MODUL TUTOR SKENARIO-2

Tim Kurikulum Pendidikan PreklinikProgram Pendidikan Dokter

Universitas Islam Malang2 0 1 2

Skenario 2

Waktu Senin

01/10/12Selasa

02/10/12Rabu

03/10/12Kamis

04/10/12Jumat

05/10/12Sabtu

06/10/12

Jam I08.30 – 09.10

Ujian Pleno 1 Tutorial 1Kuliah 6 Biokimia

PakarTutorial 2 SDL8

Jam II09.20 – 11. 00

MKDU Pleno 2 SDL2 SDL3 SDL5 / PA

ISHOMA11.00 – 12.30

Sholat Dhuhur Berjamaah di Masjid Ainul Yaqin

Jam III12.30 – 14.10

MKDU

Kuliah 5Path. Kinik

Urin lengkapHLM

Praktikum 3Path. Anatomi

ESW

Kuliah 7 Mikrobiologi

YAMSDL6

/ Keg. Mhsw

Jam IV14.20 – 16.00

Introduksi SDL1

CSL 1 :Anamnesa penyakit

saluran kemihYHA

SDL4 SDL7Keg.

Mhsw

16.00Sholat Ashar Berjamaah di Masjid Ainul Yaqin

Pinggangku rasanya mau putus...

Seorang laki-laki 40 tahun datang ke praktek dokter umum dengan keluhan nyeri pada

pinggang belakang. Nyeri telah berlangsung sejak 1 minggu yang lalu disertai demam. Buang

air kecil terasa agak nyeri dan panas.

Bagaimana sikap / tindakan / pemikiran Anda selanjutnya ?

Identitas :

Nama : Tn. PA

Umur : 40 tahun

Pekerjaan : Petugas kebersihan

Alamat : Desa Karang Duren, Kecamatan Pakisaji, Kab. Malang

Keluhan utama : nyeri pinggang belakang

Riwayat penyakit sekarang :

Nyeri pinggang sejak seminggu yang lalu dan nyeri pinggang disertai nyeri seperti terbakar

saat buang air kecil sejak tadi malam. Selain nyeri pasien juga demam dan mual-mual serta

seperti anyang2en. Rasa ingin kencing beberapa kali kekamar kecil tetapi buang air kecil

hanya sedikit-sedikit dan terasa tidak tuntas.

Riwayat penyakit sebelumnya :

Setahun yang lalu pasien pernah menderita kencing nanah, dan sudah sembuh setelah berobat

kedokter.

Riwayat penyakit keluarga :

Kedua orang tua pasien tidak ada yang menderita gangguan seperti ini.

Riwayat pengobatan :

selama sakit ini minum obat penghilang rasa nyeri yang dibeli di warung

Riwayat kebiasaan :

Pasien adalah perokok, biasanya menghabiskan 1 – 2 pak sehari, dan peminum kopi

Pemeriksaan fisik :

Status present

Ku : kesakitan, kesadaran : CM, tekanan darah : 150/100, nadi : 90 x/minutes, RR : 24x/m, t :

39º C, BB : 45 Kg, TB : 160 cm

Status general :

Kepala : Rambut : normal, Mata : anemia -/-, Icteric -/-, Hidung : secret -/- , krusta -/-,

concha inferior hyperemia -/- dan dilatasi, deviasi septum -, Mulut : oropharyng Normal,

tonsil tidak membesar, Telinga : auricula normal, meatus acusticus eksterna secret (-),

serumen (-), foliculitis (-) atau benda asing (-), membrana tympani kiri tampak bomban, dan

warna gelap/tidak mengkilat, perforasi (-).

Leher : JVP is normal, Submandibular gland swolen -/-, Tyroid gland is normal

Thoraks :

Paru : Rh -/-, Wh -/-, Vesiculer sound of respiration

Jantung : HR 90 x/menit reguler, bising (-)

Abdomen :

Inspeksi : tidak ada penggembungan, tidak ada tumor, tidak ada spider naevi.

