Download e-book for iPad: ABC of Urology by Chris Dawson, Hugh Whitfield
By Chris Dawson, Hugh Whitfield
Urological difficulties surround quite a lot of either distressing and almost certainly lifestyles threatening stipulations and the variety of basic perform displays is starting to be swiftly as a result expanding age of the inhabitants. either trustworthy and complete, the second one version of the ABC of Urology presents a completely up to date and revised consultant to the speciality which highlights the new advances during this quarter. Concentrating particularly at the therapy and analysis of the commonest stipulations, the emphasis is on shared care, the place the abilities of the first care workforce are utilized in conjunction with medical institution referral.
This concise, well-illustrated and hugely useful textual content will give you the ideal reference for normal practitioners and perform nurses, in addition to junior medical professionals dealing with clinic referrals
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The specific adhesins determine the degree and site of invasion. Adhesion of bacteria to the epithelium is followed by proliferation, invasion, and initiation of the inflammatory process. Protective glycoprotein layers that cover the urothelium are broken down, promoting colonisation of the exposed deeper layers. Patients susceptible to urinary tract infection also have increased carriage of adhesive bacteria in the large intestine, perineum, introitus, and prepuce. Features of urinary tract infections ● ● ● ● ● ● ● Urinary tract infection is common, particularly in women Urinary tract infection may be less common in men because the extra urethral length prevents bacterial colonisation of the bladder Cystitis produces symptoms of frequency, urgency, dysuria, and suprapubic pain Local symptoms may be absent, particularly in elderly people, who may present only with increasing confusion Urine often has an offensive odour Underlying functional or anatomic disorders must be excluded Ascending infection causes pyelonephritis, which typically presents with fever, loin pain, and malaise Risk factors for complicated urinary tract infection Male sex Old age ● Febrile urinary tract infection ● Symptoms for Ͼ 7 days ● Haematuria ● History of stone disease ● Recent hospitalisation ● ● ● Common urinary bacterial pathogens Klebsiella spp Providencia spp ● Citrobacter spp ● Serratia spp ● Enterococcus faecalis ● ● ● ● Escherichia coli Staphylococcus saprophyticus ● Streptococcus faecalis ● Proteus spp ● Pseudomonas spp Urinary tract infection symptoms Management of urinary tract infection in women Urinary tract infection is extremely common in women, as the short urethral length permits easy bacterial colonisation of the bladder.
Primary carcinoma in situ rarely presents with haematuria. It may present with irritative symptoms. Papillary transitional cell carcinoma Investigation of patients with suspected bladder cancer All patients with bladder cancer should be managed by urologists who are part of a multidisciplinary team associated with a cancer network. Initial investigations Most patients now are seen in specialist haematuria clinics. Fibre optic cystoscopy under local anaesthetic will be the initial investigation.
Half of such cases develop renal cell carcinoma. The gene for Von Hippel-Lindau disease is a tumour suppressor gene on chromosome 3. It contains three exons and encodes a protein of 213 amino acids. Loss of its activity favours tumour growth. Abnormalities in the gene for Von HippelLindau disease are evident in 75% of sporadic cases of renal cell carcinoma. Furthermore, mutation of p53 has been reported in 6–40% of cases of renal cell carcinoma and may correlate with tumour grade and stage. 5%) 34 Definition Ͻ7 cm confined to kidney Ͼ7 cm confined to kidney Into adrenal or perinephric fat not Gerota’s fascia Involvement of the vena cava below diaphragm Involvement of the vena cava above diaphragm Beyond Gerota’s fascia One regional node More than one regional node Distant metastases Altered hypoxia inducible factor I Vascular endothelial growth factor Neovascularity of tumour Proposed pathway of effect of loss of Von Hippel-Lindau gene activity ABC of Urology Second Edition Edited by Chris Dawson and Hugh N Whitfield © 2006 Blackwell Publishing Ltd.
ABC of Urology by Chris Dawson, Hugh Whitfield