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Infections of the urinary tract
1.
2.
3. Urinary tract infections (UTIs) are the
infections caused by pathogenic
microorganisms in the urinary tract with or
without signs and symptoms lower urinary
symptoms may predominate at the bladder or
urethra
4. infections involving the upper urinary truct
acute or chronic pyelonephritis (inflammation
of the renal pelvis)
interstitial nephritis (inflammation of the
kidney)
renal abscesses
5. bacterial cystitis (inflammation of the urinary
bladder)
bacterial prostatitis (inflammation of the
prostate gland),
bacterial urethritis (inflammation of the
urethra).
6. uncomplicated
community acquired
complicated,
occurs in people with urologic abnormalities
occurs due to recent catheterisation
nosocomial
7. pyelonephritis -inflammation of renal
parenchyma
cystitis - inflammation of bladder wall
urethritis - inflammation of urethra
urosepsis -UTI spread into systemic
circulation
8. The incidence rises to 50% in women over
the age of 80 .A UTI is one of the most
common reasons patients seek healthcare.
Most cases occur in women, with one of every
five women
9. Epidemiologically, UTIs are subdivided into
catheter associated(or nosocomial) infections
and non-catheter-associate(orcommunity
acquired)infection symptomatic or
asymptomatic
10. Many different microorganisms can infect the
urinary tract,but the most common agents
are the gram-negative bacilli. Escherichiacoli
causes 80% of acute infections in patients
without catheters,urologic abnormalities, or
calculi. Other gram-negative rods, especially
Proteus and Klebsiella and occasionally
Enterobacter,staphylococcus aureus,shigella
,proteus etc
11. the physical barrier of the urethra,
urine flow,
ureterovesical junction competence,
various antibacterial enzymes
antibodies,
anti adherent effects mediated by the
mucosal cells
12. For infection to occur, bacteria must gain
access to the bladder, attach to it and
colonize the epithelium of the urinary tract to
avoid being washed out with voiding, evade
host defence mechanisms, and initiate
inflammation. Most UTIs result from focal
organisms that ascend from the perineum to
the urethra and the bladder and then adhere
to the mucosal surfaces
13. increasing the normal slow
shedding of bladder epithelial cells
Glycosaminoglycan (GAG)
The normal bacterial flora of the vagina and
urethra
Urinary immunoglobulin (IgA)
14. Urethrovesicalreflux- which is the reflux
(backward flow) of urine from the urethra into
the bladder With coughing, sneezing, or
straining, the bladder pressure rises, which
may force urine from the bladder into the
urethra. When the pressure returns to normal,
the urine flows back into the bladder,
15. Bacteriuria is generally defined as more than 105
colonies of bacteria per millilitre of urine.
Because urine samples (especially in women) are
commonly contaminated by the bacteria normally
present in the urethral area, a bacterial count
exceeding105 colonies/mL of clean-catch
midstream urine is the measure that
distinguishes true bacteriuria from
contamination. In men, contamination of the
collected urine sample occurs less frequently;
hence, bacteriuria can be defined as 104
colonies/mL urine
16. Infection can ascend up the urethra (ascending
infection),
through the blood stream, (haematogenous spread),
By means of a fistula
colonize the periurethral area and subsequently enter
the bladder by means of the urethra.
In women, the short urethra offers little resistance to
the movement of uro pathogenic bacteria.
Sexual intercourse .
(haematogenous spread) from a distant site of
infection
. through direct extension by way of a fistula from
the intestinal
17. no symptoms.
pain at the urethra
burning on urination,
frequency, urgency
nocturia,incontinence
suprapubic or pelvic pain.
Hematuria and back pain may also be present.
In older individuals, these typical symptoms are
seldom noticed
Signs and symptoms of upper UTI (pyelonephritis)
include fever, chills,
flank or low back pain, nausea and vomiting,
headache,
malaise, and painful urination.
