Cystitis

Overview bladder is the most common urinary system diseases, particularly female styles. Of the disease in most cases not as an independent diseases. urinary infection but part of the urinary system or other diseases of secondary infection. Normal bladder of a strong bacterial resistance, the bacteria is difficult to pass urothelial invasive bladder wall, distal urethra of bacteria that normally can not enter the bladder, the bladder Even in normal circumstances, along with the excretion of urine and expelled from the body, and causing bacteria in the bladder can not remain, breeding and causing infections. But the upper urinary tract infections, lower urinary tract obstruction, bladder disease resistance itself reduced, normal bladder mucosal barrier against infection vulnerable to damage, bladder infections also can easily cause. Bladder inflammation that can be divided into acute and chronic two, the two can transform, acute cystitis may not definitive treatment of chronic persistent. Chronic cystitis in the lower body resistance or aggravating factors partial lesions, but also into acute attack. Pathology Disease (1) pathogens : bladder nonspecific infection is the most common gram-negative bacillus bacteria yes, about 70% more of these bacteria including Escherichia coli, Proteus, gas production bacteria, and vice Escherichia coli, Pseudomonas aeruginosa. Followed by Gram-positive cocci, it is common for staphylococcus, streptococcus, a rare fungal infection. Clinical seen many cases is caused by a bacteria caused by the above mixed infection. (2) - induced factors : destruction of all antimicrobial normal bladder mucosa, changes in the normal bladder wall structure and suitable for bacteria stranded the growth and reproduction of all the factors can be induced cystitis happening. If urinary retention caused by the excessive expansion of the bladder damage normal bladder mucosa of the barrier, lower urinary tract obstruction caused by residual urine is not an effective way to enter the bladder bacteria excreted, stone, foreign body damage to the bladder mucosa of the normal organizational structure, tumor necrosis organization is conducive to bacterial growth and reproduction, Endovascular urinary examination and treatment such as catheterization, urethral dilation, cystoscopy, retrograde pyelography check if such operations were crude, the idea of sterile poor, but also for the bacterial invasion provided the opportunity. In addition, cystitis can still secondary to the system or the adjacent organ infection, such as kidney, prostate, vagina, cervical and other parts of the inflammation. (3) infection in a way. Uplink infections : bacteria enter transurethral bladder, the most common source of exposure. The female urethra is short and straight, especially infants, pregnant newlywed period and more susceptible to cystitis. Urinary screening Transurethral operation bacteria into the bladder, after indwelling catheter can be induced cystitis. 2. Downlink infections : secondary infection in the kidneys, urine by the bacteria with the ureter into the bladder. 3. Local direct infection : bladder after ostomy skin directly with the outside world, so that the vesicovaginal fistula, bladder Fistula, Fistula by bacteria directly into the urinary bladder causing infections. Clinical manifestations (1) acute cystitis incidence of acute cystitis sharp, and often too tired, catch cold, prolonged limp urine, life after the disease, the course is typically a two-week dissipated on its own or after treatment dissipated. Its incidence is characterized by "radical" inflammatory response "important" lesions "shallow." Common symptoms of urinary frequency, urgency and urge irritation, pyuria and terminal hematuria, or even entire gross hematuria. Due to severe bladder inflammation and spasm of the bladder so urine can not be stored, not counting frequent urination. incontinence similar phenomenon. Acute inflammatory lesions in the "shallow", bladder mucosa absorption capacity is very weak, urinary frequency pyuria make timely discharge, So simple acute cystitis systemic symptoms mild fever is not over. If chills, fever, they should also consider merging with other genitourinary organs between the presence of acute infection. (2) chronic cystitis chronic cystitis symptoms and acute cystitis similar, but to a lesser extent. its incidence is characterized by "slow" inflammatory response "light" lesions "deep." Chronic cystitis often secondary to other primary lesions, only in very few cases is an independent disease. Therefore, the chronic cystitis is found to have special or permanently disabled patients are required for the inspection, find out the cause of illness for effective treatment. Diagnosis of acute cystitis due to symptoms more typical, general diagnosis is not difficult. Under Frequency urination, urgent urination and irritation of history, urine routine examination showed red blood cells, pus, urine bacterial cultures of bacteria per milliliter of urine counts more than 100,000 will be diagnosed. Chronic cystitis mostly secondary to the genitourinary system in other diseases, as urinary tract obstruction, bladder primary lesion, on the genitals or urinary tract infection. Therefore, in addition to general diagnosis general inspection, the most important thing is to identify the types of bacteria and drug sensitivity test results, Find causing infections continuation or recurrence of reasons. For a long time, the result is not satisfactory treatment or recurrent patients, it would need to conduct a comprehensive inspection of urinary system, including dilated cystoscopy examination, excretory urography and angiography bladder, and, when necessary, may make bladder tissue biopsy and the adjacent organs of inspection, to identify the cause cystitis incentives. Chronic nonspecific cystitis and specificity to differentiate cystitis, such as tuberculosis cystitis (Table 6 -1) Interstitial cystitis, and trichomonas, rheumatoid fungal bladder. Table 6 -1 nonspecific cystitis and tuberculous cystitis identification project nonspecific cystitis tuberculosis cystitis symptoms repeatedly attack, when light when a steadily increasing weight, General symptoms stubbornly negative urine culture positive urine within Mycobacterium tuberculosis can be negative as positive cystoscopy extensive congestion, Visibility edema tuberculosis nodules or ulcers pyelography normal destructive lesions for the treatment of non-specific treatment of cystitis, relying solely on the antibacterial drugs to control infection, often failed to achieve the desired effect. If cystitis patients infected not only clearly exists, also be able to identify the causes that lead to infection and to give the necessary time, and enhance the patient's body resistance. be more effective infection control, prevent repeated attack. (1) general treatment of acute cystitis patients in need of appropriate rest, the water to increase urine output, attention to nutrition. do not eat hot spicy food, hot water bath with ease symptoms. Irritable bladder symptoms of the patients given drugs to ease symptoms of spasticity. (2) the treatment of anti-infective drugs based on urine culture and sensitivity test results drug effective use of antibacterial drugs. Has been obtained from the bacterial culture results before the acute infection, he calls for the prompt treatment. So can first obtain urine smear Gram staining, According seen bacillary or cocci initial treatment program prior treatment, or can be applied to broad-spectrum antibiotics or urinary excretion within high concentrations, the side effects of antibiotics, such as sulfonamides, furans, when we have bacterial culture and drug sensitivity test results after adjustment treatment programs. Treatment should be adequate dosage, will take a longer time, generally applied to the symptoms dissipated, urine routine after continued use of the normal one to two weeks. To the course of treatment for recurrent urinary bacterial culture and drug sensitivity testing of bacteria at any time sensitive antibacterial drugs, with a view to achieving an early and complete cure, and to prevent recurrence. (3) treatment causes a significant incentive to chronic cystitis, must be lifted cause, otherwise, cystitis difficult to control. If removing the obstruction, foreign body removal of the bladder stone; For women found to have cystitis should conduct gynecological examination, to exclude and treatment of female reproductive tract inflammation; right upper urinary sources, such as male circumcision inflammatory prostatitis. should also actively addressed. Chronic cystitis could also be carried out within the bladder drug perfusion, bladder irrigation, such as 0.5 ~ 1% neomycin fluid, 1 / 5000 ~ 1 / 10000 of silver nitrate solution, 5% ~ 10% of the protein liquid silver and 0.5% metronidazole and other liquid.