Palpasi : nyeri tekan (-), Hepar dan Lien tidak teraba, Undulasi (-)

Perkusi : tympani, Shifting Dulness (-), Nyeri ketok ginjal +/-

Auskultasi : Bising usus (+) normal

Extremitas : dbN

Status Urogenitologi

Flank d/s : I : Bulging -/-, massa -/-, P : Ballotement -/-

Suprapubic : massa (-), nyeri tekan (-)

Penis : circumcisi (-), discharge (-)

Scrotum : dbn

WDx : UTI

DD : pyelonephritis akut, Urolithiasis, Glomerullonephritis akut

Laboratory examination :

Darah lengkap :

Hb: 10 gr/dL ,Ht : 31% ,leukosit : 8000/mm3 , Trombosit 363.000/mm3

BUN: 53 mg% , kreatinin serum: 1,4 mg/dL

Urinalyis:

Warna : kuning keruh, berat jenis meningkat, Protein (+), Bilirubin (-), Urobilin (-), Keton

(+), Eritrosit banyak, Leukosit 5-10, bakteri (+).

Cystoscopy, Ultrasonography, CAT scan dan IVP : kesimpulan menunjukkan adanya tanda-

tanda inflamasi/kerdangan pada ginjal

Dx : Pyelonephritis Akut

1`st jump : Key words

2`nd jump : Problem list

1. Apa yang terjadi dengan pasien diatas

2. Apa penyebab kelainan diatas ?

3. Mengapa pasien tersebut nyeri pinggang seperti terbakar, mengapa

terjadi gangguan proses berkemih?

4. Bagaimana mendiagnosa kelainan ?

5. Bagaimana penatalaksanaan?

3`rd jump : Brainstorming

Mahasiswa melakukan curah pendapat untuk menganalisa problem list

yang sudah ditentukan. Setiap mahasiswa harus melakukan curah

pendapat.

4`th jump : Mapping Conssept

5`th jump : Learning Obyectives

1. Mampu menjelaskan patofisiologi penyakit-penyakit ginjal akibat gangguan renal,

2. Mampu menginterpretasikan hasil pemeriksaan klinis dan pemeriksaan penunjang,

menegakkan diagnosis dan menyingkirkan diferential diagnosis,

3. Mampu melakukan manajemen penatalaksanaan, dan melakukan KIE pada pasien

penyakit ginjal akibat gangguan renal.

6`th jump : Self Directed Learning.

Mahasiswa belajar sendiri dengan cara: kuliah, konsultasi pakar,

jurnal dari internet, pustaka, praktikum, skill lab, penugasan, diskusi

bebas

7`th jump : Reporting.

Mahasiswa mengkaji ulang langkah 4 dan 5 dan mencoba

menjelaskan LO sesuai dengan hasil langkah 6 yang telah didapat.

Pada langkah ke 7 ini, mahasiswa harus menunjukkan referensi,

tetapi tidak boleh dibaca saat diskusi terakhir. Pada langkah ke 7,

setelah diskusi selesai, tutor memberikan feedback tentang LO dan

mengoreksi hasil diskusi menjadi benar, sehingga saat diskusi

berakhir semua mahasiswa mempunyai pemahaman yang benar

dan sama untuk semua skenario.

MAPPING KONSEP :

Upper

Causa Risk Faktor Sign and Symptom

Urinary system

Anatomi

lower

Fisiology Histology

GANGGUAN/KELAINAN

INFEKSI OBSTRUKSI WEAKNESS

Fisik Diagnostik Px Penunjang

DIAGNOSTIKK/DD

PENATALAKSANAAN

MAPPING KONSEP KASUS:

MAPPING KONSEP TEORY:

 

SIGN & SYMPHTOMDysuria (painful voiding of urine), abdominal pain (radiating to the back on the affected side) and tenderness of the bladder area and the side of the involved kidney (costovertebral angle tenderness) which may be elicited by performing the kidney punch. In many cases there are systemic symptoms in the form of fever, rigors (violent shivering while the temperature rises), headache, and vomiting. In severe cases, delirium may be present.[1]

back, side, and groin pain urgent, frequent urination pain or burning during

urination fever nausea and vomiting pus and blood in the urine

PYELONEPHRITIS

Causa:E. coli (70-80%) and Enterococcus faecalis. coliforms and enterococci, Klebsiella spp., Pseudomonas aeruginosa).RISK FAKTOR: Mechanical : any structural abnormalities to the

kidneys and the urinary tract, vesicoureteral reflux (VUR) especially in young children, calculi (kidney stones), urinary tract catheterisation, urinary tract stents or drainage procedures (e.g. nephrostomy), pregnancy, neurogenic bladder (e.g. due to spinal cord damage, spina bifida or multiple sclerosis) and prostate disease (e.g. benign prostatic hyperplasia) in men

