1 1. Theme of the lesson: « Urology states requiring urgent help» - 2 hours 2. Actuality of theme. Actuality of theme is determined in a number of important moments: а) Among patients needing medicare on urgent testimonies, considerable specific gravity (to 7- 10%) is made by persons along with the diseases go by the damages of genitourinary organs. b) The urgent states in urology, being complication of row of urology diseases, create extreme situations, requiring rapid diagnostics and tactically correct treatment by not only doctors-urologists but also doctors of contiguous specialities. 3. Aims of the lesson: 3.1 General aim: To familiarize with modern information: - about etiologic factors, which result in appearance of kidney colic, macrohematuria, anuresis, acute delay of urination. - about the basic mechanisms of the opened and closed trauma of buds, urinary bladder and outward privy parts. - about the basic clinical displays of kidney colic, macrohematuria, anuresis, acute delay of urination and acute purulent inflammatory diseases of the genitourinary system. - about possibilities of ultrasonic, roentgenologic, endoscopic and laboratory researches in diagnostics of kidney colic, macrohematuria, anuresis, to the acute delay of urination, acute purulent inflammatory diseases and traumas of the genitourinary system. - about modern possibilities of cupping of kidney colic, including the method of extracorporal lytotrypsya and instrumental, endoscopic methods of extraction of concrements. - about methods of cupping of macrohematuria conditioned by new formations of urinary bladder and buds: conservative and instrumental. - about testimonies and methods of operative manuals at macrohematuria, anuresis, acute delay of urination and acute purulent inflammatory diseases and traumas of the genitourinary system. 3.2. Educating aims: - to underline contribution of the Ukrainian and Russian scientists, especially soldiery physicians to the decision of problem of the urology states requiring the first aid - to develop clinical thought in relation to rapid differential diagnostics, choice of optimum method of treatment at the states requiring the first medical aid. - to form presentation about the necessity of rapid, careful and maximal organsaving treatments at the traumas of buds and outward privy parts. - to underline rapid scientific- technical progress and introduction of effective endoscopic noninvasive technologies at approach to the urology states requiring urgent interference. For achievement of the put aims it is necessary to remember from the course of anatomy the location and structure of organs of the genitourinary system; from the course of normal physiology - function of buds, ureters, urinary bladder, privy parts; from the course of pathological physiology - acute kidney insufficiency, communications of kidney nervous interlacement with other interlacements; from the course of pathological anatomy morphological changes at the acute inflammatory diseases of organs of the genitourinary system, at acute kidney insufficiency; from the course of operative surgery - technique of suprapubic punction, dissections of abscess of 2 prostatic gland, nefrostomya, nefrektomya; from the course of pharmacology antybacterial preparations, dyuretics, hormonal preparations and other Communications with other disciplines They need the knowledges got students at the study of urgent urology pathology and traumas of organs of the genitourinary system during work not by only urologists but also internists, surgeons, gynaecologists, travmatologists. Kidney colic, can have a similar clinical picture with the such surgical diseases, as acute appendicitis, acute pankreatitis, intestinal impassability, and also about the diseases of womanish sexual sphere. Correctly collected anamnesis, disuria, character of pains, change in urine, information of chromocystoskopya and roentgenologic research allow to differentiate the indicated states. Points of contiguity about a nephrology arise up at presence of hematuria, when it is necessary to conduct a differential diagnosis with a glomeruloneph- ritis,nephrotic syndrome and other system defeats of buds. The acute delay of urination can be conditioned both by the urology diseases (adenoma of prostatic gland, sclerosis of prostatic gland, structure of urethra, stone of urinary bladder, tumour of urinary bladder, cancer of prostatic gland) and reflex – after the carried heart attack of myocardium, stroke, operations on the organs of abdominal region pectoral and, and gynaecological and obstetric interferences.Conducting of rectal,endoscopic and roentgenologic inspection allow to set the reason of acute delay of urination. The acute inflammatory diseases of buds must be differentiated from the common infectious diseases, pneumonia, acute cholecyctytis and appendicitis. At acute prostatytis often there is a necessity to conduct differential diagnostics with paraproctytis. Points of contiguity with surgeons, travmatologists and internists place can take at presence of anuresis.In connection with the necessity of finding out of reasons causing anuresis, from what the carrying on proper measures depends. In travmatology anuresis more frequent is conditioned by shock, trauma of organs of the urinary system: in surgery – heavy general state, intoxication: in therapy - acute glomerulonephritis, tobe the result of poisoning by the nefrotoxic substances. Correctly collected anamnesis, researches of urine, allow conducting of the special