Urinary Tract Disorders 尿路功能紊乱.ppt

Urinary Tract Disorders May 12, 2005 Objectives Distinguish types of UTI, including bacteriuria, urethritis, cystitis, and pyelonephritis Describe the pathophysiology related to UTI, such as organisms and host factors Describe pathophys of common forms of nephrolithiasis, including risk factors for development of nephrolithiasis Describe typical clinical presentations, and elicit a pertinent history, in a patient with UTI or nephrolithiasis Describe the diagnostic methods and diagnostic criteria for the various types of UTI Summarize the methods used for dx of nephrolithiasis Describe modes of therapy for acute, chronic, and complicated UTI, including prophylaxis for recurrent infection Summarize therapeutic options for nephrolithiasis, and strategies to prevent recurrence Urinary Tract Infection Lower urethritis cystitis prostatitis Upper pyelonephritis intrarenal and perinephric abscess Also categorized into Non-catheter associated (commum. acquired) Catheter associated (hosp. acquired) Any category may be sx or asx Urinary Tract Infection Pathogenic microorganisms in urine, urethra, bladder, kidney, prostate Usually growth 105 organisms per milliliter From midstream “ clean catch” urine sample If sx or from catheter specimen can be significant with 102 or 104 organisms per mL Etiology Most common is Gram neg. bacteria E. coli = 80% of uncomp. acute UTI Proteus – assoc. with stones Klebsiella – assoc. with stones Enterobacter Serratia Pseudomonas Etiology Gram pos. cocci Staphylococcus saprophyticus 10-15 % acute sx UTI in young females Enterococci – occas. in acute uncomp. cystitis Staphylococcus aureus – assoc. with renal stones, instrumentation, increased susp. of bacteremic kidney infection Etiology Urethritis from chlamydia, gonorrhea, HSV – acute sx female with sterile pyuria Ureaplasma urealyticum Candida or other fungal species – commonly assoc. with cath. or DM Mycobacteria Pathogenesis Usually ascent of bacteria from urethra to bladder to kidney