Urinary infection
Introduction
Introduction to urinary infection Urinary infection is inflammation caused by bacteria directly invading the urinary tract. Urinary tract infection is a general term for diseases such as pyelonephritis, cystitis, and urethritis caused by bacteria. It belongs to the category of "lean disease" and "closed" of Chinese medicine. Generally, low back pain, frequent urination, urgency, and dysuria are the main clinical features. There are more children than adults, more women than men, and easy to recurrent. 80% of pathogenic bacteria causing urinary inflammation are Escherichia coli, Proteus, and Streptococcus faecalis in the intestine. Acute simple urinary tract infections are caused by a pathogen, chronic, recurrent infections, may have congenital urinary tract abnormalities, about 1/2 to 1/3 of patients have bladder, ureteral reflux, or stones, Chronic renal insufficiency embolism. There are a variety of bacteria caused by mixed urinary tract infections. basic knowledge Proportion of disease: according to the specific disease, the proportion of illness is different Susceptible people: no specific population Mode of transmission: partial sexual transmission Complications: pelvic inflammatory disease prostatitis
Cause
Cause of urinary infection
The main reasons for inducing urinary tract infections are as follows:
1. Obstruction and reflux
Urinary obstruction and reflux can cause abnormal changes in urodynamics, which can cause poor drainage of the urine and remain in the urinary tract, which is easy to cause infection. There are two reasons for obstruction and reflux:
(1) mechanical obstruction, such as congenital malformations, stones, foreign bodies, scar contracture caused by chronic inflammation and prostatic hypertrophy.
(2) neurological obstruction and reflux, such as neurogenic bladder, congenital anatomical defects, giant ureter, ureteral bladder reflux.
Urinary obstruction and reflux can all impede urine drainage and produce local urine retention. Since urine is a good environment for bacterial growth, it is easy to cause infection. According to statistics, the incidence of obstructive urinary tract infection is more than 10 times higher than that of non-obstructive infection, and the incidence of lower urinary tract obstruction is 2 times higher than that of upper urinary tract obstruction. For cases of recurrent urinary tract infections, it is necessary to check for the presence or absence of urinary tract obstruction and reflux. These factors must be removed, otherwise it is difficult to cure.
2, pregnancy
Changes in the body's secretion during pregnancy and uterine compression of the lower ureter can cause poor drainage of urine. At the 10th week of gestation, the renal pelvis and ureteral dilatation can be seen from the venous pyelogram, especially on the right side. According to the measurement of normal human renal pelvis and ureter urine output is 6 ~ 15ml, pregnancy can reach 20 ~ 60ml, this urine retention, delayed discharge is likely to lead to infection.
In the prenatal examination, 2 to 13% of pregnant women have asymptomatic bacterial urine. If no treatment is given, 25 to 40% of patients will have symptomatic urinary tract infection (acute pyelonephritis). Urinary tract infections can occur at various stages during pregnancy, so multiple bacterial cultures are required. As for the damage of urinary tract infection and renal function, the urine concentration test can be used as an exploration. In pregnant women, those with urinary tract infections will have decreased urine concentration. After treatment, the urine concentration function can be restored to normal after the bacteria in the urine are eliminated. It is currently believed that the change in urine concentration function is due to inflammation of the renal papilla or a decrease in blood flow. In animal experiments, a large number of bacteria enter the kidney without renal dysfunction, and if the kidney nipple has bacterial invasion, renal dysfunction occurs. It has been proven that acute pyelonephritis occurring during pregnancy tends to invade the renal papilla and a decrease in endogenous creatinine clearance.
3, diabetes problem
It is well known that diabetic patients are prone to infection due to a series of metabolic disorders and changes in immune function, and it is more difficult to control once infection occurs. It has been reported that the incidence of urinary tract infections in diabetic patients is five times higher than that of normal people, and that 20% of women with diabetes have asymptomatic bacteriuria. Therefore, it is unanimously advocated that diabetic patients should avoid unnecessary urinary tract examinations; if necessary, blood glucose should be controlled before examination, and bacterial growth in urine should be eliminated as much as possible.
4, congenital malformations
There are many congenital malformations in the urinary system, such as horseshoe kidney, ectopic kidney, renal insufficiency, renal ureteral junction stenosis, double ureteral stenosis, ureteral ectopic, bladder valgus, etc. These lesions can often cause Urinary obstruction leads to infection.
