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Urnary tract infectin, Acute pyelonephritis Renal and perirenal abscess

壢新醫院畢業後 一般 醫學內科訓練課程教案. Urnary tract infectin, Acute pyelonephritis Renal and perirenal abscess. Sep, 22, 2005 Dr. Chien-Lung Chen. 學習目標. Complete history, physical examination and laboratory analysis Differential diagnosis. Adequate management and treatment. Contents. 1. Definition

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Urnary tract infectin, Acute pyelonephritis Renal and perirenal abscess

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  1. 壢新醫院畢業後一般醫學內科訓練課程教案 Urnary tract infectin, Acute pyelonephritis Renal and perirenal abscess Sep, 22, 2005 Dr. Chien-Lung Chen

  2. 學習目標 • Complete history, physical examination and laboratory analysis • Differential diagnosis. • Adequate management and treatment

  3. Contents • 1. Definition • 2. Risk factors • 3. Clinical presentation.. • 4. Diagnosis • 5. Treatment

  4. Definition • Upper UTI: pyelonephritis • Lower UTI: cystitis, urethritis, prostatitis • UTI Relapse: same organism, <2wks • UTI reinfection: different organism, >2wks

  5. Definition • Symptomatic: frequecy, urgency, dysuria • flank pain, fever,chills • 1) cystitis • 2) APN • 3) prostatitis • Asymptomatic UTI: s/s(-), pyeuria(+)

  6. Definition • Uncomplicated: • 1) normal urinary tract • 2) normal renal function • Complicated: • 1) Abnormal urinary tract: stone, VUR, ileal • conduit, indwelling catheter, prostatitis, ….. • 2) Immune compromised: DM, C/T, neutropenia • 3) Virulent organism: metastatic Staphylococcus • aureus, Proteus mirabilis • 4) Male

  7. Risk factors • 1. Age • 2. Pregnancy • 3. Diaphragm use • 4. Sexual activity • 5. Chronic disease, DM, H/T, CVA

  8. Clinical features • 1. Acute urethral syndrome: frequency, • dysuria, burning, suprapubic pain, cloudy • urine, incontinence • 1) vaginitis: leukorrhoea, candida albicans • trichomonas vaginalis, gardnerella • vaginalis, G(-) bacilli • 2) Urethritis: chlamydia, herpes virus • 3) Prostatitis

  9. Clinical features • 2. UTI • 1) Cystitis: dysuria,frequency, pelvic pain • bacteriuria, hematuria • 2) APN: flank pain, fever, malaise, …… • 3) Cx: • a. abscess formation • b. Xanthogranulomatous pyelonephritis • c. Emphysematous pyelonephritis • d. CRF

  10. Diagnosis • 1. Complete history • 2. Symptoms and signs • 3. Pyuria: WBC > 5/hpf, nitrite(+), leucyte • esterase, bacteria • 4. Leucocytosis • 5. U/C • 6. B/C

  11. Management • 1. Asymptomatic UTI: no tx except • pregnancy and URO invasive procedure • 2. Uncomplicated lower UTI: • Oral A/B( baktar, keflex, amoxil) x 3D • 3. APN: • IV A/B ( Cef +GM ) x 3-5 d  fever (-) •  oral A/B x 7-10d

  12. Renal abscess

  13. Renal abscess

  14. Renal abscess

  15. Xanthogranulomatous pyelonephritis • 1. Chronic bacterial PN • 2. Uncommon, <1% • 3. Old age, female 70% • 4. Path: unknown • 5. Mψ with PAS(+) granules • 6. P. mirabilis, E. coli, S. aureus • 7. Dx: CT • 8. Tx: local resection + antibiotics

  16. Perirenal abscess • 1. Etiology: S. aureus, E.coli, P.mirabilis • 2. Pathogenesis: pus-material in the Gerota’s fascia. • 3. S/S: fever, flank pain, chills, dysuria • 4. Dx: echo, CT, angiography, Ga scan • 5. Emphysematous pyelonephritis- gas-forming organism.

  17. Treatment • 1. Early surgical drainage • 2. Antibiotics as adjunctive treatment • 3. Antibiotics irrigation prior to nephrectomy. • 4. Prognosis is poor, mortality is 20-50% • 5. Prompt diagnosis and immediate definitive surgery.

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