methods of research to put a correct diagnosis. UROLOGY CONDITION REQUIRED URGENT FIRST AID. Basic need of class. Renal colic: complex symptomatic of many diseases of kidneys and upper urinary tract. This basically includes acute disorder in flow of urine from upper urinary tract on account of their blockage (shutting, thrombosis embolism) or pressure. Often renal colic is caused by stones in kidneys and in ureters. Moving along upper urinary tracts concrement shows or causes irritation of receptor apparatus of urothelia. In the to this causes acute local spasm around concrement. On accoun of this develops occlusion of upper urinary tracts causing internal pelvic hypertension from this continuing admission of urine in calixo-pelvic system. Increase of internal pelvic pressure percieves baroreceptors of renal pelvis, transfers to corrosponding segment of spinal cord, and also – to cores of brain, were transforms into pain. From this rarely increases internal pelvic pressure which forms or admits as reflective spasm of renal vessels, oedema. Of renal parenchyma, which carries to increase in size of organs and tension of fibrous capsule/ which contains more number of receptors, that more or in creases the pain. Renal colic causes sudden, appearing sharp pain, in the lumbar region. Pain causes or brings sharp character, attacking type, patient does not finds place himself. 3 Pains have irradiation, character which depends on location and level of obstruction. At location of concrements in region of upper and middle thirds of ureters pain irradiates in the lower part of abdomen, in the umbulical region. At the location of concrements at the level of middle- lower third of ureter pain irradiates along anterior surface of femur and in supra pubic region. At locations of stones in intramural region causes dysuria, pain irradiates in sexual organs. Renal colic usually accompanies nausea, vomiting paries of intestine of intestine, which or that condition irritation of solar plexus and peritonium in consequence of narrow or crowded connections with around or near renal nervous plexus. Usually positive symptom of pasternats, on pressure in osteovertebral angles are also diseased. May observe sub febriletet, characterised bradycardia, in some patients may be noticed increases arterial pressure, leucocytosis. Characteristic for renal colic’s shows appearance of erythrocytes in urine after a quite or calm attack. On the height of renal colic’s urine often is usually normal. Haematuria does not causes because stone damages or destroys renal tracts, and often from this damages fornical zone of renal calyces. For diagnosis of renal colic and putting down or knowing its reasons when subjective and objective signs are not sufficient, consumes or needs endoscopic and x-ray-radiological methods for examination. In connection with resultative clinical estimations (card) renal colic its necessary to differentiate from (with) acute appendicitis, renal colic’s, acute cholecystitis, pancreatitis, intestinal impassability (blockage), acute aonokcytis, extrauterine pregnancy, acute radiculitis. Treatment. For treatment of renal colic’s needs or consumed is chlorethyc blocades – irrigation of skin in the region of kidneys and along the way of ureters, intravenous injection of “cocktail” (2ml 50% analgini, 1ml 1% dimedrol, 2ml no-shpa or papaverin, 1ml 0.2% platyphillin, or 5 ml baralgon intramuscular, or intravenous ). Reduces the pains by warm baths, injecting narcotics. If clinical data’s indicates, that reasonable renal colic’s shows such a process in lower region of ureters, then good effect may be received from blockades of seminal canal of men, and in women – infiltration’s of tissue with novocaine, which are lying or laid neares supra osteoum and thickness of labium mojor, where attaches around round ligament of uterus. In fulfilling the indicated blockages are administered 0.5% - 60-70 ml novocaine (accomplishing blockages (blockades) with lorineinstein written seperately). We may use intra pelvic novocaine blockage with or by scholnics: on icm internal from anterio-upper (proximal) crest of iliac bone, after anasthesia of skin with long neeple on upper crest of iliac bone front the front to backwars or back side is injected 0.25% solution of novocaine. Accomplishing paranephral blockage needs big carefullness and severe or tough evidences or dealing’s. In connection with the possibility of damaging the kidneys. In such cases, when stated measures does not penders a must effects and specially in increased temperatures till 38-39 °C catheterisation of upper renal tracts, necessary for operative methods. Character of last depends on given examinations, open or given x-ray, this is ureterolithetomy, nephrostomia, nephrectomy, in difinite evidences we may use instrumental methods of treatment-extraction of concrements-basketdormia, petlei seisa. Blockage seminal funicle (canal) and round ligament of uterus. Used are as one among the methods of treatment help in renal colic (and its differential diagnosis). And also in inflamatory diseases of testicle and its epidydimus. 