广州医科大学（广州医学院）：《内科学》课程PPT教学课件（讲稿）第四讲 尿路感染

尿路感染 (肾盂肾炎)

尿路感染 （肾盂肾炎）

病因 ◆细菌:大肠杆菌—70%以上 变形杆菌、克雷白杆菌、绿脓杆 菌、葡萄球菌 ◆真菌、支原体、衣原体、病毒

病因 ◆细菌：大肠杆菌—70%以上 变形杆菌、克雷白杆菌、绿脓杆 菌、葡萄球菌 ◆真菌、支原体、衣原体、病毒

发病机制 ◆感染途径:上行感染 血行感染 ◆机体抵抗力:尿液冲洗;前列腺液杀菌; 尿道粘膜分泌;酸性尿 ◆易感因素:尿路复杂因素(梗阻、异物) 泌尿系统畸形、尿路器械、尿道口 周围炎、全身抵抗力差 ◆细菌毒力:吸附能力

发病机制 ◆感染途径：上行感染 血行感染 ◆机体抵抗力：尿液冲洗；前列腺液杀菌； 尿道粘膜分泌；酸性尿 ◆易感因素：尿路复杂因素（梗阻、异物） 泌尿系统畸形、尿路器械、尿道口 周围炎、全身抵抗力差 ◆细菌毒力：吸附能力

4 Double ureters are seen exiting from each kidney and extend ing to the bladder that has been opened A small segment of aorta is seen between the normal, smooth-surfaced kidneys

Double ureters are seen exiting from each kidney and extending to the bladder that has been opened. A small segment of aorta is seen between the normal, smooth-surfaced kidneys

流行病学 女性多,2~5% 男性:50岁以下罕见

流行病学 • 女性多，2~5% • 男性：50岁以下罕见

病理 充血、水肿、炎症细胞浸润

病理 ■充血、水肿、炎症细胞浸润

The large collection of chronic inflammatory cells here is in a patient with a history of multiple recurrent urinary tract infections. This is chronic pyelonephritis

The large collection of chronic inflammatory cells here is in a patient with a history of multiple recurrent urinary tract infections. This is chronic pyelonephritis

There was a large renal calculus(stone) that obstructed the calyces of the lower pole of this kidney leading to a focal hydronephrosis(dilation of the collecting system). The stasis from the obstruction and dilation led to infection. The infection with inflammation is characterized by the pale yellowish-tan areas next to the dilated calyces with hyperemic mucosal surfaces. The upper pole is normal and shows good udfomedullary demarcations

There was a large renal calculus (stone) that obstructed the calyces of the lower pole of this kidney, leading to a focal hydronephrosis (dilation of the collecting system). The stasis from the obstruction and dilation led to infection. The infection with inflammation is characterized by the pale yellowish-tan areas next to the dilated calyces with hyperemic mucosal surfaces. The upper pole is normal and shows good corticomedullary demarcations

临床表现 膀胱炎 ■急性肾盂肾炎 ■无症状细菌尿

临床表现 ■膀胱炎 ■急性肾盂肾炎 ■无症状细菌尿

膀胱炎 占60% 尿路刺激征(尿频、尿急、尿痛) 30%血尿 无明显全身症状 大肠杆菌多见

膀胱炎 • 占60% • 尿路刺激征（尿频、尿急、尿痛） • 30%血尿 • 无明显全身症状 • 大肠杆菌多见