renal block膀胱炎肾块课件.pptVIP

PROF. HANAN HABIB CystitisRenal Block Introduction Urinary Tract infection (UTI) divided into upper and lower urinary tract infections Patient presents with urinary symptoms and significant bacteriuria= 105 bacteria/ml Asymptomatic bacteriuria when the patient presents with significant bacteria in urine but without symptoms Prevalence of Bacteriuria in different age groups Classification Lower UTIs: Cystitis (infection of the bladder; superficial mucosal infections) Urethritis (sexually transmitted pathogens) - urethritis in men women Prostatitis and epididymitis Upper UTIs: Acute pyelonephritis Chronic pyelonephritis Uncomplicated UTI (empirical therapy is possible) Complicated UTI (nosocomial UTIs, relapses, structural or functional abnormalities ) Cysytitis In women is common due to a number of reasons : - short urethra - pregnancy - decreased estrogen production during menopause. In men: mainly due to persistent bacterial infection of the prostate. In both sexes: common risk factors are : - presence of bladder stone - urethral stricture - catheterization of the urinary tract - diabetes mellitus Pathogenesis of cystitis Due to frequent irritation of the mucosal surfaces of the urethra and the bladder. Infection results when bacteria ascends to the urinary bladder . These bacteria are residents or transient members of the pereneal flora, and are derived from the large intestine flora. Toxins produced by uropathogens. Condition that create access to bladder are: - Sexual intercourse due to short urethral distance. Pathogenesis of cystitis Uncomplicated UTI usually occurred in non pregnant , young sexually active female without any structural or neurological abnormality Risk factors : - Catheterization of the urinary bladder , instrumentation - structural abnormalities - obstruction Hematogenous through blood stream ( less common) from other sites of infection Etiologic agents E.coli is the mos