Urinary tract infection

Presented by:
Arshid ali
Ihsan mohsin
Arooba ayaz
 Anotomy and physiology of UTI

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 Definitions
Urinary System: The system which is specialized to filter
the blood plasma, excrete waste products , and regulate the
body’s water, acid-base, and electrolyte balance.
Nephrology: The scientific study of the anatomy,
physiology, and pathology of the kidneys.
Urology: The branch of medicine which deals with the male
and female urinary systems and the male reproductive
system.

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 Organs of the urinary system

Urinary system consists of six organs:

Two kidneys
Two ureters
One urinary bladder
One urethra

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 Anatomy of the Kidneys
The paired kidneys are bean-shaped.
Located between the levels of the last thoracic and third lumber
vertebrae.
Partially protected by the eleventh and twelfth pairs of ribs.
Lying just above the waist between the peritoneum and the
posterior wall of the abdomen, hence they are said to be
retroperitoneal (retro= behind) for their position.
The right kidney is slightly lower than the left because the liver
occupies considerable space on the right side superior to the
kidney.

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 Retroperitoneal position

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 External Anatomy
A typical adult kidney is 10—12 cm long, 5—6 cm wide, and
3 cm thick.
It weighs about 135—150 g.
The concave border of each kidney faces the vertebral column.
Near the center of the of the concave border is a deep vertical
fissure called the renal hilum, through which the ureter
emerges from the kidney along with blood vessels, lymphatic
vessels, and nerves.

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kidney 1: A longitudinal section, B nephron and adjacent blood vessels;
1 renal papilla, 2 renal column(column of bertini), 3 capsule, 4 renal
pyramid, 5 calyx, 6 ureter, 7 renal pelvis, 8. renal vein, 9 renal artery, 10 interlobar
artery, 11 arcuate artery, 12 interlobular artery, 13 interlobar
vein, 14 cortex, 15 interlobular vein, 16 renal sinus, 17 arcuate
vein,18 medulla, 19 vasa recta, 20 loop of Henle, 21 collecting duct, 22 arcuate
vein,
9 23 arcuate artery, 24 proximal convoluted tubule, 25 glomerulus, 26 Bowman's
capsule, 27 distal convoluted tubule
 Nephron
Nephrons are the functional units of the kidneys.
Each nephron consists of two main parts: a renal corpuscle,
where blood plasma is filtered, and a renal tubule into which
the filtered fluid passes.
Renal corpuscle consists of glomerulus (capillary network)
and the glomerular (Bowman’s) capsule, an epithelial cup
that surrounds the glomerular capillaries.

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 Nephron cont….
Blood plasma is filtered in the glomerular capsule, and then
the filtered fluid passes into the renal tubule.
The renal tubule has three main parts. In the order that fluid
passes through them is:
1) proximal convoluted tubule, 2) loop of Henle, and 3)
distal convoluted tubule.
The distal convoluted tubules of several nephrons empty into
a single collecting duct.
Collecting ducts then unite to form ducts of billini and
converge into large papillary ducts, which drain into the
minor calyces, major calyces, renal pelvis and then ureter.

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 Nephron

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 Nephron of the kidney. The labeled parts are:
1. Glomerulus, 2. Efferent arteriole, 3. Bowman's capsule, 4. Proximal
convoluted tubule, 5. Cortical collecting duct, 6. Distal convoluted tubule,
7. Loop of Henle, 8. Duct of Bellini, 9.Peritubular capillaries, 10. Arcuate
vein, 11. Arcuate artery, 12. Afferent arteriole, 13. Juxtaglomerular
13 apparatus.
 Flow of urine

Through Nephron down from Nephron

Bowman’s capsule Collecting duct

Proximal conv. Tubule Papillary duct
Descending limb of loop of Minor calyces
Henle Major calyces
Ascending limb of loop of Renal pelvis
Henle Ureter
Distal conv. Tubule Bladder
Urethra

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 Urine Formation in Nephron
To produce urine, nephron and collecting ducts perform three
basic processes—glomerular filtration, tubular reabsorption, and
tubular secretion.
 Glomerular Filtration: In the first step of urine production,
water and most solutes in blood plasma move across the wall of
the glomerular capillaries into the glomerular capsule and then
into the renal tubule.

