PATHOPHYSIOLOGY of GENITOURINARY TUBERCULOSIS

CONTRIBUTING FACTORS:
PREDISPOSING FACTORS:
-Environment
-Age: 20 years old
>poor sanitation
-Gender: Male PRECIPITATING FACTORS: -socio-economic status
Mycobacterium tuberculosis -lifestyle condition

Exposure or inhalation of infected aerosol through droplet nuclei

(exposure to infected clients by coughing, singing, sneezing, and talking)

Tubercle bacilli invasion in the apices of the lungs or near plurae of the lower lobes to the alveoli

Bacterial cell wall binds with macrophages

Phagocytosed tubercle bacilli are ingested by macrophages

Arrest of phagosome; triggers bacilli replication

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 Bronchopneumonia develops in the lungs’ tissue

Necrotic Degeneration occurs

Production of cavities filled with cheese-like mass of tubercle bacilli, dead productive coughs
WBC, and necrotic lung tissue

Drainage of necrotic materials into the Alveoli fluid increase

tracheobronchial trees

Decrease gas exchange difficulty of

Ghon’s Lesions may calcify and form scar and breathing
Complex heal over a period of time
Decrease O2 supply in the pallor
blood

Tubercle bacilli immunity Tubercle bacilli remain in Decrease O2 supply in the malaise, fatigue and
develops (2-3 weeks of the body as long as living blood tissue syncope
infection) bacilli remains in the body

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 Acquiring the immunity leads to further growth of
infection or bacilli development

ACTIVE INFECTION

Activation of Activation of Activation of Increase capillary

hypothalamus thalamus hypothalamus permeability

(+) Sputum Test

Elevated thermal release of Loss of appetite Fluid in
regulation nociceptors interstitium

fever Dorsal horn Weight loss Reduce gas

interneurons exchange

Spinothalamic cyanosis
pathways

Sensory cortex

Acute chest pain Palpable slow Persistent

growing masses productive cough

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 Immunosuppression of all systems

Reactivation of the tubercle individuals

SECONDARY INFECTION

Severe occurrence of lesions in the lungs

Cavitation in the lungs occurs

thoracic duct delivers mycobacteria T. to the venous blood

(-) Sputum Test

06/25/2010 Secondary infection spreads throughout the body systems through bloodstreams

Infiltration of tubercle bacilli in other organs

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 Slow tissue destruction of the renal cortex and medulla
Laboratory results:

(June 16, 2010)

Renal medullary hypertonic environment impairs the phagocytic function
WBC=17.47x10g/L:
Neutrophils=86.4%:
Eosinophils=1.3%:
Granulomas formation into renal pelvis
Lymphocytes=5.4%:

(July 1, 2010) Progressive ulceration of fine necrotic debris into renal pelvis
Lymphocytes=18.5%:
Monocytes=14.5%:

Kidney becomes fibrotic and scarred

(July 10, 2010)
Lymphocytes=15.5%:
Monocytes=11.8%:

Slow tissue destruction into the urinary ureter Hematuria, dysuria,

distended urinary
bladder

Tubercles involve the transitional epithelium

Mucosal granulomas scheme into the ureteric lumen

fibrosis occurs

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 Growing granuloma continuously erode into the urinary bladder

Interstitial cystitis occurs

XRAY result:
Negative
Bladder mucosal ulceration and thickening of the bladder wall
(June 21, 2010)

UTZ result: Distention with diffuse urinary sediments

(June 21, 2010)
Nephritis both
Kidneys with left
pelvocaliectasia, distended
urinary bladder with diffuse
urinary sediments vs. pelvic
abscess formation with fine
necrotic debris.
Surgical Procedure done
(July 08, 2010)
under Dr. Castillo
Diminished capacity of the urinary bladder Suprapubic Tube
Cystostomy
Growing granuloma continuously erode into the urethra

Infection widely spread will form large, caseating

masses to destroy renal tissue Pressure ulcer grade
1 at left ischial area

Renal pelvic traction and calcium deposition with stone 24

formation and stricture formation
 Enlargement of granulomas Pelvic abscess
or pelvocliectasia formation Surgical
Procedure done
(July 08, 2010)
under Dr.
Bacteria migrates to skin Castillo
Obstruction and Incision and
Urinary retention progressive renal Drainage of
dysfunction Right Thigh
Right thigh abscess
formation Abscess

Painful and inflamed

Tubercles reach the epididymis
scrotal swelling

Partial or complete
Intraluminal calcification in the vas deferens with
occlusion or
tuberculosis
blockage Fibrosis
of the and
Tuberculosis of the seminal vesicles
lumen
calcification occurs

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 Antegrade infection
Tuberculosis in prostate gland
within the urinary
tract

Characterize as thin Fibrosis, inflammation,

and reddish blue, Tuberculosis in scrotum sinus tracts and focal
pale granulation micro-abscesses
tissue with scanty secondary to bacterial
serosanguineous infections
discharge and ulcer

Characterize with lesion and few

erythematous, non-tender and necrotic
Tuberculosis in penis
papules, pustules and granulation
tissue

Patient base

Case base

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