Constitutional: diabetes mellitus, immuno compromised states

Behavioural: change in sexual partner within the last year, spermicide use

Positive family history (close family members with frequent urinary tract infections)

Infections in the bladder Use of a catheter to drain urine from the bladder Use of a cystoscope to examine the bladder and

urethra Surgery on the urinary tract Conditions such as prostate enlargement and

kidney stones that prevent the efficient flow of urine from the bladder

Defects or abnormalities in the urinary tract that block the flow of urine

PATHOLOGYExudative purulent localized inflammation of the renal pelvis (collecting system) and kidney. The renal parenchyma interstitium abscesses (suppurative necrosis), neutrophils, fibrin, cell debris and central germ colonies (hematoxylinophils). Tubules are damaged by exudate and may contain neutrophil casts. In the early stages, glomeruli and vessels are normal. Gross pathology often reveals pathognomonic radiations of hemorrhage and suppuration through the renal pelvis to the renal cortex. Chronic infections can result in fibrosis and scarring: Xanthogranulomatous

pyelonephritis :granulomatous abscess formation and severe kidney destruction.

DIAGNOSIS : History of symptoms, allergies, medications, illnesses, surgeries, habits and risk factors. Medical exam/ Physyc Diagnosis: Fever, Flank or abdominal pain,Sweaty skin Urine analysis -- microscopic analysis of a plain urine sample and a dyed (Gram stain) sample may

show blood cells (white and red blood cells) and the bacteria that cause the infection, white blood cells in the urine (Pyuria), Red blood cells

Urine Cultures Cystoscopy or an Ultrasonography (using sound), CAT scan (using computer imaging) and IVP (using

a dye that is injected into the blood) can provide detailed pictures of the kidneys, bladder, ureters, prostate, and the urethra.

Penatalaksanaan :1. Promotif : promkes tentang kausa dan risk faktor2. Preventif : cranberry juice, blueberry juice, and fermented milk products containing probiotic bacteria,3. Kuratif : ambulatoar: Antibiotik, analgesic, MRS: IV fluids hydration and IV antibiotic

treatment: ciprofloxacin IV 400mg every 12 hours is the first line treatment of choice. Alternatively, ampicillin IV 2g every 6 hours plus gentamicin IV 1mg/kg every 8 hours also provide excellent coverage. If the patient is pregnant, ampicillin/gentamicin

PyelonephritisPyelonephritis is an ascending urinary tract infection that has reached the pyelum (pelvis) of the kidney (nephros in Greek). If the infection is severe, the term "urosepsis" is used interchangeably (sepsis being a systemic inflammatory response syndrome due to infection). It requires antibiotics as therapy, and treatment of any underlying causes to prevent recurrence. It is a form of nephritis. It can also be called pyelitis.[1]

Signs and symptomsIt presents with dysuria (painful voiding of urine), abdominal pain (radiating to the back on the affected side) and tenderness of the bladder area and the side of the involved kidney (costovertebral angle tenderness) which may be elicited by performing the kidney punch. In many cases there are systemic symptoms in the form of fever, rigors (violent shivering while the temperature rises), headache, and vomiting. In severe cases, delirium may be present.[1]

DiagnosisThe presence of nitrite and leukocytes (white blood cells) on a urine dipstick test in patients with typical symptoms are sufficient for the diagnosis of pyelonephritis, and are an indication for empirical treatment. Formal diagnosis is with culture of the urine; blood cultures may be needed if the source of the infection is initially doubtful.[1]

If a kidney stone is suspected (e.g. on the basis of characteristic colicky pain, disproportionate amount of blood in the urine), X-rays of the kidneys, ureters and bladder (KUB) may assist in identifying radioopaque stones.[1]