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Tubular Reabsorption: As the filter fluid flows along the renal
tubule and the collecting duct, the cells in the tubule reabsorb
about 99% of the filtered fluid and many useful solutes. Thus,
the water and solutes return to the blood.
Tubular secretion: As the fluid flows along the renal tubule and
the collecting duct, their cells secrete other materials, such as
wastes, drugs, and excess ions, into the fluid. Thus tubular
secretion removes waste substances from the blood.

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 Ureter
The Ureters are thick walled tubes which are 25-30 cm long and
1 to 10 mm in diameter.
Three layers form the ureters.
The outermost layer is adventitia, the middle is lamina propria,
and the innermost is mucosa which is surrounded by
muscularis.
The ureters open obliquely through the wall of the posterior
aspect of the urinary bladder.

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 Urinary Bladder
The urinary bladder is a hollow, distensible muscular organ
situated in the pelvic cavity posterior to the pubic symphysis.
In males it is anterior to the rectum; in females, it is anterior to
the vagina and inferior to the uterus.
Folds of the peritoneum hold the urinary bladder in position.
It rises into the abdominal cavity when it is full. Urinary bladder
capacity averages 700—800 ml.
it is smaller in females because of the uterus.

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 In the floor of the urinary bladder is a small triangular area
called the trigone.
The two posterior corners of the trigone contain the two
ureteral openings and internal urethral orifice.
The three tissue layers of the wall of the urinary bladder are the
same as those of the ureters. The muscularis that surrounds the
mucosa is also called detrusor muscle (detrusor= to push
down).
Rugae (the folds in the mucosa) are also present to permit
expansion of the bladder.
Inferior to the internal urethral sphincter is the external urethral
sphincter which is under voluntary control.

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 Urinary Bladder

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 Urethra
The urethra is a small tube leading from the internal urethral
orifice in the floor of the urinary bladder to the exterior of the
body.
Urethra in female is shorter (4 cm) than that in the male (20 cm).
There are two urethral sphincters, internal and external.
 The internal sphincter muscle of urethra: located at the
bladder's inferior end and the urethra's proximal end at the
junction of the urethra with the urinary bladder. The internal
sphincter is made of smooth muscle, therefore it is under
involuntary or autonomic control.

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 The external sphincter muscle of urethra:
located at the bladder's distal inferior end in females and inferior
to the prostate (at the level of the membranous urethra) in males.
Unlike the internal sphincter muscle, the external sphincter is
made of skeletal muscle, therefore it is under voluntary control
of the somatic nervous system. The male urethra is subdivided
into three regions:
Prostatic urethra—passes through prostate
Membranous urethra—the shortest portion which passes through
the deep perineal muscles.
Spongy urethra—the longest portion which passes through the
penis

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 Urethral sphincters

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 Urinary tract infection
Definition:
A urinary tract infection (UTI) is an infection that
affects part of the urinary tract.[1] When it affects the
lower urinary tract it is known as a bladder
infection (cystitis) and when it affects the upper
urinary tract it is known as kidney infection (
pyelonephritis)

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 Causes of UTIs
Urine is normally sterile, which means it doesn’t
contain any bacteria, fungus or viruses. To infect the
urinary system, a micro-organism usually has to enter
through the urethra or, rarely, from the bloodstream.
The most common culprit is a bacterium common to
the digestive tract called Escherichia coli (E. coli). It is
usually spread to the urethra from the anus.

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 Other micro-organisms, such
as mycoplasma and chlamydia, can cause urethritis in
both men and women. These micro-organisms are
sexually transmitted so, when these infections are
detected, both partners need medical treatment to
avoid re-infection

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 Symptoms of UTIs
Some of the symptoms include:wanting to urinate
more often and urgently, if only a few drops
burning pain or a ‘scalding’ sensation when urinating
a feeling that the bladder is still full after urinating
pain above the pubic bone
blood in the urine.

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 People experiancing pyelonephritis may experience
flank pian, fever,nausea and vomiting.
pyuria ( pus in the urine) may
also occur. In chid incontenence may occur

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 Types of UTI

URETHRI
uuURETHRITIS

urethritis – infection of the urethra

cystitis – infection of the bladder
pyelonephritis – infection of the kidneys.

 PROSTATITIS
 CYSTIT
 PROSTATITIS

 CYSTITIS

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 Cystitis
Cystitis usually occurs when the urethra and bladder,
which are normally sterile (microbe-free)
become infected by bacteria.
Bacteria fasten to the lining of the bladder using
thread-like structures (pili); this causes the area to
become irritated and inflamed.

