NHIM TRNG

TIU
i tng: Y4

ThS BS HUYNH NGOC PHNG THO

MC TIU

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 NTT
5. Trnh by cc bin chng ca NTT.

NH NGHA
-

Nhim 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 NGHA
-

NTT 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 NGHA
-

NTT 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 TRNG
-

Nc tiu:

m o:

Bng quang:

Niu qun:

Thn:

p ng min dch:

CC C CH BO V NG
TIU CHNG NHIM TRNG

Nc 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 th
Dng nc tiu lu thng t tren cao xung

CC C CH BO V NG
TIU CHNG NHIM TRNG

m 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 TRNG

Bng quang:
Kh nng tng xut NT ca BQ
Lp 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 TRNG

Thn:
Vng v thn khng nhim trng tt hn vng
ty

Cc 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
1. Be tac ng tieu.
2. Trao ngc.
3. Tuoi va gii.
4. Cac thu thuat
5. Cac benh ly noi khoa.
6. Thai k
7. BQ thn kinh
8. Suy gim min dch

CC YU T NGUY C

CC YU T NGUY C

CC YU T NGUY C
Thai k

Tn 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 BNH

E. Coli:
KN v K: c ch kh nng thc bo

KN O: Phn ng vim, t ln c trn NQ

Cc cu trc ngai tb nh pili hay

fimbriae.

Hemolysin: polypeptide c tb

TC NHN GY BNH
-

VIM NIU O LY QUA QUAN H

TNH DC:
Do Chlamydia trachomatis, Neisseria
gonorrhea

CC KST V SIU VI
Adenovirus gy vim BQ xut huyt

Herpes gy vim niu o cp

Mt vi lai KST

NG VO CA TC NHN GY
BNH
-

NG NGC DNG:
Thng gp nht

NG MU

NG VO T CC CQ KHC:
D ng tiu ra da, vo m o, vo
i trng.

LM SNG
Hi chng niu o cp: tiu but gt,
tiu lt nht v tiu gp.
au h v trn xng mu
Tiu c
i khi tiu mu i th.
St km n lnh
au 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)

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:
LU m

tnh gi: ch n t nitrate, dng thuc li tiu, pH NT acide, nc

Nu
c trong
leucocyte
tnhc
thmen
kh nng
nhim
trng tiu cng cao
tiu
BQesterase
di v
4h,nitrite
VKdng
khng
nitrate
reductase

XT NGHIM NC TIU- TPTNT

SOI TI NT

BC, Tb m

Nhum Gram

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

CH NH CY NT

C 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:

1.

Ly nc tiu gia dng

2.

Thng tiu

3.

Chc ht bng kim v trng qua BQ trn xng mu

4.

Chc ht kim v trng qua h thng ng thng tiu

kn.

5.

Trc v sau khi xoa nn TLT chn an tiu VK

t TLT

CHN AN NTT THEO PHNG

PHP LY NT
Phng php Tiu chun xc nh tiu VK c ngha
ly NT
Gia dng

N c TCLS 103 khm coliform/mL hoc

105 khm khng phi coliform/mL
Nam c TCLS 103 khm VK/mL
Khng c TCLS 105 khm VK/mL cng mt
lai VK qua hai ln cy lin tip.

Chc ht BQ > 102 khm VK/mL

Thng tiu

103 khm VK /mL

CY NT

m 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 KHC

Cy mu.
Chc nng thn
Cng thc mu, CRP

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

hin bin chng ca nhim trng tiu.

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..

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).

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 SNG

VIM BQ CP:
Hi chng niu o cp: tiu but
gt, tiu lt nht v tiu gp.

au h v trn xng mu
Tiu nhiu BC, tb m
Tiu mu i th (Vim BQ xut
huyt)

LM SNG

VIM NIU O CP:

Hi chng niu o cp: tiu but
gt, tiu lt nht v tiu gp.

Tiu c u dng
VK thng gp ly qua quan h tnh
dc nh: Chlamydia trachomatis,
Neisseria gonorrhea, Herpes simplex

LM SNG
-

VIM TIN LIT TUYN CP:

Triu chng ca vim BQ cp

St, lnh run, HC nhim trng

TLT au khi thm khm trc trng.
-

Bin chng: Abces TLT, b tiu cp, NT

huyt.

LM SNG

VIM TIN LIT TUYN MN:

NTT ti pht thng xuyn

Tiu m, au vng gn hu mn

Khng st, lnh run, khng HC nhim

trng r rt

Thm khm TT: khng c hiu.

Chn an: NP xoa bp TLT

LM SNG
-

VIM I B THN CP

St cao, lnh run

au gc sn lng hoc vng hng lng
cng bn
Hi chng niu o cp c th xy ra trc
vi ngy hoc i km cc triu chng trn.
TPTNT: tr BC
HC vim: BC tng ch yu N, CRP tng

LM SNG
-

VIM I B THN CP

Bnh 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 SNG
VIM I B THN MN

NTT ti pht nhiu ln

Triu chng ca suy thn mn

NHIM TRNG TIU KHNG

TRIU CHNG
-

Cy NT gia dng 2 ln cch 24h

105 khm/mL

Thng gp ph n c thai, ngi

gi, T, thng tiu lu, si thn.

NHIM TRNG TIU DO THNG

TIU LU
-

10-15% 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 THAI
-

Nhim trng tiu l bnh l thng gp ph n c

thai (5-10%), c nh hng nghim trng n c m
v thai

Cn 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 AN
1. Da vo triu chng lm sng
2. Tiu Bch cu, tiu m
3. Tiu vi khun

CHN AN

Nhim 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 BIT

1. Phn bit cc nguyn nhn gy tiu
but gt khng do nhim trng tiu
2. Phn bit cc nguyn nhn gy au
lng
3. Phn bit cc nguyn nhn gy tiu
bch cu, tr bch cu

BIN CHNG

- Nhim trng huyt

- Abces thn hoc Abces quanh
thn
- Hai t gai thn
- Vim BQ sinh hi v vim i
b thn sinh hi.

BIN CHNG NHIM TRNG HUYT

-

Thng gp VK Gr (-), cc c
a:

c thc hin cc th thut trn ng

tiu.
Abcs thn
C 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 THN
-

St, 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 THN

-

trn 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 HI
-

Thng 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 TR

Chn 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 TR

Thi gian iu tr:

- Bnh cnh lm sng
- c a bnh nhn
- Ti pht hay ti nhim

NGUYN TC PHNG BNH

- Tm 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