In patients with recurrent ascending urinary tract infections, it may be necessary to exclude an anatomical abnormality, such as vesicoureteral reflux (urine from the bladder flowing back into the ureter) or polycystic kidney disease. Investigations that are commonly used in this setting are ultrasound of the kidneys or voiding cystourethrography.[1]

CausesMost cases of "community-acquired" pyelonephritis are due to bowel organisms that enter the urinary tract. Common organisms are E. coli (70-80%) and Enterococcus faecalis. Hospital-acquired infections may be due to coliforms and enterococci, as well as other organisms uncommon in the community (e.g. Klebsiella spp., Pseudomonas aeruginosa). Most cases of pyelonephritis start off as lower urinary tract infections, mainly cystitis and prostatitis.[1]

Risk is increased in the following situations:[1][2]

Mechanical: any structural abnormalities to the kidneys and the urinary tract, vesicoureteral reflux (VUR) especially in young children, calculi (kidney stones), urinary tract catheterisation, urinary tract stents or drainage procedures (e.g. nephrostomy), pregnancy, neurogenic bladder (e.g. due to spinal cord damage, spina bifida or multiple sclerosis) and prostate disease (e.g. benign prostatic hyperplasia) in men

Constitutional: diabetes mellitus, immunocompromised states Behavioural: change in sexual partner within the last year, spermicide use Positive family history (close family members with frequent urinary tract infections)

PathologyAcute pyelonephritis is an exudative purulent localized inflammation of the renal pelvis (collecting system) and kidney. The renal parenchyma presents in the interstitium abscesses (suppurative necrosis), consisting in purulent exudate (pus): neutrophils, fibrin, cell debris and

central germ colonies (hematoxylinophils). Tubules are damaged by exudate and may contain neutrophil casts. In the early stages, glomeruli and vessels are normal. Gross pathology often reveals pathognomonic radiations of hemorrhage and suppuration through the renal pelvis to the renal cortex. Chronic infections can result in fibrosis and scarring.Xanthogranulomatous pyelonephritis is a form of chronic pyelonephritis associated with granulomatous abscess formation and severe kidney destruction.

TreatmentAs practically all cases of pyelonephritis are due to bacterial infections, antibiotics are the mainstay of treatment. Mild cases may be treated with oral therapy, but generally intravenous antibiotics are required for the initial stages of treatment. The type of antibiotic depends on local practice, and may include fluoroquinolones (e.g. ciprofloxacin), beta-lactam antibiotics (e.g. amoxicillin or a cephalosporin), trimethoprim (or co-trimoxazole). Aminoglycosides are avoided due to their toxicity, but may be added for a short duration.[1]

All acute cases with spiking fevers and leukocytosis should be admitted to the hospital for IV fluids hydration and IV antibiotic treatment immediately. ciprofloxacin IV 400mg every 12 hours is the first line treatment of choice. Alternatively, ampicillin IV 2g every 6 hours plus gentamicin IV 1mg/kg every 8 hours also provide excellent coverage. If the patient is pregnant, ampicillin/gentamicin combination is the treatment of choice, as ciprofloxacin is contraindicated. During the course of antibiotic treatment, serial white blood count and temperature should be closely monitored. Typically, the IV antibiotics should be continued till the patient is afebrile for at least 24 to 48 hours, then equivalent oral antibiotic agents can be given for a total of 2-week duration of treatment.[3]

If the patient is unwell and septic, intravenous fluids may be administered to compensate for the reduced oral intake, insensible losses (due to the raised temperature) and vasodilation and to maximize urine output.In recurrent infections, additional investigations may identify an underlying abnormality. Occasionally, surgical intervention is necessary to reduce chances of recurrence. If no abnormality is identified, some studies suggest long-term preventative (prophylactic) treatment with antibiotics, either daily or after sexual intercourse.[4] In children at risk of recurrent UTIs, meta-analysis of the present literature indicates that not enough studies have been performed to conclude prescription of long-term antibiotics have a net positive benefit.[5]

Ingestion of cranberry juice has been studied as a prophylactic measure; while studies are heterogeneous, many suggest a benefit.[6]

Some recommend other nutritional approaches to prevent recurrence of UTIs. Increasing fluid intake, consuming cranberry juice, blueberry juice, and fermented milk products containing probiotic bacteria, have been shown to inhibit adherence of bacteria to the epithelial cells of the urinary tract.[7]