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 Cont…..
Cystitis affects people of both sexes and all ages. It is
more common among females than males, because
women have shorter urethras.
Approximately 80 percent of all
urinary tract infections are caused by Escherichia
coli.

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 Cont……..
These bacteria form part of the healthy intestinal flora.
However, virulent types may get into the bladder
through the urethra and cause urinary tract infections.
Urinary tract infections account for a large proportion
of hospital-acquired infections, especially among
patients using urinary catheters.

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 Pathophysiology
Cystitis, acute or chronic inflammation of the
urinary bladder. The bladder, the storage sac for urine,
is lined with a mucous membrane and coated with a
protective protein layer. As a result, it is usually highly
resistant to infection or irritation. Occasionally,
however, infections arise from such neighbouring
organs as the kidneys, the vagina and urethra (in
females), and the urethra and prostate gland (in males).

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 Cont……
Other conditions such as obstructions, tumour
growths, physical injuries, and bladder stones can
disrupt the bladder and leave it more vulnerable to
infections. When cystitis occurs in very young males,
an underlying structural abnormality of the
genitourinary system should be suspected

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 Urethritis
Urethritis is a condition in which the urethra, or the
tube that carries urine from the bladder to outside the
body, becomes inflamed and irritated. Semen also
passes through the male urethra.
Urethritis typically causes pain while urinating and an
increased urge to urinate. The primary cause of
urethritis is usually infection by bacteria.

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 pathophysiology of urethritis
The cells of the mucous glands in the lining of the
urethra serve as important harbouring places for the
chlamydial and gonococcal bacteria, which invade the
glands while the infection is just beginning and remain
in them even after the mucous membrane has healed

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 Cont…..
. Another common urethral infection is caused by the
protozoan Trichomonas vaginalis, frequently resident
in the vagina. Chemical irritants or the spread of
infection from other parts of the urinary tract may also
cause urethritis. Urethritis can also be caused by
trauma, such as caused by the introduction of foreign
bodies into the urethra.

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 Symptoms in male
burning sensation while urinating
itching or burning near the opening of the penis
presence of blood in the semen or urine
discharge from the penis

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 Symptoms in female

more frequent urge to urinate

discomfort during urination
burning or irritation at the urethral opening
abnormal discharge from the vagina may also be
present along with the urinary symptoms

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 Pyelonephritis
Pyelonephritis is an inflammation of the kidney tissue
, calyces, and renal pelvis.[1] It is commonly caused by
bacterial infection that has spread up the urinary tract
or travelled through the bloodstream to the kidneys.

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 Risk factors for developing UTIs

Some people are at greater risk than others of

developing UTIs. These include:women – sexually
active women are vulnerable, in part because the
urethra is only 4 cm long and bacteria have only this
short distance to travel from the outside to the inside of
the bladder
people with urinary catheters – such as the critically
ill, who can’t empty their own bladder

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 Cont…..
people with diabetes – changes to the immune system
make a person with diabetes more vulnerable to
infection
men with prostate problems – such as an enlarged
prostate gland that can cause the bladder to only
partially empty
babies – especially those born with physical problems
(congenital abnormalities) of the urinary system.

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 TREATMENT
 Antibiotics usually are the first line treatment for
urinary tract infections. Which drugs are prescribed
and for how long depend on your health condition and
the type of bacteria found in your urine.

 in uncomplicated cases usually a short coarse of

antibiotics is given for one or three days while in
complicated cases long coarse of antibiotics or
intravenous antibiotic is given.

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 Cont……
drugs commonly recommended for simple UTIs
include:

Fosfomycin (Monurol)

Ciprofloxacin (Cipro)
Levofloxacin (Levaquin)
Cephalexin (Keflex)

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 Nursing diagnosis
 stress and anxiety R/T inflammation S/C to infection
of urinary tract.
 Vomating and nausea R/T disease proccess.
 Burning sensation R / T disease proccess .
 Dysuria R/T inability to pass urine
 Urge to frequent urination R/T inability to pass urine.

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 cont……
 Incontinence (loss of urinay bladder control) may
occur in childern.
 Pyuria (pus in the urine) R/T infection.
 Pain and fever R/T to disease.

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 PREVENTION
 MAINTAIN HYGIENE:
Wash hands before usings toilets.
Wipe front and back after urinrating or defecation.
Clean urethral meatus first while bathing.
Use wash cloth to clean pernium.

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 Cont……
Encourage the child to voide to more freqently and
empty bladder.
Plenty of oral fluid.
Treatment of constipation ,pin worm.

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