IB CSL SURGERY
UROL/ BREAST BEDSIDE
Dr NG Patil
Surgery
Thu 10-10-02
UROLOGY PT
History
- 73/M
- C/o: inability to pass urine + faeces
- 18th Sept: inability to pass urine, 19th Sept went to A&E ® admitted, catheterised
- 13th Sept: inability to pass faeces ® laxative
Urinary symptoms
- Anuria: no urine produced (kidney, pre-renal)
- Oliguria: normally 1-1.5 L urine produced/ day (oliguria 500cc/ day) ® kidney, ¯ intake
- Retention: obstruction (1) Mech - eg. Prostate (2) Path - eg. spinal path [obstructive uropathy at neck of UB]
Retention vs. Anuria/ oliguria
- Retention: inability to pass accompanied by urge to pass + pain/ discomfort due to retained urine
- Anuria/ oliguria: no urge
- Neurological condition: may have distension but not pain (eg. MS, spinal injury, DM, leprosy)
Symptoms of UB + ureter < UB
- UB: distension, discomfort
- Kidney/ ureter: may be not symptoms, colicky pain (stone), haematuria
- Symptoms either (1) Obstructive (2) Irritating
General examination
- General condition of Pt
- P, T, C
- Vital signs
- Ankle oedema
- LN: if supine, perform from in front of Pt (extend neck); do not perform at right-angles to Pt
Urological examination
- Ab: suprapubic swelling (retention), catheter, scar (eg. kidney), fullness, cough impulse, kidney ballottable, hepatosplenomegaly
- Genitals: external urethral meatus, scrotal swelling, excoriation of skin (eg. ulceration due to prolonged retraction of foreskin - eg. catheterisation), testicular pain(retrograde UTI along vas ® epididymo-orchitis), TB of epididymis (from seminal vesicle), hydrocele, varicocele
Note: symptoms
- Bacteria: epididymis
- Virus (eg. syphilis): testicles
Anatomy
- Testis usually in from of epididymis
- Sometimes epididymis in front (if congenital = bilateral; if torsion = unilateral)
- Palpation of testis: may cause vasovagal attach (bradycardia)
- Phimosis: cannot retract foreskin (1) Mild: 90% population (2) Moderate: chance paraphimosis (3) Severe: cannot see glans, "pinpoint meatus", congenital
- Paraphimosis: cannot pull foreskin to cover glans
BREAST
- Explain: courteous, chaperone, exposure
- Four quadrants, flat hand purposeful palpation (UL/M, LL/M)
- Nipple
- Attachment to skin (arm side, raised)
- Deep fixity (hands on hips)
- Regional LN (eg. axilla, hold Pt's arm)
- Other breast (usually start with normal breast)
- Conclusion: reassurance + future plan
Raised arms
- Pendulous breasts: enables vision of underside
- Skin tethering will be accentuated
- No need to lead forward if small breasts
Parts of breast
- Nipple/ areola complex: treat as separate quadrant
- Breast proper
If feel lump, complete rest of br exam and come back to lump (feel with fingertip and describe features)