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URINARY TRACT INFECTION. Dr Kulwant Singh. Principal: S H Medical College Jamshedpur. URINARY TRACT INFECTION . Second most common infection following respiratory infections

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slide1

URINARY

TRACT

INFECTION

Dr Kulwant Singh

Principal: S H Medical College

Jamshedpur

slide2

URINARY TRACT INFECTION

  • Second most common infection following respiratory infections
  • UTI occur when bacteria (E. coli) from the digestive tract get into the opening of the urinary tract and multiply
  • Bacteria first infect the urethra, then move to the bladder and finally to the kidneys
  • UTI tend to occur more in women than men
slide3
Urinary tract is normally sterile due to the fact that bacteria moving upwards are regularly washed out by urination

Normal flora found in the urethra consist of lactobacillus and staphylococcus to name a few

URINARY TRACT INFECTION

slide4
Importance of Urinary Tract Infections is demonstrated by the fact that 20% of women between ages 20-65 suffer one attack per year

Approximately 50% of women develop a UTI during their lives and there is a prevalence rate of 5% per year of asymptomatic or covert bacteriuria in non-pregnant women between ages 21 and 65

URINARY TRACT INFECTION

slide5

URINARY TRACT INFECTION

TYPES

LOWER TRACT INFECTION

UPPER TRACT INFECTION

URETHRITIS

PROSTATITIS

CYSTITIS

PYELONEPHRITIS

PERI NEPHRIC ABSCESS

slide6

URINARY TRACT INFECTION

AETIOLOGY

Background

1. Bacterial infections of urinary tract are a very common reason to seek health services

2. Common in young females and uncommon in males under age 50

3. Common causative organisms

  • Escherichia coli (gram-negative enteral bacteria) causes most community acquired infections
  • Staphylococcus saprophyticus, gram-positive organism causes 10 – 15%
  • Catheter-associated UTI’s caused by gram-negative bacteria: Proteus, Klebsiella, Seratia, Pseudomonas
slide7

URINARY TRACT INFECTION

PATHOGENESIS

BACTERIA GET ACCESS FROM URETHRA AND ASCENDS

  • FEMALES ARE MORE PRONE DUE TO:
  • SMALL URETHRA
  • GRAM NEGATIVE ORGANISM RADIATE FROM PERI ANAL AREA TO URETHRA
  • SEXUAL INTERCOURSE
  • SUSCEPTIBILITY OF EPITHELIUM
slide8

URINARY TRACT INFECTION

PATHOGENESIS

  • WHETHER BLADDER INFECTION ENSURES IT, DEPENDS ON THE FOLLOWING:
  • FLUSHING AND DILUTING OF MICURITION AND VOIDING
  • ANTIBACTERIAL PROPERTIES OF BLADDER MUCOSA AND URINE
  • SIZE OF INOCULUM
slide9

URINARY TRACT INFECTION

PATHOGENESIS

  • FEMALE SEX AND INTERCOURSE PREDISPOSES
  • PREGNANCY: URETERAL TONE AND URETHRAL PERISTALSIS DECREASES
  • OBSTRUCTION IN FREE FLOW OF URINE: TUMOR, STRICTURE, CALCULI AND BPH ETC.
  • CATHETERISATION, URETHRAL DILATATION, CYSTOSCOPY
slide10

URINARY TRACT INFECTION

PATHOGENESIS

The normal bladder is capable of clearing itself of organisms within 2 to 3 days of their introduction.

Defense mechanisms

(1)the elimination of bacteria by voiding

(2) the antibacterial properties of urine and its constituents

(3) the intrinsic mucosal bladder defense mechanisms

(4) an acid vaginal environment (female)

(5) prostatic secretions (male)

slide11

URINARY TRACT INFECTION

PATHOGENESIS

Two potential routes:

(1) the hematogenous route, with seeding of the kidney during the course of bacteremia

(2) the ascending route, from the urethra to the bladder, then from the bladder to the kidneys via the ureters.

slide12

URINARY TRACT INFECTION

PATHOGENESIS

Hematogenous Infection

Because the kidneys receive 20% to 25% of the cardiac output, any microorganism that reaches the bloodstream can be delivered to the kidneys.