EpidemiologyPyelonephritis is very common, with 12-13 cases annually per 10,000 population in women and 3-4 cases per 10,000 in men. Young women are most likely to be affected, traditionally reflecting sexual activity in that age group. Infants and the elderly are also at increased risk, reflecting anatomical abnormalities and hormonal status.[8]

References1. abcRamakrishnan K, Scheid DC (2005). "Diagnosis and management of acute

pyelonephritis in adults". Am Fam Physician 71 (5): 933–42. PMID 15768623. http://www.aafp.org/afp/20050301/933.html.

2. ̂ Scholes D, Hooton TM, Roberts PL, Gupta K, Stapleton AE, Stamm WE (2005). "Risk factors associated with acute pyelonephritis in healthy women". Ann. Intern. Med. 142 (1): 20–7. PMID 15630106.

3. ̂ The Washington Manual: Infectious Diseases Subspecialty Consult, edited by R. Starlin, et al. (2005)

4. ̂ Schooff M, Hill K (2005). "Antibiotics for recurrent urinary tract infections". American family physician 71 (7): 1301–2. PMID 15832532.

5. ̂ Williams GJ, Wei L, Lee A, Craig JC (2006). "Long-term antibiotics for preventing recurrent urinary tract infection in children". Cochrane database of systematic reviews (Online) 3: CD001534. doi:10.1002/14651858.CD001534.pub2. PMID 16855971.

6. ̂ Raz R, Chazan B, Dan M (2004). "Cranberry juice and urinary tract infection". Clin. Infect. Dis. 38 (10): 1413–9. doi:10.1086/386328. PMID 15156480.

7. ̂ Krause, Marie V.; Mahan, L. Kathleen; Escott-Stump, Sylvia (2004). Krause's food, nutrition, and diet therapy. Philadelphia: W.B. Saunders. p. 969. ISBN 0-7216-9784-4.

8. ̂ Czaja CA, Scholes D, Hooton TM, Stamm WE (2007). "Population-based epidemiologic analysis of acute pyelonephritis". Clin. Infect. Dis. 45 (3): 273–80. doi:10.1086/519268. PMID 17599303.

Pyelonephritis (Kidney Infection) in AdultsWhat is pyelonephritis?Pyelonephritis is a kidney infection, usually from bacteria that have spread from the bladder.What causes pyelonephritis?Possible causes of kidney infection include the following:

infections in the bladder use of a catheter to drain urine from the bladder use of a cystoscope to examine the bladder and urethra surgery on the urinary tract conditions such as prostate enlargement and kidney stones that prevent the efficient

flow of urine from the bladder defects or abnormalities in the urinary tract that block the flow of urine

What are the symptoms of pyelonephritis?Symptoms include the following:

back, side, and groin pain urgent, frequent urination pain or burning during urination fever nausea and vomiting pus and blood in the urine

What are the complications of pyelonephritis?Severe or recurrent infections may cause permanent kidney damage and lead to chronic kidney disease.In rare cases, infection in the kidney may spread to the bloodstream. Infection of the bloodstream is a serious condition called sepsis. Acute renal failure, a temporary condition in which the kidneys stop working, can also result.How is pyelonephritis diagnosed?Diagnosis is made with a urine test to identify bacteria and formations of white blood cells, called casts, shaped like tubes in the kidneys. If an infection cannot be easily cured, x rays might be done to look for abnormalities in the kidneys, ureters, and bladder.How is pyelonephritis treated?

