NR 507 Week 4 Assignment; Urinary System Pathologies; Common Diseases and Disorders.

The pathophysiology of a UTI is simple. First, bacteria enter and contaminate the lower urinary tract. This causes the coloniza琀椀on of bacteria in the urethra and the bladder which triggers an in昀氀ammatory response in the lower urinary tract. Neutrophils are recruited to the area where the bacteria are present. The bacteria mul琀椀ply which allows them to evade the immune system due to virulent factors. For example, Escherichia coli can bind to cells in the lower urinary tract and hide from the immune cells. The bacteria can form bio昀椀lms. A bio昀椀lm is any group of microorganisms that allow them to s琀椀ck to one another and adhere to surfaces that help them survive. If the UTI progresses or is not treated, or if the pa琀椀ent is immunocompromised, the bacteria can ascend to the kidneys and colonize there. At this point, the infec琀椀on becomes an upper UTI. From there, if le昀琀 untreated, the bacteria can spread into the circula琀椀on via the renal veins causing bacteremia that could poten琀椀ally lead to sep琀椀c shock. UTI Risk Factors There are several risk factors that predispose individuals to the development of a UTI. For women, pregnancy is a risk factor. During pregnancy, progesterone relaxes smooth muscle that causes stasis of urine, allowing the bacteria to colonize. Also, the female ureter is shorter and allows for the entrance of bacteria into the urethra. Post-menopausal women are also at risk for developing a UTI. The lack of estrogen results in vaginal and urethral dryness that promotes an environment for bacteria to grow. Sexual intercourse also contributes to the development of a UTI where bacteria can be easily introduced into the urethra. If spermicides are used during sexual intercourse, this also puts the woman at risk for a UTI. Indwelling urinary catheteriza琀椀on is also a major cause of a UTI, especially in females. The catheter itself can introduce infec琀椀ons directly into the bladder. The bacteria will colonize in the bladder and ini琀椀ate an immune response. The neutrophils enter the area to further promote in昀氀amma琀椀on. Fibrinogen accumulates on the catheter which provides an ideal environment for the a琀琀achment of uropathogens that express 昀椀brinogen-binding proteins. A昀琀er the ini琀椀al a琀琀achment to the 昀椀brinogen-binding proteins on the catheter, the bacteria mul琀椀ply to form bio昀椀ls. This results in epithelial damage to the urinary tract that leads to a kidney infec琀椀on. Lower vs. Upper Tract Disorders A UTI can be discussed in terms of its loca琀椀on. Note that a UTI can occur anywhere along the urinary tract and can be associated with another issue in the area. For example, if the infec琀椀on occurs at the opening of the urethra, then the condi琀椀on is termed urethri琀椀s. Overall, cys琀椀琀椀s is a condi琀椀on of the lower urinary tract that denotes a bladder infec琀椀on. Cys琀椀琀椀s can occur in both females and males. In males, the cys琀椀琀椀s may be associated with prosta琀椀琀椀s. followed by a course of oral an琀椀bio琀椀cs. Overall, the course of an琀椀bio琀椀cs for a complicated infec琀椀on is longer than in an individual that has an uncomplicated infec琀椀on. Interven琀椀on may