The major causes of hematogenous infection are S. aureus, Salmonella species, P. aeruginosa, and Candida species.

slide13

URINARY TRACT INFECTION

PATHOGENESIS

Hematogenous Infection

Chronic infections (skin, respiratory tract)

blood circulation kidney (cortex)

small abscess renal tubular

renal pelvis renal papillary

slide14

URINARY TRACT INFECTION

PATHOGENESIS

ASCENDING INFECTION

The ability of host defense

Urinary tract mucosal cells damaged

The power of bacterial adhesions(toxicity)

organisms urethra,periurethral tissues

bladder ureters renal pelvis

renal medulla

slide15

URINARY TRACT INFECTION

PATHOGENESIS

Voiding dysfunction is characterized by some or all of the following:

urgency

frequency

dysuria

hesitancy

dribbling of urine

overt incontinence

secondary to a UTI or to local irritants such as pinworm infestation

slide16

URINARY TRACT INFECTION

PATHOGENESIS

  • The normal bladder is capable of clearing itself of organisms within 2 to 3 days of their introduction.
  • Defense mechanisms
  • (1) the elimination of bacteria by voiding
  • (2) the antibacterial properties of urine and its constituents
  • (3)the intrinsic mucosal bladder defense mechanisms
  • (4) an acid vaginal environment (female)
  • (5) prostatic secretions (male)
slide17

URINARY TRACT INFECTION

PATHOGENESIS

  • CONTINITUATION OF UTI DEPENDS :
  • Female sex and intercourse predisposes
  • Pregnancy: ureteral tone decreased, ureteral peristalsis decreased
  • Obstruction in free flow of urine
  • Catheterisation , urethral dilatation, cystoscopy
  • Vesico-ureteric reflux: it occurs during voiding -- pressure increase in bladder, flow from bladder to kidney
  • Impaired defence
  • Neurogenic: spinal injury, sclerosis
slide18

URINARY TRACT INFECTION

HISTORY AND PHYSICAL EXAMINATION

Age-related Risk Factors for UTI

  • Advanced Age
  • Fecal incontinence/impaction
  • Incomplete bladder emptying or neurogenic bladder
  • Vaginal atrophy/estrogen deficiency
  • Pelvic prolapse/cystocele
  • Insufficient fluid intake/dehydration
  • Indwelling foley catheter or urinary catheterization or instrumentation procedures
slide19

URINARY TRACT INFECTION

CLINICAL PRESENTATION

  • Cystitis
  • dysuria (burning or discomfort on urination)
  • frequency
  • nocturia
  • suprapubic discomfort
slide20

URINARY TRACT INFECTION

CLINICAL PRESENTATION

  • Fever with chill & rigor
  • Haematuria
  • Strangury
  • Ineffectual desire
  • Cloudy urine
  • Offensive urine
  • Pain lower abdomen
slide21

URINARY TRACT INFECTION

CLINICAL PRESENTATION

  • Uncomplicated
  • Cystitis
  • Urethritis
  • Female >>> male
  • Sequel rare
slide22

URINARY TRACT INFECTION

CLINICAL PRESENTATION

  • Complicated
  • Pyelonephritis
  • Prostate obstruction
  • Relapse +++
slide23

URINARY TRACT INFECTION

INVESTIGATIONS

  • WBC ++++
  • Urine: C & S
  • Cystoscopy
  • Ultra Sound
  • IVU
  • P/R
  • PID
slide24

URINARY TRACT INFECTION

TREATMENT

  • FLUID ++
  • ALKALI
  • EMPTYING OF BLADDER
  • HYGIENE
slide25

Recurrent U.T.I.s

that are reinfection.

Unresolved

infection

Isolated infections

Classification of U.T.I.

Recurrent infections resulting

from bacterial persistence.

slide26

URINARY TRACT INFECTION

TREATMENT

  • ROAD MAP OF TREATMENT
  • To limit the period of suffering.
  • To minimise the severity of suffering.
  • To arouse the immunity of the patient to prevent reinfection.
  • To avoid dialysis and kidney transplantation.
  • To reduce the cost of treatment.
slide27

URINARY TRACT INFECTION

TREATMENT

Eryngium aquaticum

  • Burning pain with frequent urge.
  • Prostatic fluid from slightest provocation
  • Tenesmus of bladder
  • Frequency / dysurea
  • Urine burns like fire
slide28

URINARY TRACT INFECTION

TREATMENT

Eupatorium purpereum

  • Strangury
  • BHP
  • Chill runs upward
  • Burning while urinating
  • Cystitis in pregnant women
  • Sweetish smell urine
slide29