4 Technique of implementation: after removal of hairs of the pubis and of the inavino-scrotal region and dressing of the operative floor with alochol and iodine palpatory determines seminal canal in outer opening in inguinal canal and, press it between II and I fingers of left hand, right is administered in thickness of seminal canal (vesicle) 40-60 ml 0.25% solution of novocaine and 1 ml penicillin. At the end of administration of solution novocaine in seminal vesicle shows itself tuaoelastic form, going from testicle canal. In women solution novocaine of such a does (dosage) is injected in region of peripheral region (part) of round ligament of uterus. At the place of entrance of its in outer opening of the inguinal canal. Haematuria, blood profusion and assistance or rendering first aid in those. Admixture (touch) of blood in urine is known as haematuria. Haematuria may be symptom in rows of diseases of kidneys, renal pelvis, ureters urinary bladder, posterior urethra, prostate gland. For explaining or describing location of diseased process causing or admitted haematuria, three beaker test is used. Patient urinates in three vessels. If urine is coloured with blood only in first vessel, speech goes on about initial, starting haematoria. In colouration of only in third vessel about terminal haematuria. When all three portions are coloured with blood, total haematuria. Along stages of intensivity it is divided into microscopic and macroscopic haematuria, specially macroscopic, must see or check as serious and dangerous symptom and condition, needing urgent medical examination. Last must go in two directions. 1. Topical diagnosis of disease. 2. Determination of character of disease. Volume and character of diagnostic measures of various and are situated in dependable from condition of patient, intensivity, of haematuria. In profused haematurias, acute blood loss and creative threat for life of patient, in all cases at the first line its necessary: control of frequency of pulse, blood pressure, diuresis and stages of aneminisation without deposition goes on conservative measure, which starts with intravenous effect 55 solution aminocapronic acid (100-200 ml) 1% solution pambe (5-10 ml). Haemostatic effect of last grows after internal administration through 5- 15 minutes. On the necessities resorts the force to transfusion single grouped conseruated blood and plasma. If differentiated measures in course of nearer hours do not give perceptible (appreciable) results. Grows aneminisation, and given anamnesis and physical examination are insufficient, so that (so as to) explain profused haematuria damaging prostate gland and urethra, then at a time urgently carries out instrumental urological and x-ray examination. If sources of haematuria shows (causes) urinary bladder, alona the row with differentiated high volumes of conservative therapy. necessary to do or attempting to stop blood flow enovesical coagulation of blood vessel. In profused blood flow in the &&&&& tumour of urinary bladder with the success may be used intra bladde –rnic injection 10% solution of formalin for is min, with further cleaning bladder solution of furacillin. In case of profused haematuria in adenome prostate gland shows introduction of continous catheter with cleaning of blood serums and finally irrigation of bladder with furacilin solution. 5 Urethral blood flow may be stopped or ceased by introducing continous catheter along the possible big diameter, with leaving it inside for 5-7 days. 6 Acute detention or arrest of urination. Absence of independent urination during a freeflow urine or blood in the urinary bladder and presence of inclination to vomiting (navsea) during urination has the name or called as acute arrest of urination. Detention of urination may cause or appear as owing to consequence 1. Mechanical reason (adenoma or tumour of prostate, trauma of urethra, tumour of urinary bladder, phimosis (fimosys)). 2. Diseases of c.n.s. (tumour (cancer) of brain or spinal cord, trauma of spinal cord. Shock an others). 3. Reflective functional reason (after or post operative, during severe emotional shocking, alcoholic intoxication, medical intoxication(chemical)). Detention of urina is necessary to be differentiated from anuria. In acute detention of urine, by inclination to vomitting during urination, causes pain in supra pubic part, on perinium, presents cold, sticky sweat, bursting pains in the lumbar region, shivering (chill fever) uncomfortable (uneasy). Often in the supra pubic contouring urinary bladder. Acute detention of urination needs extra help, which consist of emptying urinary bladder and readmit outer passage of urine. Emptying of urinary bladders realizes properly catheterisation or supra pubic puncture of its, cystotomy, and during reflective detention – during help of medical substance. Selection of medical gratuity (allowance) depends on character of disease and condition of patient. At last carries out technique of catheterisation and supra pubic puncture of urinary bladders During deflective detention of urination may be stopped by injecting nhe patient 1 ml solution of pilocarpin, calinin. These medicines increases tone. And causes contraction of urinary bladder detention of urination may be liquidified properly by itravenous injection of 5-10 ml 40% of urotropin solution. First aid in detention of urination. (detention of urine – less accurate name) in detention of urination first aid consist of evacuation of urinary bladder and its catheterisation or supra pubic puncture. Catheterisation of urinary bladder – conducting in urinary bladder in urinary canal with rubber stripes, elastic (from polymeric material) or metallic catheter. Compulsory needs or consomption to technique 1. Diameter of catheter should be accordingly to diameter gap of urinary canal. 2. In catheterisation needs the most severe maintainence of aseptics. 