课件：泌尿道保健关於泌尿道感染.ppt

E.Coli in urine analysis 腎膿瘍 Kidney infection Acute pyelonephritis– inflammation of kidney and renal pelvis, diagnosis made clinically Presentations-- chills, fever, and costovertebral angle tenderness CT scan: perfusion defects (segmental, multifocal or diffuse), renal enlargement Tx: parenteral antibiotics for 7-10 days then oral antibiotics for 10-14 days Kidney infection Chronic Pyelonephritis Repeat renal infection- renal scarring, atrophy and renal insufficiency. Refers to radiologic findings of the small, contracted, atrophic kidney, focal coarse Correct underlying problems, prophylactic antibiotics Removal if hypertension or nonfunction with stone burden Kidney infection Emphysematous Pyelonephritis acute necrotizing infection caused by gas-forming uropathogens(E.coli, Klebsiella…) 80-90% have DM KUB and CT: gas presentation Poor prognosis: CRE?, Platelet?, renal/perirenal fluid in association with a bubble/loculated gas, gas in collecting system Tx: Drainage combination with medical treatment Kidney infection Renal Abscess Renal/ Perinephric / Paranephric abscess Most hematogenous spread before but now E.coli more common Ultrasonography: echo-free or low–echo-density space-occupying lesion CT: hypodnesity- fluid collection with rim enhancement Tx: empiric therapy plus aminoglycoside or 3rd-generation cephalosporin Percutaneous drainage is indicated if treatment failure Kidney infection Xanthogranulomatous Pyelonephritis黃色肉芽腎盂腎炎 rare, severe, chronic infection ?diffuse renal destruction. Lipid –laden macrophages, mistaken for RCC Most unilateral, nonfunctioning, enlarged kidney associated with obstructive uropathy secondary to nephrolithiasis. CT: large heterogenous, reniform mass with central calcification Nephrectomy 居家保健 多喝水(1600-2000ml/day)，避免憋尿， 避免食糖和含糖食品， 飲用未加糖的蔓越莓汁，服用蔓越莓濃縮膠囊 (cranberry supplements), 漿果(berry)類食物 以及在每天最後一餐時服用維生素C，可縮短感染的時間。 台灣產的漿果 台灣產的漿果很多，一般菜市場可以買得到的有：大漿果類? ：木瓜?、鳳梨??、奇異果?、百香果?、番荔枝?、香蕉?等。小漿果類?：楊桃???、蓮霧?、番石榴?、葡萄?、草莓 (?)?、小番