urethritis group D presentation.pptxpresentation

Medicine

1. urethritis Presented By: Chan charles

2. Definition. Urethritis is defined as infection-induced inflammation of the urethra. It is commonly due to infection by bacteria The condition is normally categorized into either Gonococcal urethritis (GU) or Nongonococcal urethritis (NGU). 4/29/2015 Presented by chan charles 2

3. Causative agents urethritis is caused by infection by bacteria that enter the urethra from the skin around the urethra's opening. E.g E. coli and other bacteria present in stool Gonococcus, Chlamydia trachomatis, The herpes simplex virus (HSV-1 and HSV-2) can also cause urethritis. Trichomonas 4/29/2015 Presented by chan charles 3

4. Signs and symptoms Signs and symptoms in patients with urethritis may include the following: Urethral discharge: May be yellow, green, brown, or tinged with blood; production unrelated to sexual activity Dysuria (in men): worst during the first morning void Itching: Sensation of urethral itching or irritation between voids Orchalgia: Heaviness in the male genitals Worsens during menstrual cycle (occasionally) in females. Systemic symptoms ( e.g fever, chills, sweats, nausea): Urine retention due to blocked or pain during urination. In men, blood in the semen or urine 4/29/2015 Presented by chan charles 4

5. Diagnosis History taking. Physical Examination Penis: for skin lesions that may indicate other STDs, Urethral discharge, palpate along urethra for areas of tenderness, suggestive of abscess, firmness suggesting foreign body Testes: mass or inflammation/swelling, Lymphatics : Check for inguinal adenopathy Prostate: Palpate for prostatitis Examine female patients in the lithotomy position. For Skin lesions that may indicate other STDs, Urethra: Strip the urethra for any discharge Pelvis: Complete pelvic examination, including the cervix A mucopurulent or purulent urethral discharge 4/29/2015 Presented by chan charles 5

6. Diagnosis cont’ Investigation: Urethral smear (5 leukocytes per oil immersion field on microscopy) First-voided urine specimen (at least 10 WBCs/ hpf on microscopy) Gram stain: may show Neisseria gonorrhoeae and C trachomatis Endourethral and/or endocervical culture for N gonorrhoeae and C trachomatis 4/29/2015 Presented by chan charles 6

7. Diagnosis cont’ Urinalysis: (Not useful) cystitis or pyelonephritis Nucleic acid–based tests: For C trachomatis and N gonorrhoeae (urine specimens) and other Chlamydia species ( endourethral samples) Serology (VDRL) and HIV serology Nasopharyngeal and/or rectal swabs: For gonorrhea screening in men who have sex with men Pregnancy testing: In women who have had unprotected intercourse 4/29/2015 Presented by chan charles 7

8. Management Antibiotics used in the treatment of urethritis include the following: Azithromycin Ceftriaxone Cefixime Ciprofloxacin Ofloxacin Doxycycline 4/29/2015 Presented by chan charles 8

9. Surgical Management Patients with urethritis may undergo the following procedures: Catherization : urinary retention and tamponade urethral bleeding Cystoscopy : In cases when catherization is not possible, to remove foreign body or stone in the urethra Dilation of urethral strictures with filiforms Placement of suprapubic tube: In severe cases of urethral trauma temporizing measure to divert urine and relieve patient discomfort 4/29/2015 Presented by Chan charles 9

10. Complications Penile Lymphangitis kidney infection Pyenephritis (cystitis) Salpingitis Infertility Ectopic pregnancy cervicitis 4/29/2015 Presented by chan charles 10

11. Some diagrams 4/29/2015 Group D presentation 11

12. Some diagrams cont’ 4/29/2015 Presented by chan charles 12

13. Some diagrams cont’ 4/29/2015 Presented by chan charles 13

14. Reference. Author: Martha K Terris, MD 4/29/2015 Presented by chan charles 14

15. Cystitis Presented By: Chan charles 4/29/2015 Presented by chan charles 15

16. Definition. Cystitis is the medical term for inflammation of the bladder which is caused by a bacterial infection, and it's called a urinary tract infection (UTI). cystitis may occur as a reaction to certain drugs, radiation therapy or potential irritants, such as feminine hygiene spray, spermicidal jellies or long-term use of a catheter. Cystitis may also occur as a complication of another illness. 4/29/2015 Presented by chan charles 16

17. Brief notes on urinary Bladder. Tubes called ureters carry urine from your kidneys to the bladder, where it's stored until it exits your body through the urethra. when bacteria outside the body enter the urinary tract through the urethra and begin to multiply. Most cases of cystitis are caused by a type of Escherichia coli (E. coli) bacteria. Bacterial bladder infections may occur in women as a result of sexual intercourse. But even sexually inactive girls and women are susceptible to lower urinary tract infections because the female genital area often harbors bacteria that can cause cystitis. 4/29/2015 Presented by chan charles 17

