L1: Urological History Taking Flashcards
Parts of Urological History Taking
Urological Symptomatology
Pain arises from either obstruction or inflammation & rarely Tumors
β¦
Etiology of Renal Pain
Caused by acute distention of the renal capsule.
Nerves Carrying Renal Pain
Sympathetic nerves convey the pains from the kidney (T10-L1).
Characters of Renal Pain
Dull aching pain or Renal colic.
Site & referal of Renal Pain
- Origin: Costo-vertebral angle or loin.
- Radiation: Umbilicus, lower abdominal quadrant & testis.
Renal Pain may be associated with β¦..
Relation of Renal Pain to posture & eating
Upper third Ureteric Pain
Mid Third Ureteric Pain
Lower Third Ureteric Pain
Rolling Sign
Characterstic to Ureteric Colic
Nerve Supply to bladder
Somatic, Autonomic.
Etiology of Bladder Pain
- Most common cause: Acute Urine Retention (AUR).
- Other causes: Inflammation, Tumors, Trauma, Neuropathic & Myogenic disorder.
Criteria of pain due to full bladder:
- Constant Suprapubic pain related to act of micturition, terminal dysuria.
- Referred to distal urethra.
Criteria of pain due to AUR
- Suprapubic severe agonizing, bursting pain.
- Sudden inability to urinate in spite of desire to do so.
- The bladder is full and over-distended.
Criteria of pain due to CUR
- Painless (i.e. just Suprapubic discomfort).
- Dribbling with overflow incontinence.
Criteria of pain due to Cystitis
- Suprapubic intermittent burning pain.
- Severe when the bladder is full & relieved partially by voiding.
Site of Acute Prostatic Pain
Pain in perineal, rectal & may be referred to low back.
Acute Prostatic Pain may be associated with β¦β¦
- Irritative &/or obstructive voiding symptoms.
- Rectal tenesmus.
- High grade fever.
CP of Chronic Prostatitis
Vague discomfort, UTI.
Etiology of Testicular Pain
- Orchitis or epididymo-orchitis, torsion, trauma.
- Tumors cause pain in only a minority of cases.
When testicular pain Is lost?
in leprosy, syphalis, calcified hematoma, testicular tumor,
Can the testis have a referred pain from another site? What is the most common site?
refered from kidney or ureter
Can testicular pain be referred to other sites? Where?
refered to lower abdomen
Etiology of Epidydimal Pain
Most frequently due to epidydimo-orchitis.
Site & Referral of Epidydimal Pain
- Site: In the scrotum, may be felt in the groin, lower abdomen.
- Referred from inflammation of the vas.
Masses in Urology may be β¦β¦
How to Differentiate Enlarged Spleen & Lt Renal Mass:
How to Differentiate Enlarged Spleen & Lt Renal Mass:
- Direction of Enlargment
- Insinuation of finger
- Notch & Surface
- Movement with respiration
- Ballotment
- Percussion
How to Differentiate Enlarged Spleen & Lt Renal Mass:
- Direction of Enlargment
- Insinuation of finger
- Notch & Surface
- Movement with respiration
- Ballotment
- Percussion
How to Differentiate Enlarged Spleen & Lt Renal Mass:
- Direction of Enlargment
- Insinuation of finger
- Notch & Surface
- Movement with respiration
- Ballotment
- Percussion
How to Differentiate Enlarged Spleen & Lt Renal Mass:
- Direction of Enlargment
- Insinuation of finger
- Notch & Surface
- Movement with respiration
- Ballotment
- Percussion
How to Differentiate Enlarged Spleen & Lt Renal Mass:
- Direction of Enlargment
- Insinuation of finger
- Notch & Surface
- Movement with respiration
- Ballotment
- Percussion
How to Differentiate Enlarged Spleen & Lt Renal Mass:
- Direction of Enlargment
- Insinuation of finger
- Notch & Surface
- Movement with respiration
- Ballotment
- Percussion
Etiology of Bladder Mass
Acute & Chronic Urine Retention.
Characters of Bladder Mass
- Rounded or globular swelling.
- Arising from the pelvis towards the lower abdomen in the midline.
