医药健康泌尿系结核Tuberculosis（TB） of the Genitourinary 课件.pptVIP

Tuberculosis(TB) of the Genitourinary Tract泌尿生殖系结核 瑞金医院泌尿外科 Urinary TB A disease of young adults. 60% between 20~40y. Infecting organism — Mycobacterium tuberculosis (结核分支杆菌，结核杆菌), Tubercle bacilli Infecting Route(感染途径) Hematogenous route(血行途径) from the lungs. Primary sites(初发部位): Kidney, Prostate (前列腺) Other organs involved: direct extension Pathogenesis(发病机理) Tubercle bacilli hit the renal cortex(肾皮质): ?Normal resistance(抵抗力): organism destroyed ?Sufficient virulence(致病力): clinical infection established. Pathogenesis TB of kidney: progresses slowly, 15~20y to destroy a kidney with good resistance. No clinical disturbance until the calyces / pelvis(肾盏/肾盂) involved. Pathology(病理) Kidney Ureter (输尿管) Grossly: a soft, yellowish localized bulge (隆起). On section: involved area filled with cheesy material (caseation, 干酪样物质). Kidney Ureter Walls of pelvis, calyces and ureter thickened. Ulceration(溃疡形成) in calyces. Complete ureteral stenosis(输尿管狭窄) ?Autonephrectomy(肾自截). ?Bladder urine normal and symptom absent. Kidney Ureter Basic lesion——Tubercle foci(结核结节) Epithelioid reticulum(上皮样网) Peripheral giant cells Heal by fibrosis(纤维化). Kidney Ureter TB is a combination of caseation(干酪样变), cavitation(空洞形成) and healing by fibrosis scarring(纤维化和疤痕愈合). Depending on virulence vs resistance. Calcification(钙化): strongly suggestive of TB. Secondary renal stones in 10%. Left kidney: autonephrectomy Right Kidney: hydronephrosis ureteral reflux (肾积水输尿管返流) Contraction of the bladder (膀胱孪缩) 左肾萎缩 萎缩肾外观 Caseation Fibrosis L Renal Dysfunction on Isotope Scan (同位素扫描) Calcification (钙化) Bladder Tubercle form: white/yellow raised nodules(结节) surrounded by a halo of hyperremia(充血). Tubercles break down?deep ragged ulcers ?bladder irritable. Diagnosis(诊断) Just saying you had turned a corner doesn’t make it so. Just saying there is massive destruction doesn’t make it so. __John Kerry Just saying there is TB als