The one who was presenting is Maryam. It was a urology case, I missed the history presentation, I was from cafe. Bad student. Haha. So, what I've got is that the patient was an old man. That was it. I was like, "HEY, GUYS! WHY YOU NO LET ME BE INFORMED THAT MR. ISLAH WAS ALREADY THERE? COME ON." but never mind. Hmph!!!
Well, actually I'm not really sure how to organize the input for today. So when after I went to the ward to follow up my patient, then went to send my car for repair, played basketballs with the girls, bought kitten food for Kuro, finished my laundry...I finally I got time to open my lecture notes when I was in BMS. And yes, whatever Mr. islah has taught me this morning, more or less was taught last time. We just need to revise and apply.
In Urological cases, should should master the definition of each spectrum of symptoms and the spectrum of the disease along the urinary tract.
HISTORY TAKING and PHYSICAL EXAMINATION
Urinary tract infection
Actually our urinary tract has its own natural defense mechanism
- normal flora lactobacilli, corynebacteria, streptococci
- urine flush mechanism and urine content itslef (pH)
- bladder has its own immune response and induced exfoliation
But any alteration of these defences will actually lead to urinary tract infection or together with some othe urological pathology. The possible alterations are :
- obstruction
- vesicoureteric reflux
- diabetic
- renal papillary necrosis
- HIV
- pregnacy
- neurogenic bladder
- underlying disease
- iatrogenic
1.Look if any of the risk factors of UTI are present
- advanced age
- anatomical abnormalities
- poor nutritional status
- smoking
- immunocompromised
- chronic catheterrization in neurological problem for example
- hospitalization and intrumentation
2. Clinical features which may occur in UTI
- lower urinary tract infection symptoms ( dysuria, urgency, frequency,hematuria)
- fever
- acute urinary retention
- pain
- loin pain
- suprapubic pain
3. Look also for any symptoms of the complication of UTI to anticipate in management
- painful urinary retention
- LOW / LOA
- hypoalbunemia (???)
- lethargic
- uremic symptoms
Uremia is a clinical state in which the blood urea nitrogen level, an indicator of nitrogen waste products, is elevated. In uremia, the kidneys’ failure to filter nitrogen waste properly leads to excessively high levels of nitrogen wastes in the bloodstream. Uremia is life-threatening because too much nitrogen in the blood is toxic to the body. Symptoms of uremia include confusion, loss of consciousness, low urine production, dry mouth, fatigue, weakness, pale skin or pallor, bleeding problems, rapid heart rate (tachycardia), edema (swelling), and excessive thirst. Uremia may also be painful.
Uremia is reversible if treated quickly; however, permanent damage to the kidneys may occur. Kidney failure may also result from the underlying processes that cause uremia. -medscape-
- obstructive symptoms ( problem in voiding)
- poor stream
- interminttent stream
- retentio
- irrentetive symptoms (problem in storing)
- frequency
- nocturia
- urgency
- hesitancy
- sequelae of renal failure
Signs and symptoms of acute kidney failure may include:4. Hence based on these dont forget to aks if the patient has any
- Decreased urine output, although occasionally urine output remains normal
- Fluid retention, causing swelling in your legs, ankles or feet
- Drowsiness
- Shortness of breath
- Fatigue
- Confusion
- Nausea
- Seizures or coma in severe cases
Sometimes acute kidney failure causes no signs or symptoms and is detected through lab tests done for another reason. -mayoclinic-
- Chest pain or pressure
- previous episode
- stone disease
- trauma at
- urinary tract
- spinal cord
- brain
- instrumentation or operation
- includes abdominal patho or procedure
- systemic diseases
- gouty arhthritis
- hyperparathyroidism
- diabetes mellitus
- suprapubic tenderness and warm
- renal punch at renal angle which will be postive for
- renal stone
- pyenephrosis
- pyelonephritis
- renal abcess
- abdominal mass be it from urinary tract or other intraabdominal organs which may compress
- palpable bladder
- ballotable kidney
6. Genitalia examination
- stone in the urethra
- Per Rectal examination...look for any abnormality : eg: prostate (cancer, BPH or inflamed), invasion of cervix cancer, etc.
- urethral caruncle if female
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| https://edc2.healthtap.com/ht-staging/user_answer |
Urethral caruncles are benign, distal urethral lesions that are most commonly found in postmenopausal women, although a case of urethral caruncle has also been described in a male.[1] Urethral caruncles resemble various urethral lesions, including carcinoma. The differential diagnoses of urethral caruncle include urethral diverticulum, urethral prolapse, urethral carcinoma, and periurethral gland abscesses.-medscape-
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7. Check for other related system
8. Symptoms of urinary tract malignancy or urothelial tumor
- painless hematuria
- suprapubic mass
- malignant cystitis
- irritability
- urgency
- dysuria
- metastases diseases
- AUR
- bone pain
- abdominal distension
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