NHIM TRNG TIUThS BS HUYNH NGOC PHNG THOi tng: Y4

1.Nu c cc nh ngha NTT.

2. Trnh by cc c ch bo v ng tiu, cc yu t nguy c, cc tc nhn gy bnh thng gp, ng vo cc tc nhn

3. Trnh by cc bnh cnh lm sng ca NTT.

4. Nu v phn tch c XN CLS chn an NTT5. Trnh by cc bin chng ca NTT.

6. Trnh by nguyn tc iu tr ca NTT.

MC TIU

NH NGHANhim trng tiu l hu qu gy ra bi s xm nhp ca cc VSV vo ng tiu. VSV gy nn NTT c th l vi khun, virus, vi nm, KST.NTT khng triu chng l c s hin din ca VK m khng c cc triu chng nh tiu gt, tiu lt nht, au hng lng.NTT khng c triu chng thng khng cn iu tr ngai tr trng hp xy ra trn i tng c yu t nguy c: thai k, gim BC, suy gim min dch, cn lm th thut trn ng niu.

NH NGHANTT n gin: xy ra ph n, khng c c a c bit, khng c bnh l ni khoa i km v khng c bt thng v gii phu hoc chc nng ca ng niu.NTT phc tp: NTT xy ra nhng BN c t nht mt YTNC lm cho d b bin chng nng hoc lm cho vic iu tr kh khn.

NH NGHANTT ti nhim l NTT tr li do mt lai VK khc vi VK ca ln NTT trc.NTT ti pht l NTT tr li do cng mt lai VK ca ln NTT trc.

DCH T HC

CC C CH BO V NG TIU CHNG NHIM TRNGNc tiu:m o:Bng quang:Niu qun:Thn:p ng min dch:

CC C CH BO V NG TIU CHNG NHIM TRNGNc tiu: P thm thu cao, urea v acid hu c cao, pH acid, c protein Tamm Horsfall c ch kh nng bm dnh ca VK, c khng thDng nc tiu lu thng t tren cao xung

CC C CH BO V NG TIU CHNG NHIM TRNGm o: VK thng tr Lactobacillus c ch kh nng pht trin ca cc VK gy bnh. (Thng gp ph n s dng mng trnh thai v thuc dit tinh trng lm cht VK thng tr m o.

CC C CH BO V NG TIU CHNG NHIM TRNGBng quang: Kh nng tng xut NT ca BQLp mucin bao ph nim mc c kh nng cn tr s bm dnh ca VK.Niu qun:Nhu ng NQ t trn xung. (VK tit cht lm gim nhu ng.Ri lan hat ng van NQ-BQ (mc phi hoc d dng bm sinh.

CC C CH BO V NG TIU CHNG NHIM TRNGThn: Vng v thn khng nhim trng tt hn vng tyCc p ng min dch:Khng th trong nc tiu gp phn ngn cn kh nng bm dnh ca VK v nga nhim trng ti pht.H thng b th khi c hat ha s li cun cc tb BC n hn ch NT.

CC YU T NGUY C Be tac ng tieu.Trao ngc.Tuoi va gii.Cac thu thuatCac benh ly noi khoa.Thai kBQ thn kinhSuy gim min dch

CC YU T NGUY C

CC YU T NGUY C

CC YU T NGUY C Thai kTn sut NTT khng triu chng ph n c thai l 6%. Nu khng iu tr s c khang 30% NTT khng triu chng tr thnh NTT c triu chng lm sy thai hoc sanh non.C ch do cc yu t ni tit v gii phu hc lm chng nc NQ v ng nc tiu.

TC NHN GY BNH

TC NHN GY BNHE. Coli:KN v K: c ch kh nng thc boKN O: Phn ng vim, t ln c trn NQCc cu trc ngai tb nh pili hay fimbriae.Hemolysin: polypeptide c tb

TC NHN GY BNHVIM NIU O LY QUA QUAN H TNH DC:Do Chlamydia trachomatis, Neisseria gonorrheaCC KST V SIU VIAdenovirus gy vim BQ xut huytHerpes gy vim niu o cpMt vi lai KST

NG VO CA TC NHN GY BNHNG NGC DNG:Thng gp nhtNG MUNG VO T CC CQ KHC:D ng tiu ra da, vo m o, vo i trng.

LM SNGHi chng niu o cp: tiu but gt, tiu lt nht v tiu gp.au h v trn xng muTiu ci khi tiu mu i th.St km n lnhau gc sn lng hoc vng hng.