18. 1. Physical examination
2. pain and tenderness in the area of the
costovertebral angles
3. urine dipstick may react positively for blood
,white blood cells nitrates
4. indicating infection
5. urine microscopy shows red blood cells and
many white blood cells per field
6. without epithelial cells
7. urine culture is used to detect presence of
bacteria and for antimicrobial
8. sensitivity testing
9. USG and CT studies
19. . A colony count of at least 105 colony-
forming units (CFU) per millilitre of urine on
clean-catch midstream or catheterized
specimen is a major criterion for infection
About one third of women with symptoms of
acute infections have negative midstream
20. Microscopic Hematuria (greater than 4 red
blood cells [RBCs] per high- powerfield
Pyuria (greater than 4 white blood cells
[WBCs] per high-power field)
27. 1. Acute pain related to inflammation and
infection of the urethra, bladder, and other
urinary tract structures as evidenced by
positive urine culture results
2. Deficient knowledge related to factors
predisposing the patientto infection and
recurrence, detection and prevention of
recurrence, and pharmacologic therapy
28. relieving pain
monitoring and managing potential
complications
measures to prevent catheter associated
infection
promoting home and community-based care
teaching patients self-care
31. Transitional cell (urothelial) carcinoma
Urothelial cells also line other parts of the
urinary tract, such as the lining of the kidney
(called the renal pelvis), the ureters, and the
urethra, so transitional cell cancers can also
occur in these places. In fact, patients with
bladder cancer sometimes have other tumors
in the lining of the kidneys, ureters, or
urethra. If someone has a cancer in one part
of their urinary system, the entire urinary
tract needs to be checked for tumors
32. Non-invasive bladder cancers are still in the
inner layer of cells (the transitional
epithelium) but have not grown into the
deeper layers.
Invasive cancers grow into the lamina propria
or even deeper into the muscle layer.
Invasive cancers are more likely to spread
and are harder to treat.
33. Papillary carcinomas
They grow in slender, finger-like projections
from the inner surface of the bladder toward the
hollow center. Papillary tumors often grow
toward the center of the bladder without growing
into the deeper bladder layers. These tumors are
called non invasive papillary cancers. Very low-
grade, non-invasive papillary cancer is
sometimes called papillary neoplasm of low-
malignant potential and tends to have a very
good outcome.
34. Flat carcinomas
They do not grow toward the hollow part of
the bladder at all. If a flat tumor is only in the
inner layer of bladder cells, it is known as a
non-invasive flat carcinoma or a flat
carcinoma in situ (CIS).If either a papillary or
flat tumor grows into deeper layers of the
bladder, it is called an invasive transitional
cell (or urothelial) carcinoma.
35. Cigerette smoking
Exposure with chemical dyes
Exposure with cytoxan
Radiation therapy
Chronic irritation of the bladder
Excessive use of phenacetin
36. The tumour usually starts in the epithelium of
the inner bladder the tumour gradualy
invades the muscular layer followed by serous
layer at his stage their can be local lymph
node involvement the next stage is extensive
local spread tumour can spread to
peritoneum prostate ,or uterus in females
,patient will present with haemorrhagic
symptoms and tumour related pressure effect
. the next stage is distant metastasis in which
tumour spreads to bones lungs ,brain etc
37. Painless Hematuria ,either gross or
microscopic
Dysuria
Frequency
Urgency
Pelvic flank pain
Leg oedema
38. 1. cystoscopy
2. bladder washed cytology
3. urine for flow cytometry
4. IVP
5. MRI scan
6. Chest x ray
7. excretory urography,
8. CT scan,
9. ultrasonography,
10. bimanual examination
11. Biopsies of the tumour and adjacent mucus
40. American Joint Committee on Cancer
Also called the TNM system.
41. T category( tumour )
letter T is followed by numbers and/or
letters to describe how far the main (primary)
tumor has grown through the bladder wall
and whether it has grown into nearby tissues.
Higher T numbers mean more extensive
growth.
42. N category( node )
The letter N is followed by a number from 0
to 3 to indicate any cancer spread to lymph
nodes near the bladder. Lymph nodes are
bean-sized collections of immune system
cells,
to which cancers often spread first.
43. M category (metastasis)
The letter M is followed by 0 or 1 to indicate
whether or not the cancer has spread
(metastasized) to distant sites, such as other
organs or lymph nodes that are not near the
bladder.
44. Has minimal role, concentrates on symptom
management and supportive in nature
Treatment of bladder cancer depends on the
grade of the tumour
45. T categories for bladder cancer
The T category describes the main tumor. of
TX: Main tumor cannot be assessed due to
lack of information
T0: No evidence of a primary tumor
Ta: Non-invasive papillary carcinoma
Tis: Non-invasive flat carcinoma (flat
carcinoma in situ, or CIS)
46. T1: The tumor has grown from the layer of
cells lining the bladder into the connective
tissue
below. It has not grown into the muscle layer
of the bladder.