5, urinary tract examination
Commonly used such as indwelling catheter, cystoscopy, urethral dilatation, urography (retroversion pyelography, bladder urethrography, etc.), due to operational damage to the mucous membrane or disinfection is not strict, can bring bacteria into the urinary tract, or the original There is infection in the spread of infection. In particular, urinary retention caused by spinal injuries or cerebrovascular accidental paraplegia cases. Long-term bed rest, placement of indwelling catheter, 100% infection. These cases generally do not die from the primary lesion, and most die from urinary tract infections. For those who need long-term application of indwelling catheter, the suprapubic bladder fistula should be switched to drain the urine. It is necessary to use a transurethral indwelling catheter, and a high-quality catheter should be used. The current silicone gel catheter coated with hydrogel is ideal, and its biological habits can minimize the stimulation of the body tissue, which can reduce the infection. .
6, other
The patient's body has decreased resistance, excessive fatigue, malnutrition, and regular application of hormones and immunodeficiency. Another example is urinary calculi, in addition to the stone itself can cause obstruction of the urinary tract, there are bacteria that decompose urea to make the urine alkaline, promote magnesium, ammonium, phosphate and other sedimentation of stones, but also bacteria as the center of peripheral crystal deposition Infectious stones are formed, and bacteria can often be cultured in the center of the stone. There are also chronic potassium-deficient nephritis and hyperuricemia, calcium metabolism disorders, etc., are all factors that induce infection.
Prevention
Urinary infection prevention
1, keep the vulva clean
(1) The baby girl should change the diaper in time after urination, wash the perineum and buttocks, and the diaper used must be clean and clean. Children after the age of l, regardless of gender, should wear trousers and do not sit on the ground to avoid infection of the vulva and urinary tract.
(2) Adults should clean the vulva once a day, change underwear frequently, and habitually wipe the anus after bowel movements, from front to back, to avoid bringing anal dirt to the urethra.
(3) Disabling the bath. If you sit in the bath and take a bath, the sewage will easily immerse into the urethra and cause infection. Because the female urethra is short and wide, the urethral opening is close to the vagina and anus, especially attention should be paid.
2, pay attention to sexual hygiene
The cause of urinary tract infections, sexual life hygiene habits are more common, male and female vulva, vagina, urethra bacteria are easily transmitted to the other side, it is also easy to self-infection. Therefore, the external genitalia should be cleaned before sex. If you use a contraceptive, you should clean or disinfect the contraceptive. Before and after sexual intercourse, you should urinate once. In addition, abstain from masturbation, especially with masturbation, to prevent urinary tract infections and injuries.
3, to prevent urine from staying
(1) When there is urine, urinate in time, do not urinate, empty the bladder before going to sleep every night.
(2) Women who have been pregnant for more than 5 months should sleep on the left and right side of the right side, so as to prevent the uterus from compressing the ureter, causing poor urine flow.
(3) Active treatment of diseases that cause urinary tract obstruction, such as urinary calculi, tumors, benign prostatic hyperplasia, phimosis, renal ptosis, scar stenosis, congenital malformations of the urinary system.
4, remove invasive bacteria
(1) Active treatment of infectious diseases, such as tonsillitis, cutaneous swollen or traumatic infection, cholecystitis, pelvic inflammatory disease, appendicitis, prostatitis, caries infection, sinusitis, etc., should be adequately used, thoroughly clean, to prevent bacteria from passing through the blood Lymphatics, etc. enter the urinary system, while killing the bacteria that have invaded the urinary tract.
(2) Drink plenty of water, increase the amount of urine, so that the urine continuously flushes the urinary tract, discharge bacteria and toxins as soon as possible, and keep the urinary tract clean.
Complication
Urinary infection complications Complications pelvic inflammatory prostatitis
1, may be complicated by systemic diseases.
2, male patients with complications such as epididymitis, prostatitis, seminal vesiculitis, etc.; women with endometriosis with endometritis, salpingitis, pelvic inflammatory disease, peritonitis.
3, urethral infection can directly spread to the bladder or prostate and cause cystitis or prostatitis. If the acute urethritis is improperly treated, it can be accompanied by paraurethral abscess. Abscess can penetrate the penis skin and become urethral fistula. Fibrosis can cause urethral stricture during the healing of urethral inflammation.