18. Causes The commonest organisms are bacteria: E. coli (about 80%), Klebsiella . Proteus. Gonococcus. Staphylococcus saprophyticus . Enterococci. 4/29/2015 Presented by chan charles 18

19. Risk factors Women have shorter urethra than men have, which cuts down on the distance bacteria must travel to reach the bladder. There for they are at greatest risk of UTIs include those who: Are sexually active. Sexual intercourse can result in bacteria being pushed into the urethra. Use certain types of birth control. Women who use diaphragms are at increased risk of a UTI. Diaphragms that contain spermicidal agents further increase the risk. Are pregnant. Hormonal changes during pregnancy may increase the risk of a bladder infection. Other risk factors in both men and women include: Interference with the flow of urine. This can occur in conditions such as a stone in the bladder or, in men, an enlarged prostate. Changes in the immune system. This can occur with conditions such as diabetes, HIV infection and cancer treatment. Prolonged use of bladder catheters. It increases vulnerability to bacterial infections as well as bladder tissue damage. 4/29/2015 Presented by chan charles 19

20. 4/29/2015 Group D presentation 20

21. Cystitis 4/29/2015 Group D presentation 21

22. Noninfectious cystitis Although bacterial infections are the most common cause of cystitis, a number of noninfectious factors also may cause the bladder to become inflamed. These include; Interstitial cystitis. chronic bladder inflammation, Drug-induced cystitis. Certain medications, particularly the chemotherapy drugs cyclophosphamide and ifosfamide , can cause inflammation of your bladder as the broken-down components of the drugs exit your body. Radiation cystitis. Radiation treatment of the pelvic area can cause inflammatory changes in bladder tissue. 4/29/2015 Presented by chan charles 22

23. Noninfectious cystitis cont’ Foreign-body cystitis. Long-term use of a catheter can predispose you to bacterial infections and to tissue damage, both of which can cause inflammation. Chemical cystitis. Some people may be hypersensitive to chemicals contained in certain products, such as bubble bath, feminine hygiene sprays or spermicidal jellies, and may develop an allergic-type reaction within the bladder, causing inflammation. Cystitis associated with other conditions. Cystitis may sometimes occur as a complication of other disorders, such as gynecologic cancers, pelvic inflammatory disorders, endometriosis, Crohn's disease, diverticulitis, lupus or tuberculosis. 4/29/2015 Presented by chan charles 23

24. S/S Cystitis signs and symptoms often include: A strong, persistent urge to urinate A burning sensation when urinating Passing frequent, small amounts of urine Blood in the urine (hematuria) Passing cloudy or strong-smelling urine Discomfort in the pelvic area A feeling of pressure in the lower abdomen Low-grade fever Back or side pain Fever and chills Nausea and vomiting 4/29/2015 Presented by chan charles 24

25. LAP 4/29/2015 Group D presentation 25

26. Tests and diagnosis Urine analysis. Determine whether bacteria, blood or pus is in your urine. Cystoscopy . A thin tube with a light and camera attached that can be inserted through the urethra into your bladder — may help with the diagnosis. (biopsy) for analysis in the lab. Imaging tests. X-ray or ultrasound may help rule out other potential causes of bladder inflammation, such as a tumor or structural abnormality. 4/29/2015 Presented by chan charles 26

27. Treatments and drugs Antibiotics are the first line of treatment for cystitis caused by bacteria. First-time infection. Antibiotic treatment for three days to a week, depending on the severity of infection. Repeat infection. If it is recurrent UTIs, longer term antibiotic treatment or refer. Postmenopausal women may be particularly susceptible to cystitis. As a part of your treatment, you may recommend a vaginal estrogen cream. 4/29/2015 Presented by chan charles 27

28. Treating other forms of noninfectious cystitis If you're hypersensitive to certain chemicals in products such as bubble bath or spermicides , avoiding these products may help ease symptoms and help prevent further episodes of cystitis. Treatment of cystitis that develops as a complication of chemotherapy or radiation therapy focuses on pain management, usually with medications, and hydration to flush out bladder irritants. Most cases of chemotherapy-induced cystitis tend to resolve after the chemotherapy is finished 4/29/2015 Presented by Chan charles

29. Complications When left untreated, they can become something more serious. Complications may include: Kidney infection. An untreated bladder infection can lead to kidney infection called pyelonephritis. Blood in the urine. With cystitis, there will be hematuria. by 4/29/2015 Presented by chan charles 29