A kidney infection is treated with an appropriate antibiotic taken for several weeks. Anatomic abnormalities may need to be surgically treated.Severely ill patients with kidney infections may be hospitalized until they can take fluids and needed drugs on their own.Various drugs are available to relieve the pain of a kidney infection. A heating pad may also help.The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.Definition of PyelonephritisPyelonephritis is a serious bacterial infection of the kidney that can be acute or chronic.Description of PyelonephritisOne of the most common renal diseases, acute pyelonephritis is a sudden inflammation caused by bacteria. It primarily affects the interstitial area and the renal pelvis or, less often, the renal tubules. Chronic pyelonephritis is persistent kidney inflammation that can scar the kidneys and may lead to chronic renal failure. This disease is most common in patients who are predisposed to recurrent acute pyelonephritis, such as those with urinary obstructions or vesicoureteral reflux. Causes and Risk Factors of PyelonephritisDoctors believe that the bacterial infection causing pyelonephritis may sometimes develop elsewhere in the body and travel through the bloodstream to the kidney. Far more commonly, however, the infection is the result of bacteria from outside the body traveling back up the urinary stream through the urethra to the bladder and eventually to the kidneys, in which case it is known as an ascending infection. This may explain why women, whose urethras are short and in close proximity to the anus, a potential source of bacteria, have four times as many cases of pyelonephritis as men. The flow of urine backward is known as reflux and may be caused by an anatomical defect or by an obstruction. In the former case, instead of a tight valve between the bladder and the ureter, there is a wide opening. When the bladder contracts during urination, the urine goes both ways, out through the urethra and back up through the ureters. The defect is not easy to correct and those who have it are subject to repeat infections. Obstructions that cause reflux in women are commonly in the form of a stricture, or scar tissue, itself formed from infection or inflammation in the urethra. In young men, such strictures form less often and usually are a consequence of a sexually transmitted infection. In older men, the prostate is commonly responsible for obstruction to the flow of urine. Reflux can also be caused by the insertion of catheters or instruments such as cystoscopes for diagnosis or treatment. The introduction of any foreign body into an area of obstruction is fraught with danger of infection which can be more difficult to treat. Symptoms of PyelonephritisNo matter what the underlying cause, the symptoms of acute bacterial pyelonephritis are often the same. The first indications are usually shaking chills, accompanied by a high fever and pain in the joints and muscles including flank pain. Attention may not be drawn to the kidneys at all. The situation may be especially confusing in children, when high temperature may suddenly bring on a seizure or a change in mental state, or in the aged, where fever may bring confusion, or the infection may be masked by generalized aches and pains. There may be irritative voiding symptoms (burning when urinating, a sense of urgency, or increased frequency of urination).

In acute infections, the symptoms develop rapidly, the fever noted first, followed by possible changes in the color of the urine, and then tenderness in the flank. As the kidney becomes more inflamed, pain, loss of appetite, headache, and all the general effects of infection develop. This type of kidney pain differs from renal colic pain of kidney stones in that it is continuous and does not come in waves, stays in one spot, and may be worse by moving around. While patients with chronic pyelonephritis may have acute infections, sometimes there are no symptoms, or the symptoms may be so mild that they go unnoticed. This carries the risk that the infectious inflammatory disease may progress slowly undetected over many years until there is enough deterioration to produce kidney failure. Thus, hypertension (high blood pressure) or anemia or symptoms related to renal insufficiency may be the first indication of trouble. Unfortunately, irreversible damage may have already taken place. Diagnosis of PyelonephritisYour physician will take a medical history, perform a physical exam, and recommend tests including blood tests and blood cultures, urinalysis and urine culture, and possibly an ultrasound study of the kidneys.Treatment of PyelonephritisTreatment centers on antibiotic therapy appropriate to the specific infecting organism, after identification by urine culture. When the infecting organism cannot be identified, therapy usually consists of a broad-spectrum antibiotic. Symptoms may disappear after several days of antibiotic therapy. Although urine usually becomes sterile within 48 to 72 hours, the course of such therapy is 21 days. Patients with severe infections or complicating factors require hospitalization at least initially. In some patients, surgery may be necessary to relieve obstruction or correct an anatomical anomaly.Follow-up treatment includes reculturing the urine several weeks after drug therapy stops in order to rule-out reinfection. Patients at high risk of recurring urinary tract and kidney infections - such as those with prolonged use of an indwelling (Foley) catheter- require long-term follow-up. Prevention of PyelonephritisSome cases of pyelonephritis can be prevented by prompt recognition and treatment of minor bladder infections that, if left untreated, may progress to this more severe condition.Urethritis is infection of the urethra, the tube that carries urine from the bladder out of the body.

Bacteria, including those that are sexually transmitted, are the most common cause of urethritis.

Symptoms include pain while urinating, a frequent need to urinate, and sometimes a discharge.