XT NGHIM NC TIU- TPTNT QUE NHNG (DIPSTICK)Leucocyte esterase: Esterase c gii phng t nhng t bo BC c ly gii trong nc tiu. Bnh thng: m tnh Bt thng: 25 500/L gp trong nhim trng tiu, cc trng hp vim khng nhim (vim cu thn cp, vim ng thn m k, si niu) Dng tnh gi: dch m o m tnh gi: Nng cao Albumin, Ascorbic acid, glucose, tetracycline, cephalexin, cephalothin, hoc lng ln oxalic acid c th c ch phn ng ny.

XT NGHIM NC TIU- TPTNT Nitrite C ch: vi trng Gr ng rut bin nitrate thnh nitrite Dng tnh: kh nng nhim trng tiu Dng tnh gi: m tnh gi: ch n t nitrate, dng thuc li tiu, pH NT acide, nc tiu trong BQ di 4h, VK khng c men nitrate reductaseLU Nu c leucocyte esterase v nitrite dng tnh th kh nng nhim trng tiu cng cao Tuy nhin nu c hai m tnh khng c ngha lai tr

XT NGHIM NC TIU- TPTNT SOI TI NTBC, Tb mNhum Gram

CY NT v lm KS- L XN quuyt nh chn an v c tnh hng dn T.

CH NH CY NTC triu chng c nng v thc th ca nhim trng tiu.Theo di kt qu iu tr ca nhim trng tiu.Khi rt thng tiu lu.Tm sat nhim trng tiu khng triu chng ph n c thai.Trc khi tin hnh cc th thut trn bnh nhn c bnh thn tc nghn

CC BIN PHP LY NT gim kh nng dy nhim VT t ngai vo, phi XN nc tiu trong vng 1 gi sau khi ly mu:Ly nc tiu gia dngThng tiuChc ht bng kim v trng qua BQ trn xng muChc ht kim v trng qua h thng ng thng tiu kn.Trc v sau khi xoa nn TLT chn an tiu VK t TLT

CHN AN NTT THEO PHNG PHP LY NT

CY NTm tnh gi: NT lang qu, acide qu, TT hoc nng ur qu cao, c s dng KS trc, dy thuc st khun, NTT do cc VK khng pht trin trn mi trng cy thng thng.Dng tnh gi: diphtheroids, lactobacillus, streptococci tiu huyt .

CC XN KHCCy mu.Chc nng thnCng thc mu, CRP

HNH NH HC MC CH Pht hin yu t nguy c gy nhim trng tiu. Pht hin bin chng ca nhim trng tiu.

CH NH Nam NTT ln u. NTT phc tp hoc c NT huyt i km. Nghi ng c tc nghn hoc si ng niu. Tiu mu sau nhim trng tiu.. Khng p ng vi iu tr KS thch hp. NTT ti pht.

HNH NH HC CC XN HNH NH Siu m bng. XQ b niu khng sa san XQ b niu c chch cn quang qua ng tnh mch. CT- Scan b niu. Scanner b niu c cn quang (UROSCAN). XQ bng quang niu qun ngc dng. Soi bng quang..

Hnh nh siu m Vim i b thn cp: Thn tng kch thc, c nhng vng gim m, phn bit v ty khng r, , dn nh i b thn hoc NQ, nc thn chc nng, v bnh thng sau 3-6 tun.

Hnh nh CT Scanner c cn quang Vim i b thn cp: vng gim m gi u thn T (hnh A), v hnh tia cc trn thn T (hnh B)

CT Scanner c cn quang vim i b thn cp: bt quang khng u, t dch khoang quanh thn, dy mc ni Gerota.

HNH NH HC Hnh nh tro ngc mc nng (Grade 4)

HNH NH HC XQ b niu c cn quang, hnh nh tc ngh niu qun.

HNH NH HC Hnh nh siu m. Hnh A: Nc tiu tn lu trong BQ sau khi tiu xong. Hnh B: TLT to, ng nht.

HNH NH HC Hnh nh CT Scanner vng chu. Hnh A: Nc tiu tn lu trong BQ sau khi tiu xong. Hnh B: TLT to, ng nht.

LM SNGVIM BQ CP:Hi chng niu o cp: tiu but gt, tiu lt nht v tiu gp.au h v trn xng muTiu nhiu BC, tb mTiu mu i th (Vim BQ xut huyt)

LM SNGVIM NIU O CP:Hi chng niu o cp: tiu but gt, tiu lt nht v tiu gp.Tiu c u dngVK thng gp ly qua quan h tnh dc nh: Chlamydia trachomatis, Neisseria gonorrhea, Herpes simplex

LM SNGVIM TIN LIT TUYN CP:Triu chng ca vim BQ cpSt, lnh run, HC nhim trngTLT au khi thm khm trc trng.Bin chng: Abces TLT, b tiu cp, NT huyt.

