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URINARY TRACT STRUCTURE & INFECTION

URINARY TRACT STRUCTURE & INFECTION. Innervation of the Urinary Tract. Sympathetic fibers from the lower splanchnic nerves – lumbar ganglion – kidney Parasympathetic vagal fibers via the coeliac plexus Regulation vasomotor tone, renal blood flow

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URINARY TRACT STRUCTURE & INFECTION

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  1. URINARY TRACT STRUCTURE &INFECTION

  2. Innervation of the Urinary Tract • Sympathetic fibers from the lower splanchnic nerves – lumbar ganglion – kidney • Parasympathetic vagal fibers via the coeliac plexus • Regulation vasomotor tone, renal blood flow • Stimulation – causes intrarenal vasoconstriction and reduces renal blood flow, enhances Na reabsorption stimulates local RAAS • Both sympathetic and parasympathetic nerve fibers supply the ureter, vesica urinaria

  3. Infection of the Urinary Tract • Asymptomatic bacteriuria, presence of bacteria in UT, absence of symptoms, colonization from female periurethral area • Significant bacteriuria = > 100.000 bct/ ml in 2 voided specimens or 1 in-out catheter specimen in a woman, or 1 voided specimen in a man • Treatment only when risk factors for potential complicated UTI, eg pregnancy,

  4. Acute UTI • Lower UTI : dysuria, frequency, urgency. • Upper UTI : infection involving the kidney • Complicated, uncomplicated • Clinical presentation in children more variable and frequently nonspecific • Cystitis • Prostatitis, urethritis • Acute bacterial Pyelonephritis: bacterial invasion of the kidney, clinical syndrome w/ chills and fever, flank pain, constitutional symptoms • Chronic pyelonephritis, path ~ tubulointerstitial nephritis caused by # of disorders: VUR, chronic obstructive uropathy, drugs & toxins, renal medullary ds, chronic / recurrent renal bacteriuria • Complicated infection :abnormal anatomy, obstruction, dilatation & impaired drainage risk of renal damage, abcess formation,septicemia

  5. 85% 50%

  6. Urease • Proteus mirabilis, P vulgaris, S saprophyticus • Involved in tissue adherence • Splitting urea into into CO2 & Ammonia • Urinary alkalinization • Precipitation of Mg, NH4, PO4 • Stone formation, struvite

  7. Investigation of UTI 5 • Dx: Microbiological: bacterial count >10 CFU /ml • Midstream urine collection • Women, introitus should be cleaned with NaCl, midstream urine is collected with the labia spread apart • Suprapubic aspiration ( infants % children ) • Urine can be stored at 4’C for up to 48h before culture • Infection may be present CFU 10 - 10 • Mixed culture w/ low colony counts in F ~ contamination • Urinalysis ~first line screen, nitrates, leucocytes + hematuria, proteinuria • Urine microscopy, white cell casts ~ renal parenchymal infection 5 2

  8. IVP Obstructions Prostate, Urethral stricture Congenital anomalies Of urinary tract: Reflux, urethral valves Abscess

  9. Displacement / lateral ectopia Of the ureteric orifice, Loss of valve like action

  10. Treatment of UTI • Most cases, uncomplicated lower UTI, 3 day course of antibiotics, no culture needed Trimethoprim, cephalexin, amox/clavulanate, ciprofloxacin • Relapsing infections , 10 – 14 days if persist / recurs, further investigation • Prophylactic low dose antibiotics for recurrent, >3x/y UTI • In patients w/ clear relation between infection and sexual activity, single dose after intercourse may be effective • Acute pyelonephritis ~ Rx in Hospital, IV fluids & antibiotics started before culture results • Antibiotics IV – oral , 2 weeks • If no improvement in 48H, review AB, further investigation (obstruction, abscess?)

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