3. Catheter is necessary to be lubricated with sterile vaseline oil’s or glycerine, polymixnovic oil and others. 4. After emptying the urinary bladder for prophylaxis of infection neds its cleaning by disinfecting solutions. 7 Technique of administering rubber catheter in women. Position of patient lying on spine with bifurcated or sliding and elevated femurs. a) Right hand with sterile foreceps which capture sterile catheter on 2-3 cm high sided . end of the catheter is holded by the nurse or she turns up and holds between 4-5 fingers in that right hand. b) Pulling apart the labium minor on sidies 1-m and 2-m with fingers of left hand, so that it helps to see outer opening of urinary canal. Nurse dresses outer opening of urethra with tampones, with the help of antiseptic solutions – tampone is conducted from pubic to perinium. If manipulation is conducted with out assistant, then early fullfics points b) and then point a). c) Catheter is lubricated with oils. d) With the right hand is administered the catheter with 5-8 cm depth. Till the recieving from its gap or space of urine. Along which female urethra catheter usually enters without problem. e) Washing of cleaning urinary bladder Technique of introducing rubber catheter in men: a) taking the penis lower the glans 3m and 4m with fingers opening the lips of the outer oopening of the urinary canal. Dressing the outer opening of the urinary canal with balls, with the solution suleme 1:1000 ml 1% solution of chloramin. b) Captures catheter as if this was written above in women. Point a). c) Catheter carefully labriated. d) Catheter flowingly is introduced in outer opening of urinary canal and goes to the extent of urinary bladder. Sometimes in (at) entrance of perinium part of urethra catheter meets obstacles from the spasm of sphincter. In such case it is necessary for some minutes stoppage, requiring or advising the patient to do some deep breathing. After which catheter constantly overcomes the obstacle, enters in urinary bladder. e) After evacuation of urinary bladder needs to clean it (cm. lower). Metallic female catheter with spreading on its end of rubber tube introduced without foreceps with hands with sterile gloves or dressing with spirit. In the rest of the technique does not differentiates from techniques of catheterisation with rubber catheters. Technique of catheterisation in men with metallic catheters: Patient must lie on spine (its back) with seperated femors (legs). Doctor standing on the right. a) Conducted or introduced or carried out as point a) in men. b) Instrument are taken in right hand as, or so that the pavilion is laid on palmar surface with two first phalanes of big and middle fingers and bearing lying upwards with index fingers. c) Catheter should be nicely lubricated. d) First moment of introduction: catheter encloses to outer opening of urethra parallel with right inguinal deposits of the patient, with a curvature down, beak meeting to pubic articulation end of the beak is introduced in outer opening of urethra and pulling (or 8 pushing) sex organ (penis) in the instrument, as gloves on the Finaers beaks of the catheter must feel upper wall of urethra. e) Second moments introduction: constantly progressively or gradvally transferred or remitted the instrument to middle lines, and beaks of the catheter enters in bulbous part of urethra below or under proper difficulty. f) Third moment of introduction: right hand starts flowingly introduced instrument in the urinary bladder, which, nextly direction of urinary canal, must describer the arc or shaft bow. Center of which is situated on upper crest of pubic articulation. For this pavilion of instrument seperate or remove from abdomen and describe their (them) fourth round so that body of the instrument stands or remains perpendicular to the body of the patient. Left hand at this time may be placed on the instrument on the drum or hollow part of the urethra. g) Fourth moment of introduction: pavilion of the catheter is let downwards. Its seaks at this time enters the drum part (hollow) of urethra and in forther sinkings (set loose downwards) of the pavilion downwards goes or enters the urinary bladder. On that or on this there should be ejection or flow of urine, and pavilion of catheter easily may be turned around axis of the instrument . h) After emptying the urinary bladder it must be cleaned or washed. Washing or cleaning and instillation of urinary bladder. Catheterisation of urinary bladder successfully should be concluded by its cleaning with warm solution of furacillin 1:1000 (35-40°C), boric acid (3%). Cleaning liquid is injected with sterile syringe (comfortable syringe of jane) with 50-100 ml and repiatedly for 3-4 times. After which remains (keepin left out) 30-50 ml liquid in the urinary bladder for amore longer effect or influence. On instillation of urinary bladder imply or implicate the injection of medicine in the urinary bladder through catheter with lying of its for a longer time, usually till natural urination. Any catheterisation of urinary bladder, specially repeated, advisiable to conclude installations with 10-15 ml 3% solution of collakgole or protargole, 10 ml 1% solution of dioxydin and others. Supra pubic puncture of urinary bladder. Position of the patient on spine (on sack) with clean dressing or operative. a) On dullness (slow) of percussive sound of supra pubic confirms presence of flaccid urinary bladder supra pubically, its level must be higher than the pubis about 4 cm. b) Preparation of operative floor at supra pubic region: