1 / 10

Hematuria Hx

Hematuria Hx. Personal data: name, age, occupation, residency, place of birth and marital status CC: hematuria , for how long? HPI: Microscopic/macroscopic? Associated with pain? (flank, suprapubic ,…etc) [you have to take a full Hx of pain!]

Download Presentation

Hematuria Hx

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Hematuria Hx Personal data: name, age, occupation, residency, place of birth and marital status CC: hematuria, for how long? HPI: • Microscopic/macroscopic? • Associated with pain? (flank, suprapubic,…etc) [you have to take a full Hx of pain!] • Appearance (shape & color): - clots (threadkidney; roundbladder) –fresh • Timing: • At the beginning: • Midstream • At the end • Continuous • frequency. • Bleeding from other sites: e.g. menstruation. • Did the patient suffer from the same condition before?

  2. 8. Other urinary symptoms: • Storage (irritative): • Frequency • Urgency • Noctoria • Urge incontinence • Dysuria • Voiding (obstructive): • hesitancy: delay in starting micturation. • Intermittent folw • Weak stream: diminished force and caliber with prolonged voiding time. • Double voiding • Straining to void • Terminal dribbling • Constitutional symptoms: • Fever • Anorexia • Malaise • Weight loss • Bone pain

  3. Risk factors: • PRE-RENAL: Coagulation disorder, Sickle-cell, Vasculitis • RENAL: Stones, TB, Glomerular disease, Carcinoma, Cystic disease, Trauma, A-V malformations, Emboli • POST RENAL: Stones, stricture, Infection [Bladder (schistosomiasis)/ Prostate / Urethra], Carcinoma (Bladder / Prostate), Traumatic bladder catheterisation, Inflammatory Cystitis • Drugs: rifampicin (color), warfarin (blood) • Past Hx: sotnes, schistosomiasis, trauma, HTN, DM, TB • Family Hx: stones, tumors • Social Hx: • smoking • Occupation (painting, dry cleaning, dental technician!)

  4. Investigation: • Painless haematuria is carcinoma until proven otherwise • Investigations: • full history and examination (don’t forget PR!) • Blood Investigations • FBP – Anaemic? White cell count raise indicative of infection?, Enough platelets? • U&E – Are their kidneys working? (Crude test) • Coagulation screen – Haemophilia?, Warfarin? • In Men … PSA (prostate specific antigen) • REMEMBER MSU – Direct microscopy and culture. • Urinary Cytology: • Not very sensitive, but an unequivocally positive cytology is quite specific for TCC bladder. • RADIOLOGY: • Ultrasound • IVP • Both are very sensitive and specific, but USS better for small peripheral renal lesions, and IVP better for renal pelvis and ureters. • FLEXIBLE CYSTOSCOPY

  5. NEPHROSTOMY nephrostomy

  6. NephrostomyQ1-Describe what you see. (previous slide)Q2-What are the indications for nephrostomy? • To provide urinary drainage when the ureter is obstructed by kidney stone or tumor • To remove or dissolve renal calculi • To deliver chemotherapeutic agents to the renal collecting system • If there is a hole in the ureter or bladder and urine is leaking into the body. • As a diagnostic procedure to assess kidney anatomy. • As a diagnostic procedure to assess kidney function. • Q3- What are the complications of nephrostomy? • injury to surrounding organs, including bowel perforation, splenic injury, and liver injury • infection, leading to septicemia • significant loss of functioning kidney tissue (<1%) • delayed bleeding, or hemorrhage(<0.5%) • blocking of a kidney artery(<0.5%) • Q4- When you will remove it? ? (a doctor told us that it depends! Some cases 2 days and some can stay there until the patient dies!!) ?

  7. Hx of nocturia • Personal data: name, age, occupation • HPI: • Onset • Frequency • Volume changes: oliguria, polyuria • Urine color • Painful/painless • groin, suprapubic or loin pain • Obstructive symptoms: • Retention • Poor stream • Intermittent stream • Hesitancy • Drippling • Incomplete emptying

  8. Irritative symptoms: • Frequency • Urgency • Dysuria • Incontinence • External genitalia: rash, discharge or ulceration • Constitutional symptoms: fever, loss of appetite, loss of weight, bone pain • Chronic illness: DM, HTN, renal failure ,heart failure, gout • Risk factors: smoking and alcohol(BPH), UTI, trauma, stones, catheterization • Past Hx: UTI, stones, surgery • Drugs: e.g. PGE2, lithium, tetracycline, hypercalcemia, hypokalemia. • Family Hx: malignancy, stricture, stones • Social Hx: smoking, occupation, travel,

  9. 50-year-old man diagnosed to have benign prostatic hypertrophywrite 4 irritative symptoms?Frequencyurgencynocturiadysuriaurge incontinence

  10. Lameesalashykh • Lulu alolayt

More Related