泌尿道保健关於泌尿道感染PPT课件.ppt

泌尿道保健 關於泌尿道感染 慈濟醫院泌尿科陳景亮 1 2 腎臟 輸尿管 膀胱 泌尿道 3 4 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 5 6 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 7 Pathogenesis 1 Ascendinginfection mostcommonHematogenousspread immunocompromisedandneonates uncommonexceptStaphylococcus CandidaandTBLymphatogenousspread littleevidence iatrogenic Directextension intraperitonealabscess vesicointestinalorV Vfistula 8 Pathogenesis 2 Hostfactor Anatomicorfunctionalabnormalities SecretionofIL 8fromrenalcellsmayparticipateintheinitiationandmaintenanceofrenalinflammation Increaseadherenceduetomorereceptors ChangeofpHorestrogenlevels ZnBacterialfactors UropathogenicE coli O K H havepili type1 P andhemolysin resistanttoserumbactericidalactivity 9 Pathogenesis 3 Causativepathogens aerobic Escherichiacoli 80 Proteusmirabilis Klebsiella Staphylococci Pseudomonas nosocomial anaerobicbacteria suppurativeinfections Bacteroidesfragilis Clostridiumperfringens DiabetesmorelikelycausedbyKlebsiella groupBstreptococci S saprophyticuscausingapproximately10 ofsymptomaticlowerUTIsinyoung sexuallyactivefemales 10 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 11 腎臟感染的症狀 尿液檢查可能正常 12 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 13 Diagnosis UrineCollectionmidstreamurinecollectionurethralcatheterizationsuprapubicaspirationLocalizationstudyUrinalysisPyuria 5WBC HPF M 20WBC HPF F PyuriamaybepresentintheabsenceofUTI 25 Sterilepyuria antibioticeffect atypicalorganisms tumor stonesDipsticktestsforbacteriuria nitrite orpyuria leukocyteesterase lesssensitiveUrineculture 105CFU ml 14 婦女泌尿道感染的診斷 16 17 E Coliinurineanalysis 18 腎膿瘍 19 Kidneyinfection Acutepyelonephritis inflammationofkidneyandrenalpelvis diagnosismadeclinicallyPresentations chills fever andcostovertebralangletendernessCTscan perfusiondefects segmental multifocalordiffuse renalenlargementTx parenteralantibioticsfor7 10daysthenoralantibioticsfor10 14days 20 Kidneyinfection ChronicPyelonephritisRepeatrenalinfection renalscarring atrophyandrenalinsufficiency Referstoradiologicfindingsofthesmall contracted atrophickidney focalcoarseCorrectunderlyingproblems prophylacticantibioticsRemovalifhypertensionornonfunctionwithstoneburden 21 Kidneyinfection EmphysematousPyelonephritisacutenecrotizinginfectioncausedbygas forminguropathogens E coli Klebsiella 80 90 haveDMKUBandCT gaspresentationPoorprognosis CRE Platelet renal perirenalfluidinassociationwithabubble loculatedgas gasincollectingsystemTx Drainagecombinationwithmedicaltreatment 22 Kidneyinfection RenalAbscessRenal Perinephric ParanephricabscessMosthematogenousspreadbeforebutnowE colimorecommonUltrasonography echo freeorlow echo densityspace occupyinglesionCT hypodnesity fluidcollectionwithrimenhancementTx empirictherapyplusaminoglycosideor3rd generationcephalosporinPercutaneousdrainageisindicatediftreatmentfailure 23 Kidneyinfection XanthogranulomatousPyelonephritis黃色肉芽腎盂腎炎rare severe chronicinfection diffuserenaldestruction Lipid ladenmacrophages mistakenforRCCMostunilateral nonfunctioning enlargedkidneyassociatedwithobstructiveuropathysecondarytonephrolithiasis CT largeheterogenous reniformmasswithcentralcalcificationNephrectomy 24 25 26 居家保健