??F????T??S?

1
??F????T??S?
O? ?ef??????as? ?a?a?t????eta? ? pa???s?a ?????
?p??d?p?te st?? ap??ete?t??? µ???a t??
?ef??? ?? ????? s??µat????ta? st?? a??te??
ap??ete?t??? µ???a ?a? st?? p?e????t?t? t???
ap?te????ta? ap? ???st?????? p?? ?p?????? sta
???a.
2
??????????G??

• S????t?ta 4-6 t?? ?e????? p????sµ??
• ???sß???e? s????te?a ??d?e? (21) s?????t??? p???
  t?? ???a??e?

3
???????G??

• Ge?et??? ???d???es? (??st??????a,
  ?a??????a,?pe???a?????a, p??t?pa???)
• ??µ???af???? ?a?????te?
• Ge???af??? ?ata??µ? (???µa)
• ?p???a?? ?ata??µ?
• ??a?t?t???? pa?????te?
• (?e?? p???s?? se Ca ?a? Mg, ?a?a?t???µ???,
  ß?taµ??? C,D, p??te??e?, p?????e? ?.a)

4
??F????T??S?

• ??F????? ??T??
• O?a????? asßest???
• F?sf?????? a??t?? asßest???
• F?sf?????? a??t?? µa???s???
• ????a????? asßest???
• Te????? asßest???
• ??????? a??t??
• ??st????
• ?a??????

5
??????? ??????

• ?s?µpt?µat??? (t??a?? e???µa)
• ??µat????a
• ??????? ?ef???
• ??e???ef??t??
• ?ef???? ??ep???e?a

6
??G?S???????S ???G??S

1. ??µat???????? ??e???? (Ge???? ??µat??, ????a,
   ??????, ??eat?????)
2. Ge???? ????? (a?µat????a-p?????a)
3. ?pe?????st???? ??e???? (Ro NOK, U/S, Scanning)
4. ??e???? a?t??? ????as?? (Ca, Mg,P, PTH)

7
??T?G?????

1. Te???a t?? ???a????? µ?t????? ??s?a? (matrix)
2. Te???a t?? ?pe????esµ??
3. Te???a t?? a?ast????? (µa???s??, ??t????,
   p???f?sf?????, aµ?????a, p???sa??a??te?)

8
????????S

• ????????O???S
• ??????F?OS?
• ??F???? ??????????

9
????O???S ?????????????
????????S?
?at?te??? ????p???t???? ???????t??
??st?t?? ???stat?t??
???te??? ????p???t???? ??e?a p?e???ef??t??
??d??ef???? ?a? pe???ef???? ap?st?µa ? ???µ???
µp??e? ?a ?p???e? se d??f??e? est?e? ta?t?????a.
?p??e? ?a e??a? s?µpt?µat??? ? as?µpt?µat???.
?????a p?e???ef??t?? ?a??????a?at?µ????
????. ??af??eta? se ?????a d??µes? ?ef??t?da
?fe???µe?? se ???µ???.
10
(No Transcript)
11
????????S? ????O??O? ?????????????
???? e??a? ep?pep?e?µ???
?? ?p?pep?e?µ??? G??a??a p?? ?at? ta ???a e??a?
????? ?e?
??e? ?aµ?a ?p??e?µe?? ß??ß? ?a?

de? e??a? ??????.
?p?pep?e?µ??? ???e ???? ???????µ???.
12
??t?a ?p?pep?e?µ???? ???????µ???? -1-
??at?µ???? ? ?e?t???????? a??µa??e? ???stat?t??
?p?f?a?? ????as? ?e????????? ??s?µata ??ste????
?t????? pa???d??µ?s? ??ata?a?? ?ef?????
?e?t?????a?
13
??t?a ?p?pep?e?µ???? ???????µ???? -2-
?e???sµ?? st? ????p???t???
?????a?et??a?
?ef??st?µ?a
??p???t?s? pig-tail
?etaµ?s?e?s? ?ef???
?p??e?µe?a ??s?µata
Sa??a??d?? d?aß?t??
???s??atast??? ? a??s?a?ep???e?a
??epa????tta???? a?a?µ?a
??????st??? ??s??
???s?
?a?d??? ?????a
14
????O???S ?????????????
?a?????e?a
???? µ????ß?a p???a???? ???????µ??e??
Escherichia coli, st? 80-95 t?? µ?
ep?pep?e?µ????. Proteus, p??d?a??te? se
????as?. Klebsiella, p??d?a??te? se
????as? ?nterobacter, Pseudomonas, Serratia se
ep?pep?e?µ??e? s??????. Staphylococcus
saprophyticus, pe??p?? 10 se ??e?e? ??st?t?de?
se ??e? ???a??e?. Enterococcus Staph.aureus,
s?????? ?at?p?? µ????ß?a?µ?a?.
15
????O???S ?????????????
?a?????e?a
??? e?s?????ta? st? ????p???t???
?????sa ?d?? 95 ??µat??e???, p.?. Staph.aureus
? Candida. ?eµf??e???.
16
????O???S ?????????????
?a?????e?a
?a?????te? p?? af????? t?? ?e??st? ?a? p??
p??d?a??t??? se ???????µ???
?p????sµ?? t?? ???p?? µe Gram-a???t??? e?te????
ßa?t???d?a.
Se???a???? epaf? ???a?? f?s????????? ?????da? ap?
???s? a?t?ß??t???? ??t?s????pt???, ?p??
d?af???µata ?a? spe?µat??t??e? a???f??
?p?f?a??
????? ????? Ste??µata ?pe?t??f?a p??st?t?
?e????e??? d?ata?a?? t?? ?e?t?????a?
Sa??a??d?? d?aß?t?? ???ße? ??t?a???
µ?e??? S??????s? ?at? p???a?
17
???µ??e?? ?at?t???? ????p???t????