T2: The tumor has grown into the muscle
layer.
T2a: The tumor has grown only into the inner
half of the muscle layer.
T2b: The tumor has grown into the outer half
of the muscle layer
47. T3: The tumor has grown through the muscle
layer of the bladder and into the fatty tissue
layer that surrounds it.
T3a: The spread to fatty tissue can only be
seen by using a microscope.
T3b: The spread to fatty tissue is large
enough to be seen on imaging tests or to be
seen
or felt by the surgeon.
48. T4: The tumor has spread beyond the fatty tissue
and into nearby organs or structures. It may
be growing into any of the following: the stroma
(main tissue) of the prostate, the seminal
vesicles, uterus, vagina, pelvic wall, or abdominal
wall.
T4a: The tumor has spread to the stroma of the
prostate (in men), or to the uterus and/or
vagina (in women).
T4b: The tumor has spread to the pelvic wall or
the abdominal wall
49. NX: Regional lymph nodes cannot be
assessed due to lack of information.
N0: There is no regional lymph node spread.
N1: The cancer has spread to a single lymph
node in the true pelvis.
N2: The cancer has spread to 2 or more
lymph nodes in the true pelvis.
N3: The cancer has spread to lymph nodes
along the common iliac artery.
50. M0: There are no signs of distant spread.
M1: The cancer has spread to distant parts of
the body
51. cystoscopy
bladder washed cytology
urine for flow cytometry
IVP
MRI scan
Chest x ray
excretory urography,
CT scan,
ultrasonography,
◦ bimanual examination
◦ Biopsies of the tumour and adjacent mucus
53. methotrexate, 5 fluorouracil,vinblastine,
doxorubicin (Adriamycin), and cisplatin
gemcitabine and the taxanes
Topical chemotherapy-thiotepa, doxorubicin
mitomycin, ethoglucid, and BCG) to the tumor
to promote tumor destruction.
54. Radiation of the tumour may be performed
preoperatively to reduce micro extension of
the neoplasm and viability of tumour cells
thus reducing the chances that the cancer
may recur in the immediate area or spread
through the circulatory or lymphatic systems
56. The use of photodynamic techniques in
treating superficial bladder cancer is under
investigation. This procedure involves
systemic injection of a photosensitizing
material (hematoporphyrin), which the cancer
cell picks up. A laser-generated light then
changes the hematoporphyrin in the cancer
cell into a toxic medication. This process is
being investigated for patients in whom
Intravesicalchemotherapy or immunotherapy
has failed
57. Ileal Conduit (Ileal Loop)
The Ileal conduit, the oldest of the urinary diversion
procedures ,is considered the gold standard because
of the low number of complications and surgeons’
familiarity with the procedure. In an Ileal conduit, the
urine is diverted by implanting the ureter into a 12-
cm loop of ileum that is led out through the
abdominal wall
Utreostomy
Directing ureters into skin
Nephrostomy
Urine to drainage bag directly through a catheter
58. Continent Ileal Urinary Reservoir
(Indiana Pouch)
The most common continent urinary diversion is the
Indiana pouch, created for patients whose bladder is
removed or can no longer function (neurogenic bladder).
The Indiana pouch uses a segment of the ileum and cecum
to form the reservoir for urine The ureters are tunnelled
through the muscular bands of the intestinal pouch and
anastomosed. The reservoir is made continent by
narrowing the dfferent portion of the ileum and sewing the
terminal ileum to the subcutaneous tissue, forming a
continent stoma flush with the skin. The pouch is sewn to
the anterior abdominal wall around a cecostomy tube.
Urine can collect in the pouch until a catheter is inserted
and the urine is drained.
59. Ureterosigmoidostomy, another form of
continent urinary diversion,
is an implantation of the ureters into the
sigmoid colon It is usually performed in
patients who have had extensive pelvic
irradiation, previous small bowel resection, or
coexisting small bowel disease.
60. Anxiety related to anticipated losses
associated with the surgical procedure
Imbalanced nutrition, less than body
requirements related to inadequate
nutritional intake
Deficient knowledge about the surgical
procedure and postoperative care
61. RELIEVING ANXIETY
ENSURING ADEQUATE NUTRITION
EXPLAINING SURGERY AND ITS EFFECTS