URINARY TRACT INFECTION

TREATMENT

Chimaphila umbellata

  • Plethoric young women
  • BHP
  • Urine scanty loaded with ropy mucopurulent sediment
  • Burning and scalding pain Violent tenesmus
  • Urinate only when bends forward and with feel wide open
slide30

URINARY TRACT INFECTION

TREATMENT

Equisetum

  • Fullness of bladder not relieved by urination
  • Sharp cutting / burning pain
  • Right lumber region painful
  • Constant desire to urinate
  • Aggravation immediately after urination
slide31

URINARY TRACT INFECTION

TREATMENT

Epigea repens

  • Chronic cystitis / dysurea
  • Strangury
  • Urge in continency
  • Mucopus and uric acid deposition and renal calculi
slide32

URINARY TRACT INFECTION

TREATMENT

Petroselinum

  • Urge in continence
  • Burning and tingling in urethra
  • Dysurea with BHP
  • Ameliorate by rubbing the urethra
slide33

URINARY TRACT INFECTION

TREATMENT

PRUNUS SPINOSA

  • Forked urine – slow stream
  • Cramping pain in bladder < walking
  • Sudden urge
  • Violent pain Thinking of complaints ameliorates
slide34

URINARY TRACT INFECTION

TREATMENT

CANNABIS SATIVA

  • Burning in bladder while urinating
  • Stitches in urethra
  • Urethra sensitive
  • Urine scalding and spasmodic closure of sphincter
  • Fear of going to bed
  • Time passes slowly
  • Tickling sensation as of dropping water.
slide35

URINARY TRACT INFECTION

TREATMENT

  • CANTHARIS
    • Inflammation are violent
    • Cystitis
    • Strangury
    • Haematuria with pain
    • Violent burning ,cutting ,stabbing pain
    • Urging for urination
    • Urine comes drop by drop with pain
slide36

URINARY TRACT INFECTION

TREATMENT

PARIERA BRAVA

  • Radiating pain to thigh during efforts to urinate
  • Sensation as if the bladder is full
  • Urethritis
  • Urge incontinency
  • Contains thick stringy mucus
slide37

TREATMENT

THUJA OCC.

  • Fixed ideas
  • Anger from contradiction
  • Ill effects of vaccination
  • Urethra inflamed
  • Frequent urination with pain
  • Sudden urge
  • Left sided
  • Tickling in Urethra.
  • Must be used inter-currently to prevent reappearance
slide38

URINARY TRACT INFECTION

TREATMENT

TEREBINTHINA

  • Confusion of mind
  • Irritability
  • Concentration difficult
  • Bleeding mucous membrane
  • Strangury
  • Urethritis
  • Urine scanty with odor of violet
  • Urine smoky , coffee ground
slide39

URINARY TRACT INFECTION

TREATMENT

BERBERIS VULGARIS

  • Indifferent / anxiety
  • Changeability /wandering pain
  • Pain aggravate by pressure
  • Left sided
  • Sticking / cutting / burning
  • Bubbling sore sensation in kidney
  • Frequent maturation
  • Burns when non urinating
  • Associated with renal calculi
slide40

URINARY TRACT INFECTION

TREATMENT

ARSENIC ALBUM

  • Restlessness
  • Fear of death
  • Anxiety
  • Burning like fire > by heat
  • Putrid discharges
  • Thirst unquenchable for small quantity
  • Craves of acids / warm food
  • Burning urethra during urination
  • Dysuria
  • Urine is black
slide41

URINARY TRACT INFECTION

TREATMENT

APIS MEL

  • Fearfulness , can not help crying
  • Apathy
  • Sudden shrill piercing screams
  • Ailment from suppressed sexual desire
  • Burning / stinging pain with swelling
  • Thirstlessness
  • Craving for sour
  • Nephritis / cystitis / prostatitis
  • Strangury
  • Last drop burn and smart
slide42

URINARY TRACT INFECTION

TREATMENT

NITRIC ACID

  • Irritable/ Vindictive/ Headstrong
  • Sensitiveness to noise
  • Discontented
  • Pain appear suddenly and disappear suddenly
  • Discharges are offensive
  • Love fat and salt ,hate meat and milk aggravates
  • Urine cold on passing
  • Burning stinging after urination
  • Frequent urge at night
slide43

URINARY TRACT INFECTION

TREATMENT

POPULUS TREMULOIDS

  • Urethritis
  • Dysurea –Scalding during pregnancy
  • Severe tenesmus
  • Pain behind pubis at the end of Urination
  • B.H.P.
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