shave, cleaned or dressed with iodine solution, spirit. c) In the right hand taking sterile syringe 10-20 ml with 0.25-0.5% solution of novocaine, needle length 15-20 cm with width gap nearly 1 mm. d) Tempering (annealing) along middle lines by 2 cm higher of the pubic skin, infiltrates it with novocaine solution. And then infiltrates subcutaneous tissue, and after this vertically stopping the needle to tempering. Secondly after skins dense layer. Aponeurosis of outer lateral muscles. After this needle easily penetrates pierces in the cavity of urinary bladder. e) Syringe detaches and for comfort of collection of urine in the needle, on its pavilion wears sterile rubber tube. 9 f) After stopping (cessation) of ejection or flowing of urine in or through the needle extracts, place of puncture covered with asceptic bandage. Acute in flamatory disease of excretory organs. Acute peilonephritis: tough puss-forming or (exudative) inflammatory disease of kidneys, showing threatening of life to the patient. If in time (properly) is not taken the needed advisable or required measures. Difficulty or toughness of course or duration of peilonephritis aggravates or redoubles its side effects, apostometosis nepheritis, carbuncle of kidneys, abcess of kidneys, paranephritis bacteriotoxic shock. Putting down or labeling the diagnosis of acute pielonephritis, consequently determines, shows its primary, or secondary, for conduction of medical measures in a know or confined measure or arrangement from this. Experimental and clinical establishment. That onesided acute relonephritis speedingly or fastly carries on or goes on of causing analogic processes in the opposite lying kidney. At the end of 3rd day with moment of causing pilonephritis with single or one sides of similar inflammatory process grows in the contrlateral kidney. These data’s in many determines duration’s of operative treatment of patients with acute pielonephritis. Absence of effect of theuraputic or therapies, including stopping of gushing or flushing or pushing flow of urine, in course of a day, forcing or compelling to put or conduct question about operative treatment. Symptoms of acute pielonephritis composes from general and local signs of diseases. To general symptoms confinds high body temperature, tremendous shivering, changable or changing in pouring of sweat. Nausea, vomiting, leicocytosis and others. To the local pain and tensed muscles in the lumbar region, changes in the urine (bactereuria, leicocyturia heamaturia, proteinuria), sometimes disuria. In the diagnosis of acute peilonephritis, differene of its forms mainly has or carried out is chromocystoscopia and x-ray radiologic examination radionucleoid renographia, absorbive and excretory urographia, with the x-ray films on inspiration and big help of this method supports in appearance of carbuncles and abscess of kidneys. Treatment. Amount of pathogenesis of acute pilonephritis continuing or noticed the appearance of disturbance of passage of urine, treatment of patients must be started with the restoring of flow from the upper urinary tracts. Intake or consuming powerful antibacterial medicines with restoring the pessage of urine from kidneys involving itself extremely tough or difficult side effects. The most threatening among them shows the bacteriotoxic shock. After the effect of antibacterial medicines goes on or carries out the death of microbial flora (floor) and formation of large amount of endotoxins. Which during the presence of occlusion adjoing or combines with pielovenosnom reflex. In the blood. This consequently shows shivering, hyperthermia, touch intoxication. Bacteriotoxic shock may be caused after any urologic manipulations, in cluding catheterisation of urinary bladder, ureter. Divides prodromal and shocking stages of bacteriotoxic shock. Prodromal – conditional admission or appearancein flow of blood in urine and enotoxins, which shows tremendous shivering, hypertermia, pouring sweats, head ache and other signs of intoxications. Shock phase – characterises sharp fall of body temperature (35-36°C), pouring sweat, fall of arterial pressure till 60/40 mm.rt.st. concious clouding. Often observed is fibrilled twithchina of muscles, pulse filiform tachycardia, respiration often (frequent), superficial. Leucocytosis changes to leucopaenia. 10 In prodromal phase bacteriologic shock therapy is carried out with complete fast restoring disturbances of passage of urine from kidneys, is operated with antibiotics. In the shocks – must be carried by all measures, oirecting in preventing with collapse. Then restoring flow of urine (nephrostomia) with concluding (next) operation of antibacterial therapy. Measures along preventing with collapse of conditions of bacteriologic shock operates with introduction of corticosteroids. Pressors and vascular medicines, perfusion of liquid and blood, prventing with acidosis, disturbance of protiencs and electrolyte balance. After adjustment of itravenous injection of solutions is injected go and more than mg prednisalon. Corticosteroids increases the effect of pressor medicines.decreases permeability of cappillaries, increases starch and protein exchange, possessing expressive antiallergic activity. After injecting from shock is injecting so mg prednisalon I/m 2-3 times a day. Parallely is insected pressor’s medicines nor-adrenalin 1.0 ml in 200 ml isotonic solution, or dopmine in controlling arterial pressure. I/m is injected cordiamin 2-4 ml i/v (intrvenous) is injected polyalucin, albumin, plasma, in