Diffrentiate between Normal Prostate, BPH, Prostate Cancer in terms of:
Diffrentiate between Normal Prostate, BPH, Prostate Cancer in terms of:
- Site
- Shape
- Size
- Sulci
- Rectal Mucosa
- Consistency
- Mobility
Diffrentiate between Normal Prostate, BPH, Prostate Cancer in terms of:
- Site
- Shape
- Size
- Sulci
- Rectal Mucosa
- Consistency
- Mobility
Diffrentiate between Normal Prostate, BPH, Prostate Cancer in terms of:
- Site
- Shape
- Size
- Sulci
- Rectal Mucosa
- Consistency
- Mobility
Diffrentiate between Normal Prostate, BPH, Prostate Cancer in terms of:
- Site
- Shape
- Size
- Sulci
- Rectal Mucosa
- Consistency
- Mobility
Diffrentiate between Normal Prostate, BPH, Prostate Cancer in terms of:
- Site
- Shape
- Size
- Sulci
- Rectal Mucosa
- Consistency
- Mobility
Diffrentiate between Normal Prostate, BPH, Prostate Cancer in terms of:
- Site
- Shape
- Size
- Sulci
- Rectal Mucosa
- Consistency
- Mobility
Diffrentiate between Normal Prostate, BPH, Prostate Cancer in terms of:
- Site
- Shape
- Size
- Sulci
- Rectal Mucosa
- Consistency
- Mobility
Other Urological Masses
Symptoms Related to the act of Micturation
- Obstructive voiding symptoms (Voiding LUTS)
- Irritative Voiding Symptoms (Storage LUTS)
What is another name of Obstructive voiding symptoms?
Voiding LUTS
Examples of Obstructive voiding symptoms (Voiding LUTS)
Examples of Irritative Voiding Symptoms (Storage LUTS)
Types of Incontinence
Physical Characters of Urine
- Volume
- Color
- Odor
- Aspect
- Nature
Normal Volume of Urine
0.5-1ml/hr?/kg
Abnormal Volume of Urine
Normal Color of Urine
Amber yellow
Abnormal Color of Urine
Normal Odor of Urine
Urinephrous.
Abnormal Odor of Urine
Normal Aspect of Urine
Clear
Abnormal Aspect of Urine
Def of Pneumaturia
Passage of gas in urine.
Symptoms of CRF
Etiology of Pneumaturia
- Post Instrumentation.
- Infection with gas forming organism.
- Uro-enteric fistula.
Symptoms of CRF
- Late
Hiccough & itching (late).
Symptoms of CRF
- Earliest
- Lack of concentration (Earliest)
Symptoms of Metastasis
GIT Symptoms Related to Urology
- Examples
Etiology of GIT Symptoms Related to Urology
- Reno-intestinal reflexes.
- Organ relationship.
- Peritoneal irritation.
GIT Symptoms Related to Urology
- In Females
Sexual/Genital Problems Related to Urology
- In Males
Other Objective Symptoms Related to Urology
Urological Physical Examination
1) General.
2) Abdominal and DRE.
3) Targeted neurologic examination.
Finding in Scrotal Skin
Edema, infection, cyst, ulcer, sinus, tumor.
Scrotal Examination
- Scrotal Skin
- Testis
- Tunica Vaginalis
- Epidydimis
- Spermatic Cord
Reflexes in Scrotal Skin
Cremasteric reflex: L1,2.
Normal Testes
Abnormalities in Testes
Characters of Hydrocele (in Tunica Vaginalis)
Types of Hydrocele
Congenital or Acquired (idiopathic or secondary).
Normal Epidydymis
Abnormal Epidydymis
Abnormal Spermatic Cord
Patient Position in DRE
1) Dorsal position.
2) Lithotomy position.
3) Left lateral position.
4) Elbow chest position.
5) Standing and leaning forward.
Insperction in DRE
Anal Canal Examination in DRE
Finger introduction in DRE
Prostate Zone Examination in DRE
Supra-Prostatic Zone Examination in DRE
Bi-manual Examination in DRE
- Best under anaesthesia
- For: bladder tumor staging.
Bi-Digital Examination in DRE
- Index in anus and thumb in perineum.
- For:
Cowperβs gland infection (acute, chronic).
Fistula: whip-cord induration.
Final Steps in DRE
- Finger inspection: Mucous, blood.
- Cleaning,
- Say thanks to patient.