外科-男性泌尿生殖感染课件.ppt

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1、Infection of GUTIntroduction DefinitionPathogen stay and grow in any part of GUT causing infection.BacteriuriaPyuriaBacteriuriawithoutpyuriaindicatesbacterialcolonizationratherthaninfection.Pyuriawithoutbacteriuriawarrantsevaluationfortuberculosis,stones,orcancer.Predisposing factorsObstructive:as s

2、tones,tumor,stricture,BPHPredisposing factorsBody resistance,hypertension,diabetes,pregnancyIatrogenic:catherterization,cystoscopyRenal parenchyma diseases:renal injury,renal failure,interstitial nephritisAnatomical:female urethraRoutesofinfectionAscending routeHematogenous routeLymphatic routeDirec

3、t extensionDiagnosisClinical featuresLaboratory investigation urine bacterial culture and colony counting:105/mlUrinecollectionSuprapubicaspirationUrethralcatheterizationSegmentedvoidedurinespecimensMidstreamvoidedurinespecimensImmunologyresponsesDirectagglutinationtestsPassiveagglutinationtestsAnti

4、body-coatedbacteriaPyelonephritiswerefluorescentantibody-positivecystitiswerenotantibody-coatedEnzyme-linkedimmunosorbentassaysandradioimmunoassayforimmunoglobulinsImmunoglobulinresponseinpyelonephritisPrinciples of treatmentSelect sensitive antibioticsUse at least two kinds of sensitive antibiotics

5、 to avoid production of drug resistant strainUse full dose as early as possibleAdminister lower nephrotoxin antibioticsDuration of therapyAcutepyelonephrosisClinicalpresentationchills,fever,flankpain,andunilateralorbilateralcostovertebralangletendernessdysuria,increasedurinaryfrequencyandurgencyLabo

6、ratoryfindingsUrinecultureUrinarysedimentBloodtestBloodcultureBacteriologyEColiaccountsfor80%cases.Other members of the enterobacteriaceaefamily:Klebsiella,Proteus,Enterobacter,Pseudomonas,Serratia.Gram-positive organism:E faecalis,Saureus.RadiographicfindingsIntrvenousurogramUltrasonographyTreatmen

7、tSensitiveantimicrobialfor14-daycourseBetween10%to30%patientswithacutepyelonephrosisrelapseaftera14-daycourseoftherapy.patientswhorelapseusuallyarecuredbyasecond14-daycourseoftherapy,butoccasionallya6-weekcourseisnecessaryInfectedhydronephrosisandpyonephrosisClininicalPresentationhighfever,chills,fl

8、ankpain,andtendernessAprevioushistoryofurinarytractcalculi,infection,orsurgeryiscommon.Bacteriuriamaynotpresentiftheureteriscompletelyobstructed.Managementappropriatedantimicrobialdrugsanddrainageoftheinfectedpelvis.ureteralcatheterpercutaneousnephrostomytubebeplacedNephrectomyPerinephricabscessClin

9、icalPresentationTheclassicpatientwhohasacutaneousinfectionorurinarytractinfectionthatisfollowedin1to2weeks by fever,and unilateral flank pain isuncommon.fever,flankorabdominalpain,chills,anddysuria.Physical findings showed flank or abdominaltendernessandfever.BacteriologyandlaboratoryfindingsUrinecu

10、lturesBloodculturesWhitebloodcellscountincreased.Managementantimicrobialagentsanddrainagesurgicaldrainagepercutaneous aspiration and drainage ofperirenalcollectionnephrectomyUncomplicatedcystitisE Coli in 80%.S saproplyticus in 5%to15%Otherorganismlesscommoninclude:klebsiellaspecies,Pmirabills,enter

11、ococci.LaboratorydiagnosisMicroscopicurinalysisUrinecultureremainsthedefinitivetestPretherapyculturesandsusceptibilitytestsarealsoessentialManagementAntimicrobialselectionTMPTMP-SMXFluoroquinolonesarehighlyeffectiveandwelltolerated.DurationoftherapyWithmostantimicrobialagents,3-dayregimensappearopti

12、malSingle-dosetherapycanbeused.ProstatitisTypesofprostatitis1acuteandchronicbacterialprostatitis2nonbacterialprostatitis3prostatodyniaExaminationoftheprostaticexpressateExaminationofthesemenMeasurementoftheimmuneresponseSegmentedculturesofthelowertractinmaleAcutebacterialprostatitis(ABP)sudden onset

13、 of moderate to high fever,chills,lowbackandperinealpain,urinaryfrequency and urgency,nocturia,dysuria,generalized malaise with accompanyingarthralgiaandmyalgia,andvaryingdegreesofbladderoutletobstruction.Rectal palpation usually discloses andexquisitely tender,swollen prostate glandthatispartically

14、ortotallyfirm,irregular,andwormtotouchcultureofthevoidedurine.TherapyAntibacterial agents that normally diffusepoorly from plasma into prostatic fluid,perhaps,as in acute meningitis diffuseinflammatoryreactionenhancesthepassageofthesedrugsfromplasmaintoprostateNew fluoroquinoloneagents have excellen

15、tefficacyChronicbacterialprostatitis(CBP)SymptomsIrritating symptomsDysuriaPain in perineum,loin,testis etc.Fever,chillNeuropsychiatric symptomsDREProstatic fluid exam:wbc 10 under high power microscopeHypoechoic lesion may be seen on TRUSTreatmentAdminister sensitive antibioticsProstatic massage ev

16、ery weekPhysical treatmentRegular sexuality,abandon alcoholNonbacterialprostatitis(NBP)andprostotodyniaClinicalfeaturesApredominantcomplaintispain:perineal,suprapubic,scrotal,lowback,orurethral,especially pain referred to the tip of thepenilurethraUrinary urgency and frequency,nocturia,voidingin“pul

17、ses”Treatmenta-adrenergicreceptorblockersarethemostimportantagentsinthemanagementofNBP/PDstressmanagementforsymptomsEpididymitisAcute epididymitis is a clinical syndromeresulting from inflammation,pain,andswelling of the epididymis of less than 6weeksChronic epididymitis have long-standingpaininthee

18、pididymisandtesticle,usuallywithoutswelling.EtiologyIts often complicated with prostatitis,long time catherterization and postoperation of TURP,because pathogen can pass through orifice of ejaculatory duct and result in infectionWhen urine flows retrograde into ejaculatory duct,a chemical epididymit

19、is will occurWhen there is a repeated epididymitis in children,an ectopic ureteral orifice in seminal vesicle should be suspectedSymptoms and diagnosisScrotum ache refers to spermatic cord A rapid epididymis or testis swellingHigh feverTypical history and symptomsTreatmentofacuteepididymitisdourinecultureandsensitivestudypromptlyadministerbroad-spectrumantimicrobialprescribe bed rest and perform scrotalevaluationstronglyconsiderhospitalizationevaluate for underlying urinary tractdiseaseTreatmentofchronicepididymitisantimicrobialagentsasleast4-6weeksforsymptomssurgery