LM SNGVIM TIN LIT TUYN MN:NTT ti pht thng xuynTiu m, au vng gn hu mnKhng st, lnh run, khng HC nhim trng r rtThm khm TT: khng c hiu.Chn an: NP xoa bp TLT

LM SNGVIM I B THN CPSt cao, lnh runau gc sn lng hoc vng hng lng cng bnHi chng niu o cp c th xy ra trc vi ngy hoc i km cc triu chng trn.TPTNT: tr BCHC vim: BC tng ch yu N, CRP tng

LM SNGVIM I B THN CPBnh cnh khng in hnh v nng: ngi ln tui, T, nghin ru, SDD, Ghp thn. Nng: chang NT, tc nghn, Abces thn, T, suy gim min dch, thn c nht.

LM SNGVIM I B THN MNNTT ti pht nhiu lnTriu chng ca suy thn mn

NHIM TRNG TIU KHNG TRIU CHNGCy NT gia dng 2 ln cch 24h 105 khm/mLThng gp ph n c thai, ngi gi, T, thng tiu lu, si thn.

NHIM TRNG TIU DO THNG TIU LU10-15% BN nm vin, t l tng 3-5% mi ngy lu thng.YTNC: n, t lu ngy, bnh c bn nng, h thng ng dn lu khng kn, t v CS thng tiu khng ng, khng dng KS tan thn.VT: E. Coli, Proteus, Pseudomonas, Klebsiella, Serratatia, Staphylococci, Enterococci, Candida.VT xm nhp trong lng ng hoc b mt ngai ng thng.Kh T do c mng biofilm.C th t thai lui sau khi rt thng tiu.

NHIM TRNG TIU PH N C THAINhim trng tiu l bnh l thng gp ph n c thai (5-10%), c nh hng nghim trng n c m v thaiCn pht hin sm NTT khng c triu chng mt ln mi thng bng TPTNT (giy nhng) ph n c thai t thng th t ca thai k. Nu kt qu (+) phi tin hnh cy nc tiu.iu tr sm NTT khng triu chng nhm phng trnh nguy c Vim i b thn cp

CHN ANDa vo triu chng lm sngTiu Bch cu, tiu mTiu vi khun

CHN ANNhim trng tiu c triu chng hay khng triu chng?V tr ca nhim trng tiu: i b thn, bng quang, niu o, tin lit tuyn?Nhim trng tiu cp hay mn, ti pht hay ti nhim?Cc yu t phc tp, c a c bit?Bin chng?

CHN AN PHN BITPhn bit cc nguyn nhn gy tiu but gt khng do nhim trng tiu Phn bit cc nguyn nhn gy au lng Phn bit cc nguyn nhn gy tiu bch cu, tr bch cu

BIN CHNGNhim trng huytAbces thn hoc Abces quanh thnHai t gai thnVim BQ sinh hi v vim i b thn sinh hi.

BIN CHNG NHIM TRNG HUYTThng gp VK Gr (-), cc c a:c thc hin cc th thut trn ng tiu.Abcs thnC bnh thn tc nghn hoc suy gim min dch.- Cc t/c NTH c th che lp t/c ng niu.

BIN CHNG ABCES THN V QUANH THNSt, n lnh, ri lan tiu ha, au lng.Rung thn +HC niu o cp.VBTC khng p ng T sau 72 gi.Chn an bng Siu m hoc CT Scanner

A: Abcs thn P, hnh nh gim m thn P lan ra khoang quanh thn. B: nm nghing dn lu m.

Vim i b thn sinh hi. A. CT Scan khng cn quang, B c cn quang cho thy hi trong nhu m thn v lan ra khang quanh thn.

BIN CHNG HAI T GAI THNtrn c a i tho ng, vim thn k mn, bnh hng cu hnh lim, sau ghp thn. Ging vim BT cp, nhng khng p ng T, dn n suy thn cp.Chn an: SA, Chp CQ b thn ngc dng.

BIN CHNG VIM BQ SINH HI V VIM I B THN SINH HIThng gp trn c a i tho ng. hai t ch m v sinh hi tch t trong thn hoc quanh thn .thng gp nh E. coli, Klebsiella, Proteus, 20% c nhim trng a khun . BQ, thng gp E. Coli, Clostridium Perfringens.Chn an bng siu m hoc CT Scanner.

NGUYN TC IU TRChn la KS da trn:- Tnh nhy cm ca VK- sc khng ca BN- Khng sinh thi c qua thn- t c, r tin

NGUYN TC IU TRThi gian iu tr:- Bnh cnh lm sng- c a bnh nhn- Ti pht hay ti nhim

NGUYN TC PHNG BNHTm sat v t cc NTT khng triu chng trn cc T c YTNC.Ngn nga ti pht bng cch lai b YTNC.

NGUYN TC PHNG BNH