• ?a?????te? ???d???? ??e? ???a??e?
• ???????µe?? ?st????? ?.?.
• Se???a???? ?????
• ???s? ??af???µat??
• Spe?µat??t???
• ??aß?t??
• ???t?pa??? ?????? ?????s?
• ??epa????tta???? a?a?µ?a (???s?)
• ?a??µßas? µe e??a?e?? ?a?et??a

18
???µ??e?? ?at?t???? ????p???t?????a?????te?
???d???? ???? ??d?e?

• ??? pe??t?µ?
• ?µ?f???f????? d?ast????t?ta
• AIDS

19
?a?t???????a ?p?pt?s??.G??a??e?

• ????? ?????OS?
• ?a??t??e? 1-2
• ??e? se?.e?e??e?? 2-4
• gt 60 et?? 6-8
• 70 et?? 5-10
• 80 et?? 20
• ?d??µat. ??????µ???? 30-50
• Chambers ST, 2000

20
?a?t???????a ?p?pt?s?B. ??d?e?

• ????? ?????OS?
• ?a?d?? µ?s? ?????a lt1
• 60-65 1- 3
• gt 80 et?? gt10
• ?d??µat. ??????µ???? 20-30
• Chambers ST, 2000

21
????O???S ?????????????
?a?????e?a
?a?????te? p?? af????? t? µ????ß?a
Se f?s???????? ????p???t??? ???µ??? p???a???? ta
???apa?????a µ????ß?a
?.coli
???s?????t??e? (adhesins) ?ast???a, apa?a?t?ta
??a ????s? ?a?a???? a?µ???s????, p?? d?µ?????e?
p????? st? ??tta???? µeµß???? ?a?a????
ae??ßa?t????, p?? s???e?t???e? s?d??? ??t?stas?
st? ßa?t?????t??? d??s? t?? ????.
Proteus mirabilis
???e?s? - d?asp? t?? ????a a??a???? pH ?????
?ata???µ??s? f?sf????, a???a????? ?a? µa???s???
- ????as?
22
????O???S ?????????????
??????? e????a
?e? epa??e? ??a ?a te?e? ? d?????s? t?? ???µ????
t?? ????p???t????
??af????? d?????s?
??st?t??
??s????a, S???????a ?pe??? p??? ????s?
??µat????a ?pe??ß??? ?????
???????t?? ???p?t?? (???sµ??, d?spa?e??e?a) ?pe?t?
?f?a p??st?t?? ?e?p??sµata
??e?a p?e???ef??t??
???et??, ????? ?sf???? ????? ??a?s??s?a st??
p?e???sp??d????? ????a ?a?t?a, ?µet??
23
???ast???a?? d?????s?
???tas? t?? ????? ??a p?????a
gt10 p??sfa???a/ml ?????
?a??????e?a ?????
gt100 CFU/ml se ???a??a µe s?µpt?µata ??st?t?da?
?a? p?????a gt1000 CFU/ml se ??d?a µe s?µpt?µata H
?et??? ?a??????e?a ????? ??? e??a? ap?de???
???????µ????.
?a??????e?a a?µat??
24
??? ???eta? ? s?st? ???? t?? ?????
1. ??p??? a?t?s???a µe a?t?s?pt??? d????µa p??
de? af???e?.
2. S???p?sµa µe µ?a ap?ste???µ??? ???a ??a ?a
ap?fe???e? a??µ??? t??
a?t?s?pt???? µe ta ???a.
3. G?a ?a µ?? ?????? se epaf? ta ???a µe t??
ß?e???????, apa???? t?? µe?????
?e????? st?? ???a??e? ?a? t??ß??µa
p??? ta p?s? t?? p?s??? st??? ??d?e?.
4. ? ???? ap? t? µ?s? t?? ????s??
?a ???a ??? ap? t? ???e?? d?at?????ta? µ??? µ?a
??a. ??sa st? ???e?? 24 ??e?.
25
????O???S ?????????????
Ste??a ??????a
??aµ?d?a, ???e?p?asµa ? f?µat??s? ?p?µ????s? t??
de??µat?? ?????a d??µes? ?ef??t?? ????ep?????a??
? ?????
?ef??????as?
26
????? ?? ??????G???? ??S??????

