Dr.Numa'an Session 3
Urology Sunday, August 07, 2016
1
Topics of session:
1-Urinary stones
2-Management of renal colic
3-Scrotal pathology
4-Urine retention
Note:All this topics is present in Urology Booklet from Mohadaraty
https://www.muhadharaty.com/lecture/
In urology :the symptoms lies under 4 headlines
1-irritative
2-obstructive
3-constituational
4-cachexic
*Why the colicky pain occure in this agonizing pattern? –increase intraluminal pressure
during peristalsis causing ischemia –(so ischemia pain like laber & MI pain)
*appendicitis &colic pain differ in clinical ground :-appendicitis----try not to move& Colic—
rolling around
-spiral-CT is the invastigation of choice for pt with colicky pain
Case:Management of pat. With colicky pain
1.Short informative Hx
2. Ex. The most important to see the position , rolling or not moving
3.Ix. Send for
_Imaging study
-US always 1st stip
2-KUB
ray
-
Difference between KUB & plan abdominal x
in KUB there is preparation like Fasting ,Purgative to empty the intestine.
IVU it's iodide based. Contraindication to IVU
_Hx of allergy
_Allergy to eggs and fish
بسبب احتوائها ع الي
ود
-Pregnancy
- Renal impairment cause it may cause renal shut down
-Diabetic patient on metformin
----Disadvantage Its only showing the urinary tract not like CT
3-IVU
Dr.Numa'an Session 3
Urology Sunday, August 07, 2016
2
4-CT scan( nowadays the investigation of choice in pat. With colic is CT
الن تظهر بينو كل انواع ال
stone
ويشوفنا فيلد واسع وليس فقط ال
urinary tract )
Disadvantage of CT
More radiation ,Not always available ,Expensive _Laboratory
GUE we may see pus cells and cristales
ممكن وحدها تكون سبب ال
pain)
Renal function test
Others accordingly
4.Treatment
Pain killers start with diclofenac 1_2 mg/kg/day
يعني ما اكثر من امبولين باليوم
Contraindication to diclofenac
1_Peptic ulcer----GIT
2_ Asthma ----Resp.
3_Hypertension-----CVS
4_ Renal impairment -------Renal
If patient not respond give narcotics (pethidine & morphine)
Peth. 1_2 mg/kg/dose
-
الدوز ممكن نعيدها كل
4
_
6
ساعات
Morphine 0.1_0.2 mg/kg/dose
-
vomiting with colicky pain radiating to RIF :how to manage him ?
عادة ننطي معاهم
antiemetic
النو يسببون
nausea
-indication of admission with colicky pain?
1_Solitary kidney
2_ renal failure
3_ not respond to Rx
4_ bilateral stones
5_ debilitated patient
6 _ fever
7_ no supported diagnosis.
60 year old pt wt DM +renal stone(Rt loin colicky pain)with fever &rigor ,How manage him?
Dx :Pyonephrosis caused by stone is a surgical emergency if you dont drain the pus u may
loss the patient
Dr.Numa'an Session 3
Urology Sunday, August 07, 2016
3
Hx , Ix , treatment
A_ drainage of the kidney in 2 ways
1.Percutaneous nephrostomy)
هاي المفضلة النو تسحب ال
pus
(
احسن
)
2.Double j insertion
B _antibiotics
Q/ 5 A 60-year-old female patient was seen as an emergency with high temperature, rigors
and pain in her right loin. She had a blood pressure of 160/70 mmHg, bounding pulse of
90/min and extreme tenderness in her right loin.
Dx: Pyonephrosis
-Socrotal pathology &urine retention also have been discussed
Go to
https://www.muhadharaty.com/lecture/