some cases whole blood. Advisiable introduction of sodium (Na) hydrocarbonate (NaHCO3) 2-4% 220 – 400 ml. Good realisation of inhaling oxygen. Basically treatment advisable to combinate or in combination with injecting antihistamine medicine. Dimedrol I/v 1-2 ml 1% solution or pipolfena 25% 1-2 ml. Considering deficit of heparin, toughchanges in system of vessels and inclination propensity to thrombose type is advisable to prescribe heparin. It decreases activity of lysosomal ferments inactivates histamine, produces or shows anticomplimentary effects, inhibits cytotoxic effect of lymphocytes on allogens cells missions, suppresses immune process. Heparin is prescribed in fractional doses in 5000 units for 4 times a day. For increasing micro circulation trental is prescribed I/v in 100 ml 2 times a day. With the aim of warning of acute renal insufficiency carries out infusion of haemodeza till 400 ml, lasyx – to 200 mg. Recomends also to prescribe lipocaine, methionine, glucose with insulin, vitamin group B AND c, for incressing nitrous exchange uses anabolic harmones (retabolic 1.0 ml 1 time a week, testosteron propionate in 2.0 ml after a day.) Operative treatment of patients with acute pielonephritis must be started (operated) in nephrostomia, decapsulation of kidneys, cleaving carbuncles and drainage of extraperitonial space. In post operative period it is applied to consume antidiotics in broad spectrum of its effect. The must effective, with obligatory counting of sensation along the results of antibiogrames and clinical effect. Does must be restored and dependent from functional conpition of kidneys. In complex with antibiotics is advisable to consume sulphonicamides medicines, nitrofuranes. Only in serious forms of acute pielonephritis may be restricted for (with) conservative therapies, in belief of normal flow of urine from upper urinary tracts. Acute prostitis. Abscess of prostate gland. Morphologically divides into three acute prostitis. Catharal, follicular and parenchymatous. Sideefefects of acute prostitis shows (causes) abscess of prostate gland. In catharal prostitis inflamatory changes causes main appearance in withdrawing ducts and lobes of prostate gland. In parenchymatic prostitis has multiple damage of lobes of prostate gland – purulents pours out in one (single) solid, then causes abscess of prostate gland. It may independently opens into rectum, urinary bladder also even (often) in urinary canal. 11 Catharal prostitis characterises increased urination, toughness or difficulty feeling in the perinium. In per-rectal examination of prostate gland does not changes. Clinical appearences of follicular prostitis is much expressed (exposive). Temperature 38°C and high, shivering, partly diseased urination, pain in the perinium, increases during defecations. In per-rectal examination of prostate gland is unequally increased, sharply diseased, has parts of infiltration and softening. Parenchymatous prostitis shows increased temperatures of body till 39°C, shivering, acute (sharp) pain in perinial region, irradiates in the glans of the sex organ (penis), observed terminal haematuria. Partly diseased nausea to urination constrained (pressurised) pastatic part of urethra infiltrates tissue of prostate gland may be bring into or lead to acute detention of urination. Abscess of prostate glands – purulent melting (floating) other lobes of gland. During clinical duration divides into general and local appearence of this disease. In general confindes: shivering, increased temperatures of body hectic character, pouring sweat, increased respiration, head ache, leucocytosis, in local – pains in the region of anus (anal region), perinium, infra pubic, sometimes detention of urine, terminal haematuria. Basic methods of diagnosis shows palpatation of prostate gland through rectum (per-rectal). Gland increased in size, apperes in caps of rectum, diseased, one may define fluctuation. Breakage in the contents of pus focus (hearth) in the urethra. Timely results of untreatable abscess of the prostate gland. Considerable even the sreak of pus is carried out or goes on in the rectum. Treatment of abscess of prostate gland operative. Oftenly is used perineal method (way)drainage of pus in (from) the prostate gland. Local treatment of acute prostitis include warm microclism (aneuma) with solution of camomile (ox-eye daisy), suppostosis with antibacterial medicines. In severe pain novocaine blockades with antibiotics. Obligatory prescribtione of antibiotics in broad spectrum effect. Acute epydidimoorchitis. Acute inflamation of epididymus of testis often shows or causes side effect of urethritis or results of trauma, also side effects of general infectious and viral diseases. Diseases start severly (acutely). Characterises stretching pains in the testicle, irradiates along the way of seminal vesicle, epididymus swollen (increases) dense, sharply diseased, pacpatation sharply diseased sharply increases body temperature, appears oedema and redness on skin of scrotum. Along measures of progressions of inflamatory process of testicle and epididymus forms a unit conglumerat. Treatment: Show bed rest, scrotum is fixed with suspensors, consumed are dry warmths, fulfill the novocaine blockades. In seminal canal of lokin-epsteins with addition of antibiotics. Recomends presckibtion of antibiotic in broad spectrum of effect. After subsiding acute inflamatory process is shown physioprocedures, tissue therapy. In recent years all often and broadly consumes surgical methods of treatment in early duration of disease-epididymiotomia. Evidence to epididymiotomia shows express inflamatory process, increased temperature of body more than 38°C in cource more than a day, without tendency to decrease before prescribed antibacterial therapies with medicines of broad spectrum of effect, increase in size of scrotum and epididymus. 