case 1 urology clinical interactive teaching session
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Case 1 Urology Clinical Interactive Teaching Session. You are the intern on-call and was called to see a patient in the ER Good evening I am Dr. X What is your name?. Chief complaint: Unable to pass urine. AUR VS Anuria. History of present illness: 55y old Duration=24h - PowerPoint PPT PresentationTRANSCRIPT
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Case 1
Urology Clinical Interactive Teaching Session
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•You are the intern on-call and was called to see a patient in the ER
•Good evening
•I am Dr. X
•What is your name?
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•Chief complaint: –Unable to pass urine.
•AUR VS Anuria.•History of present illness:•55y old•Duration=24h•He has suprapubic pain.( Desire to micturate)•For the last few months he noticed gradual
decrease of his stream, hesitency, drippling •Nocturia x 5, frequency q1.5h•No dysuria or urgency.
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•Hematuria:–3m ago
–Once
–Total
–No clots
–No associated pain
•No no loin pain no fever
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•One episode of AUR following cholecystectomy about 4y ago.
•It was managed by in& out Foley catheter –Postoperative failure to pass urine
•Dehydration VS retention
•PMH:–Cystoscopy for stone bladder 10y ago.–UH repair many years ago
–DM X 15y, remote CVA, Parkinson disease
–No hypertension, IHD, Bilh., T.B. or Br.Asthma
•SI:–Low back pain
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•SH:–Widow and newly remarried.–Smokes 1ppd–Works in a tire shop
FH:Brother died of prostate disease.
Medication:ASA, Otrivin for common cold, buscopane, drug for his
Parkinsonism
Drug Allergy:Summery:
55y old male patient presented with 24h history of acute urinary retention
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DD: BPHCa prostateStone bladder or urethraNeurogenic bladderDrug inducedUrethral stricture
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Examination
•General:–Pain–Signs of Uremia–Pulse–BP–Temp
•Abdomen
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SPT
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Examination:_General
_In pain, pulse, BP, temp,_Look for signs of uremia
–Abdomen :•suprapubic area, loin, liver.
–Back: No tenderness.–Genitalia: Hernia–PR :
• anal tone, size, consistency, surface, tenderness, mucosa.
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Management:
–Insert urethral catheter.–Suprapubic tube.
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•Investigations:–Urinanalysis, urine C&S.
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C&S
1) Sensitivity
2) Safety
3) Costs
4) Oral or not
5) Frequency
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–Renal profile:•creatinine=189
–PSA= 8.8
–US:•kidney
•pelvis
•TRUS
–Urethrogram