Antibiotic are usually given to treat the infection.CausesUrethritis may be caused by bacteria, fungi, or viruses (for example, herpes simplex virus). In most women, the bacteria involved are those that normally live in the lower intestine. These bacteria reach the urethra from the anus. Men are much less likely to develop urethritis because the opening of the male urethra is far removed from the anus, and thus bacteria from the anus less often reach the urethra. Bladder infection (cystitis) develops in most women who have urethritis but not in most men who have urethritis.Sexually transmitted organisms—such as Neisseria gonorrhoeae, which causes gonorrhea—can spread to the urethra during sexual intercourse with an infected partner (see Sexually Transmitted Diseases: Gonorrhea). Chlamydia and the herpes simplex virus are also commonly transmitted sexually and can cause urethritis (see Sexually Transmitted Diseases: Chlamydial and Other Infections). When men develop urethritis, the gonorrheal organism is a

very common cause. Although this organism may infect the urethra in women, the vagina, cervix, uterus, ovaries, and fallopian tubes are more likely to be infected. Trichomonas, a type of microscopic parasite, also causes urethritis in men. Urethritis may be also caused by the bacteria that commonly cause other urinary tract infections, such as Escherichia coli.SymptomsIn both men and women, there is usually pain with urination and a frequent, urgent need to urinate. Sometimes people have no symptoms. In men, when gonorrhea or chlamydia is the cause, there is usually a discharge from the urethra. The discharge is often yellowish green when the gonococcal organism is involved and may be clear when other organisms are involved. In women, discharge is less common.Other disorders that cause pain with urination include bladder infection and vaginitis. In vaginitis, urination may cause pain because urine, which is acidic, irritates the inflamed vulva and lining of the vagina.ComplicationsInfections of the urethra that are not treated or are inadequately treated eventually can cause a narrowing (stricture) of the urethra. A stricture increases the risk that infections will develop in the bladder or the kidneys. Untreated gonorrhea occasionally leads to an accumulation of pus (abscess) around the urethra. An abscess can produce outpouchings from the urethral wall (urethral diverticula), which can also become infected. If the abscess perforates the skin, the vagina, or the rectum, urine may flow through a newly created abnormal connection (urethral fistula).DiagnosisDoctors can usually make a diagnosis of urethritis based on the symptoms and examination. A sample of the discharge, if present, is collected by inserting a soft-tipped swab into the end of the urethra. The urethral swab is then sent to a laboratory for analysis so that the infecting organism can be identified.Prevention and TreatmentSexually transmitted diseases that cause urethritis may be prevented by using a condom.Treatment depends on the cause of the infection. However, identification of the organism causing urethritis can take days. Thus, doctors usually begin treatment with antibiotics that cure the most common causes. For sexually active men, treatment is usually with a ceftriaxone Some Trade Names ROCEPHIN injection for gonorrhea plus oral azithromycin Some Trade Names ZITHROMAX or oral doxycycline Some Trade Names VIBRAMYCIN for chlamydia. If tests exclude the possibility of gonorrhea and chlamydia, trimethoprim-sulfamethoxazole Some Trade Names or a fluoroquinolone antibiotic (such as ciprofloxacin Some Trade Names CILOXANCIPRO) may be used. Women are treated as if they had cystitis. An antiviral drug, such as acyclovir Some Trade Names ZOVIRAX, may be needed for a herpes simplex infect.

DAFTAR PUSTAKA

1. Dillner J et al. Microbiology & Tumor Biology Center, Karolinska Institute, Stockholm, Sweden. Joakim.Dillner@mtc.ki.se

2. Halliwel B., Gutteridge JM., 1999, Free Radical in Biology and Medicine, Third edition, Oxford Science Publication, Oxford

3. Harrison_s._Principles_of_internal_medicine_16th_edition. 2005. Mc Graw Hill. New York

4. Junquira L.C. and J Carneiro : Basic Histology. 3th ed. Lange Med. Publ. 1980.5. Robbins, 1999, Pathologic Basic of Disease, Sixth edition, Saunders Company,

Philadelphia.

6. Silbernagl.S, Lang.F., 2003, Teks & Atlas Berwarna Patofisiologi, Penerbit Buku Kedokteran EGC, Jakarta.