Aid To Medicine

Friday, June 6, 2014

Bladder outflow obstruction and Lower Urinary Track Symptoms

9:55 PM No comments

A 74 year old gentlemen who is diagnosed to have benign prostatic hyperplasia presented with inability to pass urine and suprapubic pain.
On examination there is an abdominal lump arising from the pelvis up to the level of umbilicus.
X-ray KUB

He is having bladder outflow track obstruction caused by benign prostatic hyperplasia complicated by acute retention of urine and stone formation.

Bladder outflow tract obstruction

What are the causes for Bladder outflow tract obstruction?

Mechanical causes for Bladder outflow tract obstruction

Bladder neck

Bladder neck hypertrophy
Stenosis due to prostectomy

Prostate

Benign Prostatic Hyperplasia
Prostatic carcinoma
Prostitis

Urethra

Urethral srictures

Post traumatic -

Accidental
Iatrogenic (Instrumentation, Catheterization )

Inflammatory - Gonocaccal urethritis
Neoplasms
Balanitis xerotica obliterans (a premalignant condition)
Congenital

External meatal stenosis
Tight phimosis
calculi
External compression by Pelvic tumors

Functional causes for Bladder outflow tract obstruction

Neurogenic causes

Spinal code injury
Cauda equina syndrome
Prolapsed intervertibral disc
Multiple sclerosis
Diabetic autonomic neuropathy

what are the features of Bladder outflow track obstruction?

These are called as Lower Urinary Track Symptoms

Lower Urinary Track Symptoms

There are two group of symptoms.

Voiding ( obstructive ) symptoms

Hesitancy (He want to pass urine, but there is difficulty in initiation. This worsened when bladder is full)
Poor flow ( unimproved by straining)
Dribbling
Intermittent stream (Urine flow stops and starts on one or more occasions during voiding )
Feeling of incomplete emptying
Episodes of near reteintion

Storage ( irritative ) symptoms

Frequency
Urgency ( Want to pass urine where he can not hold it. This can be associated with or without of incontinence )
Urge incontinence ( Involuntary leakage of urine accompanied or immediately preceded by urgency)
Nocturnal incontinence (Recent onset Nocturnal enuresis )

What are the complication of bladder outflow track obstruction?

Complication of bladder outflow track obstruction

Acute urine retention
Chronic urine retention
urinary stones formation
Urinary track infection
Obstructive uropathy (chronic renal failure)

Vegetarian Diet - Good or Bad

12:53 AM No comments

In these days lot of people's try to be a vegetarian. But there are several facts towards it and against it.
This space is for your ideas.

Leave your thoughts on comments.

TNM Classification for Breast Carcinoma

10:57 AM Surgery No comments

TNM Classification for Breast Carcinoma

TNM Classification is developed and maintain by UICC ( Union for International Cancer Control ) and it used to classify tumors by anatomical stage. This classification help to determine in management and prognosis.

Tumor

T1 Up to 2 cm Greatest dimension
T2 Between 2-5 cm Greatest dimension
T3 More than 5 cm Greatest dimension
T4 Any size tumor

T4 a attached to the chest wall
T4 b attached to the skin
T4 c attached to the chest wall and skin
T4 d mastitis carcinomatosis / inflammatory carcinoma

Nodes

N 0 No palpable axillary lymph nodes
N 1 Mobile axillary nodes
N 2 Fixed axillary nodes
N 3 Internal mammary chain nodes are palpable

Metastases

M 0 No radiological or clinical evidence of distant metastasis
M 1 Distant metastasis are present
M x Distant metastasis can not be assessed

Breast carcinoma is a systemic disease. It has metastasis from the beginning. But it can not assess due to small size (<0.2mm )

SIRS, Sepsis, Sever Sepsis, Septic Shock, Septicaemia, Bactiraemia Definition with Mnemonics

11:22 PM Diseases, mnemonics No comments

SIRS Mnemonics

SIRS is a pro-inflammatory condition which does not include documented source of infection.
Any two or more of the following signs indicate Systemic Inflammatory Response Syndrome (SIRS). Features of SIRS can memorize as HRT (hormonal replacement therapy) for Women.

H- Heart Rate >90 beats per minute
R- Respiratory Rate >20 beats per minute
T- Temperature >38 ^oc or <36 ^oc
W- White Blood Count >12 *10⁹ / L or <4* 10⁹ / L

Sepsis

Sepsis is systemic response to infection. It manifest as SIRS in the presence of infection.

Severe sepsis

Sepsis with evidence of organ hypoperfusion or altered cerebral function.

Septic shock

Severe sepsis with hypotension (systolic blood pressure less than 90mmHg) despite of adequate fluid resuscitation.

Septicaemia

Presence of multiplying bacteria in blood steam.

Bactiraemia

Presence of bacteria in circulation.

Pancreatitis Mnemonics : Causes, Severity

4:26 PM Diseases, mnemonics 1 comment

Pancreatitis : Mnemonics

Causes for pancreatitis : Mnemonics

Idiopathic
Gallstones (38%)
Ethanol (35%)
Tumours (peri-ampullary tumour, pancreatic carcinoma)
Scorpion venoms
Mumps
Autoimmune (SLE, Polyarteritis nodosa)
Surgery and trauma

Post surgical (cardiac surgery), Blunt trauma to abdomen, Penetrating peptic ulcer

Hyperlipidemia, Hypercalcemia. Hypothermia
ERCP or Emboli
Drugs

Azathioprine, Corticosteroids, Didanosine, Mercaptopurine, asparaginase, Estrogen, Methyldopa, Valproic acid, Acetaminophen.

Modified Glasgow criteria

Three or more positives within 48 hours indicates severe pancreatitis.

PaO2 < 8kPa (60mmhg)
Age > 55 years
Neutrophils (WBC >15 x109/l
Calcium < 2mmol/l
Renal (Urea > 16mmol/l)
Enzymes (LDH > 600 iu/L or AST > 200 iu/L
Albumin(serum) < 32g/l
Sugar (Blood Glucose >10mmol/L)

In the most severe form of pancreatitis the mortality rate is around 40% to 50%.

Anesthesia Wall Charts

4:27 AM Guidelines, PDF No comments

Anesthesia Wall Charts

I usually like to get maximum knowledge within a short time, so i practice to refer these kind of docs rather than reading lot of books. Also it is easy to memorize. So today i am going to publish some wall charts. It will give you quick review and help you to get an idea to manage these conditions.

Note,

Do not save as pictures. Open the document and download.