluid intake more than 2l/day to increase urine output.
If patient has stone, catheter or other obstruction it should
be removed
Regular complete bladder emptying.
Alkalinisation of urine.
Urinary analgesics and anti spasmodics for detressor
spasm.
In females, maintenance of adequate hygiene, empting of
bladder before and after intercourse.
Double micturation is to be practiced if vesicoureteric reflux
is present.
16. STAPHYSAGRIA
Urging to urinate, has to sit for hours
In young married women, after coition ,after difficult
labor
Burning in urethra when not urinating
Urging and pain after urinating in prostatic troubles
of old men
Prolapse of bladder
Agg – sexual excess , mental affection ,anger
indignation
17. SEPIA
Urine – deposits a reddish clay- cloured sediment
which adheres to the vessel as if it had been
burned on.
Fetid ;so offensive must be removed from the room
Enuresis , bed is wet almost as soon as the child
goes to sleep, always during first sleep
Agg – before thunderstom,
Ame – warmth of bed , violent exercise
18. CANTHARIS VESICATORIA
CONSTANT urging to urinate
Passing a few drops at a time which is mixed wit
blood
Intolerable urging ,before , during and after
urination . Violent pain in bladder
Burning cutting pain in urethra during micturation ,
violent tenasmus
BURNING PAIN AND INTOLERABLE URGING TO
URINATE .
19. APIS MELLIFICA
Incontinene of urine ; with great irritation of the
parts
Can scarcely reatain the urine a moment
When passed scalds severly
Frequent ,painful, scanty & bloody.
Pain burning stinging sore , suddenly migrating
from one part to other.