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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!]

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Hematuria Hx

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  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

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