Dr Kulwant Singh URINARY TRACT INFECTION Principal: S H Medical College Jamshedpur.

Dr Kulwant Singh

URINARY TRACT

INFECTION

Principal: S H Medical CollegeJamshedpur

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

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


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



TYPES

LOWER TRACT INFECTION UPPER TRACT INFECTION

URETHRITIS

PROSTATITIS

CYSTITIS

PYELONEPHRITIS

PERI NEPHRIC ABSCESS


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


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


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


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


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)


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.


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.


PATHOGENESIS

Hematogenous Infection

Chronic infections (skin, respiratory tract)

blood circulation kidney (cortex)

small abscess renal tubular

renal pelvis renal papillary


PATHOGENESIS

ASCENDING INFECTION

The ability of host defense Urinary tract mucosal cells damagedThe power of bacterial adhesions(toxicity)organisms urethra,periurethral tissues bladder ureters renal pelvisrenal medulla


PATHOGENESIS

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

urgency

frequencydysuria

hesitancydribbling of urine

overt incontinencesecondary to a UTI or to local irritants such

as pinworm infestation


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)


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


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


CLINICAL PRESENTATION

Cystitis• dysuria (burning or discomfort on urination)

• frequency• nocturia

• suprapubic discomfort



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



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



Complicated

• Pyelonephritis• Prostate obstruction• Relapse +++


INVESTIGATIONS

WBC ++++

Urine: C & S

Cystoscopy

Ultra Sound

IVU

P/R

PID


TREATMENT

FLUID ++

ALKALI

EMPTYING OF BLADDER

HYGIENE

Classification of U.T.I.

Recurrent U.T.I.s

that are reinfection.

Isolated infections

Recurrent infections resulting

from bacterial persistence.

Unresolved

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.


TREATMENT

Eryngium aquaticum

Burning pain with frequent urge.

Prostatic fluid from slightest provocation

Tenesmus of bladder

Frequency / dysurea

Urine burns like fire


TREATMENT

Eupatorium purpereum

Strangury

BHP

Chill runs upward

Burning while urinating

Cystitis in pregnant women

Sweetish smell urine


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


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


TREATMENT

Epigea repens

Chronic cystitis / dysurea

Strangury

Urge in continency

Mucopus and uric acid deposition and renal calculi


TREATMENT

Petroselinum

Urge in continence

Burning and tingling in urethra

Dysurea with BHP

Ameliorate by rubbing the urethra


TREATMENT

PRUNUS SPINOSA

Forked urine – slow stream

Cramping pain in bladder < walking

Sudden urge

Violent pain Thinking of complaints ameliorates


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.


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


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

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


TREATMENT

TEREBINTHINA

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


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


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


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


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


TREATMENT

POPULUS TREMULOIDS

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

Dr Kulwant Singh URINARY TRACT INFECTION Principal: S H Medical College Jamshedpur.

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Transcript of Dr Kulwant Singh URINARY TRACT INFECTION Principal: S H Medical College Jamshedpur.