1、Infection of GUT课件课件Pathogen Gram-negative:85%Bacillus coli Gram-positive:Staphylococcus aureus Chlamydia Mycoplasma Mode of infection retrograde blood lymph direct Diagnosis Clinical features Laboratory investigation Bacterial culture and colony counting:105/mlPrinciples of treatment Select sensiti
2、ve antibiotics Use at least two kinds of sensitive antibiotics to avoid production of drug resistant strain Use full dose as early as possible Administer lower nephrotoxin antibiotics Pyonephrosis Infection in parenchyma,pelvis or calyces cause broad parenchyma damage,pus accumulated in pelvis and c
3、alyces gradually,in the end the kidney becomes a pus containing cyst.It may be caused by bacterial pyelonephritis or specific infection as renal TBPyonephrotic kidney:outer surfacePyonephrosis.The dilated pelvis was filled with pus and abscesses are present in the renal parenchyma and communicate wi
4、th the pelvisDiagnosis and treatment Clinical manifestation are fever,anorexia,anemia,loin mass,tendness in renal region and bladder irritating symptoms when pus goes down along the ureter into the bladder Pus disgorging from ureteral orifice can be seen under cystoscopy when there is no obstruction
5、 in upper urinary tract IVU and isotope renogram suggest renal failure Nephrostomy or nephrectomy is neededChronic prostatitisEtiology Bacteria may retrograde into peripheral zone of the prostate when the posterior urethra become infected Non bacterial prostatitis is often related to chlamydia and m
6、ycoplasma infection There exists a prostate-blood barrier,it is difficult to control the UTIPreprostatic sphincterPeripheral zoneExternal sphincterTransitional zonetrigonedetrusorurethraAFMSCentral zoneverumontamun Symptoms Irritating symptoms Dysuria Pain in perineum,loin,testis etc.Sexual disorder
7、:premature ejaculation,ED Fever,chill:unusual Neuropsychiatric symptoms Diagnosis DRE:a soft and enlarged gland with mild tendness may be felt when prostate is congested Prostatic fluid exam:wbc 10 under high power microscope Prostatic fluid culture Hypoechoic lesion may be seen on TRUSTreatment Adm
8、inister sensitive antibiotics Prostatic massage every week Physical treatment Regular sexuality,abandon alcohol Etiology Its often complicated with prostatitis,long time catherterization and postoperation of TURP,because pathogen can pass through orifice of ejaculatory duct and result in infection W
9、hen urine flows retrograde into ejaculatory duct,a chemical epididymitis will occur When there is a repeated epididymitis in children,an ectopic ureteral orifice in seminal vesicle should be suspectedSymptoms and diagnosis Scrotum ache refers to spermatic cord A rapid epididymis or testis swelling H
10、igh fever Typical history and symptomsTreatment Administer broad spectrum antibiotics Use 33%magnesium sulfate liquid to do wet drssing on scrotum Surgical drainage if abscess developedTB of the kidneyIntroduction Pathology pathological stage clinical stage caseationComplete destruction of the kidne
11、y by tuberculosisRenal TB.In the bottom right corner of the picture is a granuloma.Clinical features Frequency dysuria Hematuria or pyuria Mass Systemic symptomsDiagnosis History and clinical features Urine exam Cystoscope X-ray PCRAn advanced middle calyceal lesion,which is shown on retrograde pyel
12、ogramTB cause fibrosis of the calyceal stem,so that the area of the kidney that drains into the diseased calyceal system ceases to function and on urography gives the typical cut-off appearanceTreatment Medical regimen INH+RFP+EBT Surgical intervention focal cleaning partial nephrectomy nephrectomy ureterocystostomy sigmoid augmentation cystoplasty Surgical choiceCT scan shows the left kidney is almost destroyed by TBNephrectomy 谢谢谢谢谢谢谢谢中山一院泌尿外科中山一院泌尿外科中山一院泌尿外科中山一院泌尿外科谢谢你的阅读v知识就是财富v丰富你的人生