Symptom
Urinary infection symptoms Common symptoms Frequent urination with urgency and dysuria Fever nerve urinary frequency urinary urinary frequency urinary pain chills nausea urgency low back pain
1, pyelonephritis:
Pyelonephritis refers to inflammation of the renal pelvis, mostly caused by bacterial infection. Pyelonephritis, also known as upper urinary tract infection, is usually accompanied by inflammation of the urinary tract. It is not easy to distinguish strictly in clinical practice. According to the clinical course and disease, pyelonephritis can be divided into acute and chronic phase. Chronic pyelonephritis is an important cause of chronic renal insufficiency. Acute pyelonephritis occurs in women of childbearing age. Patients often have low back pain, tenderness in the kidney, pain, chills, fever, headache, nausea and vomiting, and bladder irritation such as urinary urgency and dysuria. It can be seen that white blood cells are increased.
2, cystitis:
Cystitis is inflammation of the bladder that is caused primarily by specific and non-specific bacterial infections, as well as other specific types of cystitis. Specific infection refers to bladder tuberculosis. Non-specific cystitis is caused by Escherichia coli, E. coli, Proteus, Pseudomonas aeruginosa, Streptococcus faecalis, and Staphylococcus aureus. Its clinical manifestations are acute and chronic. The former has a sudden onset, a burning sensation during urination, and pain in the urethra area. Sometimes there is urgency and severe urination. Women are common. The terminal hematuria is common. In severe cases, there are gross hematuria and blood clots. The symptoms of chronic cystitis are similar to those of acute cystitis, but there is no high fever. Symptoms can last for several weeks or intermittent attacks, making the patient weak and thin, and the waist, abdomen and bladder are not comfortable or painful.
3, urethritis:
Urethritis is inflammation of the urethral mucosa. It is a common disease. It is more common in women. It is clinically divided into acute and chronic, non-specific urethritis and gonococcal urethritis. The latter two clinical manifestations are similar and must be based on medical history and bacteriology. Check to identify. Mostly caused by retrograde invasion of the urethra by pathogenic bacteria.
4, vaginitis:
Vaginitis is inflammation of the vaginal mucosa and submucosal connective tissue, and is a common disease in gynecological clinics. In normal healthy women, due to anatomical and biochemical characteristics, the vagina has a natural defense function against the invasion of pathogens. When the natural defense function of the vagina is destroyed, the pathogen is easy to invade, leading to vaginal inflammation. Young women and postmenopausal women are deficient in estrogen. The vaginal epithelium is thin, the intracellular glycogen content is reduced, and the vaginal pH is as high as about 7, so the vaginal resistance is low, which is more susceptible to infection than puberty and women of childbearing age.
Examine
Urinary infection check
The general examinations required for urinary infections are as follows:
1, urine routine: examination content including urine color, transparency, pH, red blood cells, white blood cells, epithelial cells, cast, protein, specific gravity and urine sugar qualitative.
2. Urine white blood cells: Urine white blood cells are normally present in the blood, but for some reasons some of the white blood cells are mixed into the urine to form leukocytic cells.
3, blood routine: blood routine is the most general, the most basic blood test. Blood consists of two major parts, fluid and tangible cells, which are routinely tested for blood. Blood has three different functions of cells - red blood cells (commonly known as red blood cells), white blood cells (commonly known as white blood cells), and platelets. The disease is judged by observing the quantitative change and the morphological distribution. It is one of the commonly used auxiliary examination methods for doctors to diagnose the disease.
Diagnosis
Diagnosis and diagnosis of urinary infection
diagnosis
Diagnosis can be performed based on clinical performance and laboratory tests.
Non-invasive measures (especially ultrasound, CT and MRI) reduce the need for invasive procedures. Ultrasound images can show the neoplasms of the heart and abnormalities of the pancreas, liver, kidney and bladder; CT can show abdominal tumors, retroperitoneal, retrosternal and mesenteric lymph nodes, and can also detect spleen, kidney, adrenal gland, pancreas, heart, middle Defects in sputum and pelvis, radionuclide scanning, especially with 111 indium labeled granulocytes, can help locate infections and observe infection processes. In detecting most unexplained fever, including the nervous system, MRI is superior to CT.
Injury diagnostic measures are also needed, such as liver, bone marrow or other related parts: skin, pleura, lymph nodes, intestines, muscle biopsy. Biopsy specimens should be histopathologically examined and isolated, cultured with bacteria, fungi, viruses and mycobacteria. In 90% of cases, the diagnosis methods for unexplained fever are different.
Differential diagnosis
The four diseases of pyelonephritis, cystitis, urethritis and vaginitis are differentiated.