12 Anuria Anuria – absence of urine in urinary bladder, differentiates or divided into – arenal, pre renal, renal and sub renal anuria. Arenal anuria is observed in new born children during analysis of kidneys or in results of operative (operated) removed original kidneys. Pre renal anuria – causes of in combination in consequence of insufficient or complete stoppage of flow of blood to kidneys (shock, cardiac insufficiency, thrombosis of renal vessels)/ Renal anuria grows in results of damage of renal parenchyma, conditional different reasons intoxication, poisoning with organic poisons, salts of tough metals, subrenal anuria causes in results of disorder of flow of urine from upper urinary tracts. The most reasonable part of this type of anuria shows double sided stones in kidneys, pressure in ureters. Tumour of urinary bladder or from without, dressings of ureters during operative process. Subrenal anuria – differs from other form by pathogenesis, clinical charts, diagnostics and treatmen. If in nearly 1-2 days does not stops passage of urine, then causes deep disturbances of homeostasis, depending in basic from changes of nitrous. Discharge and water (liquid) electrolytes function of kidney. Diagnosis of anuria takes depends on absence of urine in urinary bladder and sians of uremic intoxications. For differential diagnosis of anuria from others of its form necessary to conduct instrumental and x-ray exams. Treatment – during subrenal anuria main treatment shows the restoring flow of urine. Catheterisation of ureters operatine methods (nephrostomia, peicostomia, urethrocutaneostomia). During arenal, pre renal and renal forms of anuria treatment must be realised in departments, apparatus for conduction of haemodialysis. If in subrenal anuria condition of patient is relatively tough (critical) due to uremic intexication, then before operation also shown conduction seansa haemodilysis. Operation (nephrostomia) carried out one the most complete in function related to kidney. Usually this is of the kidney, on side some has the most expressive pain. During prerenal, renal forms anuria treatment is ope3rated or carried in normalisation of water-electrolytic balance, decrease in hypernitromei. On cystoogramme – accuracy of contours of urinary bladder. Needs to fulfill uretrography and tracking uretrogramme. On antiogramme – carefully note on the contours of kidney, sizes of its vascular, architecturac renal vessels. On scannogramme – diffused or local decrease accumulation of isotopes (single or double side). On x-ray’s – character of curvature, time half administration of isotope, identical changes or curvatures of left and right kidneys. Medical (treatments) measures. During renal colic determine diagnose and medical tactics (blockade seminal vesicle by lorin epsteins – dealing colic by administration of spasmolytics, analgesics, catheterisation of ureters). During acute detention of micturation expels out reasons (determine medical tactics catheterisation, puncture of urinary bladder administration of spasmolytics). 13 During haematuria restore character of haematuria (3 – cup test of urine, cystoscopy, excrectory urography). Determine medical tactics. During acute inflamatory diseases of urinogenetal system needs to determine the dianose: acute pielonephritis (primary and secondary) acute epididymoarchitis, acute prostitis. Determine medical tactics. a) Conservative treatment (antibacterial therapy, catheterisation of ureters). b) Operative treatment (nephrostomia, disection of abscess of prostate, epididymus of testicle). In anuria, stop or restore type of its, reason, determine medical tactics. With the aim of using conservative method of treatment. Itravenous administration of 10-20% solution of glucose till 500 ml. Accordinaly quantity of insulin (I-unit of insulin at 4.0 gm glucose) 200 ml of solution sodium hydrocarbonate 2-4%. During anuria does not carry out administration patient more than 700-800 ml liquid a day, so that danger from possible growth tough non cellular hyperhydration. Shown that cleaning of stomach, in testine also administered lasyx, trentol, vitamins. Evidences to conduction of haemodialysis during anuria works out electrolytic disturbance (defeciengy, hypercalcaemia), nitoromeia used in treatment and haemosorbition. Card (chart) of anamnesis For independent work for students, with patients medical help, acute detention of micturation, haematuria, acute inflamatory diseases of urinogenital organs, anuria. During collection of aspects (clinical) and anamnesis of pain. Their irradiation, the real place or point of change of colour of urine and infiltration of micturation, increase of body temperature, shivering, dryness of mouth, tireness, renal colic. In grading objective datas: determine the touhness, condition, increase of temperatures, chills position. Aterial pressure during different position of body. Symptom pasternaskovo, pek- retal examination of prostate, palpatation of kidney, palpatation of prostate, palpatation of kidney, palpatation and percution of urinary bladder. Changes of colour and transparency of urine (infiltration of micturation – checking of