泌尿道保健关於泌尿道感染.ppt

泌尿道保健-關於泌尿道感染,慈濟醫院泌尿科陳景亮,腎臟,輸尿管,膀胱,泌尿道,泌尿道感染,最常見於：生育年齡的女性，懷孕婦女、男士前列腺增大、上廁所的習慣差劣、患有糖尿病或患有鐮刀型紅血球疾病的人士罹患泌尿道感染的風險也較高。嬰兒、小孩（小於六歲）和小於50歲男性極少出現泌尿道感染，如有則通常和泌尿道結構畸型（膀胱逆流、尿路阻塞）有關。下泌尿道感染（lowerurinarytractinfections）和膀胱炎的主因通常是細菌通過尿道進入，但上泌尿道感染（upperurinarytractinfections）如腎盂腎炎則不然。上泌尿道感染的主因可能是血原性（hematogenous）的。,Definitions(定義),Bacteriuria(菌尿症)-bacteriainurinePyuria(膿尿症)-WBCsinurineUncomplicated-healthypatientwithastructurallyandfunctionallynormalurinarytract.Complicated-obstruction,anatomicorfunctionaldisorder,calculi,instrumentation,incontinence,pregnancy.Unresolvedbacteriuria-resistence,multipleorganisms,rapidreinfection,azotemia,papillarynecrosis,infectedstonesorforeignbody,patientnoncomplianceRecurrentinfection-persistenceorreinfection,Pathogenesis(1),Ascendinginfection-mostcommonHematogenousspread-immunocompromisedandneonates-uncommonexceptStaphylococcus,CandidaandTBLymphatogenousspread-littleevidence,iatrogenic?Directextension-intraperitonealabscess,vesicointestinalorV-Vfistula,Pathogenesis(2),Hostfactor-Anatomicorfunctionalabnormalities-SecretionofIL-8fromrenalcellsmayparticipateintheinitiationandmaintenanceofrenalinflammation.-Increaseadherenceduetomorereceptors-ChangeofpHorestrogenlevels,ZnBacterialfactors-UropathogenicE.coli(O,K,H)havepili(type1,P)andhemolysin,resistanttoserumbactericidalactivity,Pathogenesis(3),Causativepathogens-aerobicEscherichiacoli(80%),Proteusmirabilis,KlebsiellaStaphylococci,Pseudomonas(nosocomial)-anaerobicbacteria(suppurativeinfections)Bacteroidesfragilis,ClostridiumperfringensDiabetesmorelikelycausedbyKlebsiella,groupBstreptococciS.saprophyticuscausingapproximately10%ofsymptomaticlowerUTIsinyoung,sexuallyactivefemales,膀胱感染的症狀,尿急（urinaryurgency）尿頻（urinaryfrequency），並且在只有少量尿液時仍覺得需要排尿（urinate）夜尿（nocturia）：需要在夜間排尿。尿道炎（urethritis）：排尿時尿道口感到不適或疼痛，或是整個尿道有燒灼感排尿困難（dysuria）膿尿（pyuria）：尿液含膿或尿道排膿血尿：尿中帶血發燒：輕微發燒尿液臭和混濁小便失禁（urinaryincontinence）,腎臟感染的症狀,尿液檢查可能正常!,腎臟感染的症狀,噁心嘔吐背痛（backpain）、腰痛（flankpain）或腹股溝疼痛（groinpain）腹痛（Abdominalpain）KnockingpainatCVangleShakingchillsandhighspikingfever睡覺時出汗極度疲勞,Diagnosis,UrineCollectionmidstreamurinecollectionurethralcatheterizationsuprapubicaspirationLocalizationstudyUrinalysisPyuria-5WBC/HPF(M),20WBC/HPF(F)PyuriamaybepresentintheabsenceofUTI(25%)Sterilepyuria-antibioticeffect,atypicalorganisms,tumor,stonesDipsticktestsforbacteriuria(nitrite)orpyuria(leukocyteesterase)lesssensitiveUrineculture-105CFU/ml,婦女泌尿道感染的診斷,E.Coliinurineanalysis,腎膿瘍,Kidneyinfection,Acutepyelonephritisinflammationofkidneyandrenalpelvis,diagnosismadeclinicallyPresentations-chills,fever,andcostovertebralangletendernessCTscan:perfusiondefects(segmental,multifocalordiffuse),renalenlargementTx:parenteralantibioticsfor7-10daysthenoralantibioticsfor10-14days,Kidneyinfection,ChronicPyelonephritisRepeatrenalinfection-renalscarring,atrophyandrenalinsufficiency.Referstoradiologicfindingsofthesmall,contracted,atrophickidney,focalcoarseCorrectunderlyingproblems,prophylacticantibioticsRemovalifhypertensionornonfunctionwithstoneburden,Kidneyinfection,EmphysematousPyelonephritisacutenecrotizinginfectioncausedbygas-forminguropathogens(E.coli,Klebsiella)80-90%haveDMKUBandCT:gaspresentationPoorprognosis:CRE,Platelet,renal/perirenalfluidinassociationwithabubble/loculatedgas,gasincollectingsystemTx:Drainagecombinationwithmedicaltreatment,Kidneyinfection,RenalAbscessRenal/Perinephric/ParanephricabscessMosthematogenousspreadbeforebutnowE.colimorecommonUltrasonography:echo-freeorlowecho-densityspace-occupyinglesionCT:hypodnesity-fluidcollectionwithrimenhancementTx:empirictherapyplusaminoglycosideor3rd-generationcephalosporinPercutaneousdrainageisindicatediftreatmentfailure,Kidneyinfection,XanthogranulomatousPyelonephritis黃色肉芽腎盂腎炎rare,severe,chronicinfectiondiffuserenaldestruction.Lipidladenmacrophages,mistakenforRCCMostunilateral,nonfunctioning,enlargedkidneyassociatedwithobstructiveuropathysecondarytonephrolithiasis.CT:largeheterogenous,reniformmasswithcentralcalcificationNephrectomy,居家保健,多