医药健康泌尿系结核tuberculosis（tb） of the genitourinary 课件

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1、Tuberculosis(TB)oftheGenitourinaryTract泌尿生殖系结核瑞金医院泌尿外科UrinaryTBAdiseaseofyoungadults.60%between20~40y.Infectingorganism—Mycobacteriumtuberculosis(结核分支杆菌，结核杆菌),TuberclebacilliInfectingRoute(感染途径)Hematogenousroute(血行途径)fromthelungs.Primarysites(初发部位):Kidney,Prostate(前列腺)Otherorgansin

2、volved:directextensionPathogenesis(发病机理)Tuberclebacillihittherenalcortex(肾皮质):Normalresistance(抵抗力):organismdestroyedSufficientvirulence(致病力):clinicalinfectionestablished.PathogenesisTBofkidney:progressesslowly,15~20ytodestroyakidneywithgoodresistance.Noclinicaldisturbanceuntilth

3、ecalyces/pelvis(肾盏/肾盂)involved.Pathology(病理)Kidney&Ureter(输尿管)Grossly:asoft,yellowishlocalizedbulge(隆起).Onsection:involvedareafilledwithcheesymaterial(caseation,干酪样物质).Kidney&UreterWallsofpelvis,calycesandureterthickened.Ulceration(溃疡形成)incalyces.Completeureteralstenosis(输尿管狭窄)Aut

4、onephrectomy(肾自截).Bladderurinenormalandsymptomabsent.Kidney&UreterBasiclesion——Tuberclefoci(结核结节)Epithelioidreticulum(上皮样网)PeripheralgiantcellsHealbyfibrosis(纤维化).Kidney&UreterTBisacombinationofcaseation(干酪样变),cavitation(空洞形成)andhealingbyfibrosis&scarring(纤维化和疤痕愈合).Dependingonviru

5、lencevsresistance.Calcification(钙化):stronglysuggestiveofTB.Secondaryrenalstonesin10%.Leftkidney:autonephrectomyRightKidney:hydronephrosis&ureteralreflux(肾积水&输尿管返流)Contractionofthebladder(膀胱孪缩)左肾萎缩萎缩肾外观Caseation&FibrosisLRenalDysfunctiononIsotopeScan(同位素扫描)Calcification(钙化)BladderT

6、ubercleform:white/yellowraisednodules(结节)surroundedbyahaloofhyperremia(充血).Tuberclesbreakdowndeepraggedulcersbladderirritable.膀胱结核，多个粟粒样黄色小结节膀胱结核，结核性溃疡Diagnosis(诊断)Justsayingyouhadturnedacornerdoesn’tmakeitso.Justsayingthereismassivedestructiondoesn’tmakeitso.__JohnKerryJustsayin

7、gthereisTBalsodoesn’tmakeitso.Wemustprovide……Demonstrationoftuberclebacilliinurinebyculture.Diagnosis:Symptoms(症状)NoclassicclinicalpictureofrenalTB.Mostarevesicalin-origin(膀胱起源):burning,frequency(尿频)&nocturia(夜尿),hematuria(血尿)Diagnosis:Signs(体征)Kidney——noenlargement/tenderness(触痛)E

8、xternalgenitalia(外生殖器):thi