• ?pe?????? µ???????a??sµ?? E. Coli (70-95)
• ??????s? ?st?????, ??????? e??tas?, ?e???? ?????
  (?/a se ?t?pa s?µpt?µata)

27
????? ?? ??????G???? ???????F??????

• ??????s?
• ?st?????,
• ??????? e??tas?,
• ?e?. ?????,
• ?/a ????? (? 104 cfu/ml),
• ?/a ???, U/S ?ef???.

28
????? ???????F????S
??te ??e???eta? ape?????st???? ??e????
??d?e? ?a? pa?d?? ????? Sta
pa?d?? ??e???eta? ?a? ??e???? ??a
??ste?????t????? pa???d??µ?s?.
G??a??e? T? ?????S??? ???????G??F??? ??
?p???e? ??????? ?ef??? ? ????as? st?? ap??
???. ? p??et?? ep?µ??e? µet? t?? 72 ??e? pa?? t?
??????s? t?? ?at???????

a?t?µ????ß?a???
a?????. ?p?µ????eta? as?????st? µ????ß??, p.?.
?e?d?µ???da. ?a?e?a ?p?t??p? µe t? ?d?? µ????ß??
µet? t? d?a??p? t?? ?e?ape?a?.
29
?????S ?? ??????G????S ????????O???S S? ????S
?????S

• Sp???e? se ??d?e? 15-50 et??.
• ??????s? ?st?????, ??????? e??tas?, ?e?. ?????,
  ?/a ?????, e??tas? ?????????? e????µat??.

30
????????O???S S??? ??????? ??????

• ??????s? ? ?st?????, f?s??? e??tas? (???S???
  sta µ? e?d??? s?µpt?µata)
• ? ?/a ????? (a???????s?
  s?µf??a µe t??p? s???????)
• 90 E. Coli.
• ? U/S ?ef???,
  ??ste??????????af?a ?at? t?? ????s? (se a????a
  
• ap? t? 1? epe?s?d??
  ?a? se ????ts?a µet? t? 2? ).
• ? ?p? pa?????????
  e???µ?t?? DMSA scan.
• - Te?ape?a ? E??d?t?s?

31
??O????T?S ????T??????

• Se???a????? µetad?d?µe?? ??s?µa
• ??????s? ?st?????, ??????? e????a
• ?µes? e??tas? ?a? ?/a ?????????? e????µat??
  ?/a de??µat?? ????? p??t?? ????s??
• ?a??????? µ???????a??sµ?? ??????????, ??aµ?d?a,
  µ???p?asµa, t????µ???da

32
S??????? ???S????????S

• ????????S?
• O?e?a ßa?t???a?? p??stat?t?da
• ?????a ßa?t???a?? p??stat?t?da
• S??d??µ? ??????? p?e????? p????
• f?e?µ???de? WBC se sp??µa/ ??S/ VB3
• µ? f?e?µ???d??? a?t??????a?
• ?s?µpt?µat??? f?e?µ???d?? p??stat?t?da
  (?st??????? p??stat?t?da)

33
S??????? ???S????????S

• ?a??????? µ???????a??sµ?? a?e???s???ta? se
  5-10 t?? as?e???
• ? ??ßa??? E. Coli, Klebsiella sp.
  , Proteus mir. , Enterococcus,
  Pseudomonas
• ? Aµf?ß???? Staphylococcus,
  Chlamydia tr. , Ureoplasma ureol. ,
  Mycoplasma hom.

34
S??????? ???S????????S

• ??????s?
• ?st?????, f?s??? e??tas?
• ?p???e?sµ?? af??d?s??? ??s?µat??
• Ge?. ?????, ?/a ?????
• Stamey Meares test
• ???????µet??a, ?p??e?µµa ?????

35
??????????????????

• ??????s?
• ?st?????, ??????? e??tas?, ?/a ?????, U/S ?s????
• ?p?p?????
• ?p?st?µa, at??f?a ???e??, µet?pt?s? se ?????a
  ??s? (15 ?p?????µ?t?ta.