urino-genital organs). Laboratory evidences: anaemia, leucocytosis leucocytoria, haematuria, proteinuria, bacteriouria, gymoisostenuria, determination of urine creatinine, electrolytes, serum of blood. Grading of instrumental and x-ray data’s well timed excretion of indigocarmine in chromocystoscopy. In absortive x-ray see carefully on condition of bones (spondolysis, defencive scoliosis) accuracy of contours of lumbar muscles (m. psoas), availability of tenia, on concrements in proection of urinary tract. In excretory urogramme, welltimed excretion of contrast matter of kidneys, deformation of renal pelvis and renal calix, system. Flowing of contrast matter. Catheterisation of ureter on sides of damage, in necessity, retrograde urethopielography. Situational tasks. Patient of 35 yrs met the doctor with the complaint of pains in the lumbar region on the left side. Pain brings attacking type character, irradiates to the lower abdomen, iliac region of left side accompanying increase of micturation, in the urine in combination of blood. Waves 2-days, during objective examination pulse 76 minute rythmic, satisfactory arterial pressure 110/70 mm.rt.st. abdominal swelling, moderate disease. During palpatation in region of kidney (left) symptom 14 pasternatskovo. Positive (left) body temperature 36.8°C. in examination of precipitation of urine- leucocytes 25-25, erythrocytes 80-100. Your diagnose to find out x-ray accordingly condition for the tasks. Medical tactics. Patient 41 yrs. 41th years admitted with the complaint of severe attacking type of pain in the left half lumbar region, irradiating to the right femur, nausea, many timed vomitting swelling of the abdomen (flattous). During objective examination – abdomen (flattous). During in the right ribs and lumbar region. About such diseases one may think? Such examination are necessary for production putting the diagnose? Prescribe treatment. Lady 56 yrs met the doctor with the complaint on profused mixture of blood in the urine, similar condition first time in life. Blood in the urine appeared suddenly. Other appearences of disease unappearing or disappearing. A week ago propholyctic check of the pathalogy needing (consoming) hospitalisation, or observation of disappearing. Professional work unrelated with physical work. About which disease may go the speech which is the examination necessary to do? Point out the measures showing for the urgent help (emeruengy). Patient 65 yrs met the doctor with the complaints of impossibility of independent (free) micturation, pain in the lower abdomen. Indicate appearing the discomfort during 12 hours. Your diagnostic measure? Your diagnose? Medical measure? Child 6 yrs suffering with impossibility of free micturation/ with the words of mother, since some months the child micturates with strained force, thin stream, in the last 10-12 hours micturation increasing. During checking the urinary bladder determines in middle (average) distance between umbulicus and pubic. Doctors urgent or emergency service attended the catheterisation of urinary bladder. Once catheter faces obustraction in the prostate part of the urinary canal. Which emergent medical measures are necessary? Which examination are necessary to hake the diagnose. Orientation card. For self or independent study of medical literature and prepatory subject for practical classes of the lesson: Urological condition needing emergency (help). GRAPHIC STRUCTURE OF THE CLASSES Acute detention of urine Renal colic symptomatic reasons Haematuria types Pain in the lumbar region, Reflective adeonema of Painful, painless, terminal, vomiting nausea, paresis of prostate, cancer of prostate, total, starting. intestines, disuria stone in the urinary bladder, tumour of urinary bladder Dianose Treatment Methods of examination Haematuria Administration of 3 cup test of urine cystoscopy. chromocystoscopia, absorbive spasmolytics, catheterisation urographia, excretory infra pubic puncture urography cystostomia. 15 Treatment x-ray method Administration of spasmolytics, analgesics, novocaine Cystography, infusion blockades, warm baths, catheterisation of ureters urography. Acute inflamatury disease. Acute pielonephritis, paranephritis. Anuria Clinical, diagnostics, evidences to the operative and conservative Types: therapy. Pre renal, renal, sub renal. Diagnosis of different types Acute prostitis of anuria. Clinicals, diagnosis, treatment evidences to surgical intervention. __________ Standard answers for situational tasks. Considerable clinics of disease, one may presatiaty, that to the patient has renal colic, called (appeared) stones in the ureters. For differential diagnosis its necessory to fulfill x-ray urological examination: absorbition and excretory urography. During on take of concrement and buying (treating) painful syndrome. During absence of information of absorbtive x-ray in presence of stones, and also absence of function of left kidney shown catheterisation of ureters. Further tactics will be determined in dependence of situation. In the given cases its necessary to emphasize acute cholesystitis, for this its necessary to examine general analysis of blood, amylase of blood, and transaminase, and also after treating pain attacks needs to contemplate absortion urography, with the aim of differential diagnosis in consultation chamber. Advisiable chromocystoscopy, radio reno graphy. In presence of information of therapy conservative, instrumental or operative treatment.
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