Benign prostatic hyperplasia

Benign prostatic hyperplasia 

Benign prostatic hyperplasia involves hyperplasia of prostatic stromal and epithelial cells, resulting in the formation of large, fairly discrete nodules in the periurethral region of the prostate. When sufficiently large, the nodules compress the urethral canal to cause partial, or sometimes virtually complete, obstruction of the urethra, which interferes with the normal flow of urine.Benign prostatic hyperplasia involves hyperplasia (an increase in the number of cells) rather than hypertrophy (a growth in the size of individual cells).

 Symptoms

 Symptoms of urinary hesitancy, frequent urination, dysuria (painful urination), increased risk of urinary tract infections, and urinary retention, urgency (compelling need to void that cannot be deferred), urgency incontinence, and voiding at night (nocturia).. Although prostate specific antigen levels may be elevated in these patients because of increased organ volume and inflammation due to urinary tract infections, BPH does not lead to cancer or increase the risk of cancer.Benign prostatic hyperplasia symptoms are classified as storage or voiding.


Voiding symptoms include urinary stream hesitancy (needing to wait for the stream to begin), intermittency (when the stream starts and stops intermittently), straining to void, and dribbling. Pain and dysuria are usually not present. These storage and voiding symptoms are evaluated using the International Prostate Symptom Score (IPSS) questionnaire, designed to assess the severity of BPH.BPH can be a progressive disease, especially if left untreated. Incomplete voiding results in stasis of bacteria in the bladder residue and an increased risk of urinary tract infection. Urinary bladder stones are formed from the crystallization of salts in the residual urine. Urinary retention, termed acute or chronic, is another form of progression. Acute urinary retention is the inability to void, while in chronic urinary retention the residual urinary volume gradually increases, and the bladder distends. This can result in bladder hypotonia. Some patients that suffer from chronic urinary retention may eventually progress to renal failure, a condition termed obstructive uropathy.

Coconut

The coconut palm, Cocos nucifera, is a member of the family Arecaceae (palm family). It is the only accepted species in the genus Cocos. The term coconut can refer to the entire coconut palm, the seed, or the fruit, which, botanically, is a drupe, not a nut.

Uses
Coconuts may help benign prostatic hyperplasia.In rats, virgin coconut oil reduced total cholesterol, triglycerides, phospholipids, LDL, and VLDL cholesterol levels and increased HDL cholesterol in serum and tissues.The hexane fraction of coconut peel may contain novel anticancer compounds.Young coconut juice has estrogen-like characteristics. Inside a coconut is a cavity filled with coconut water, which is sterile until opened. It mixes easily with blood, and was used during World War II in emergency transfusions. It can also serve as an emergency short-term intravenous hydration fluid. This is possible because the coconut water has a high level of sugar and other salts that makes it possible to be used in the bloodstream, much like the modern lactated Ringer solution or a dextrose/water solution as an intravenouus solution (IV). Coconut is also commonly used as a traditional remedy in Pakistan to treat bites from rats.The tea from the husk fiber is widely used to treat several inflammatory disorders.The leftover fiber from coconut oil and coconut milk production, coconut meal, is used as livestock feed. The dried calyx is used as fuel in wood-fired stoves. Coconut water is traditionally used as a growth supplement in plant tissue 
culture/micropropagation.

#Coconut can be a food allergen and coconut-derived products can cause contact dermatitis.

Life as A Medical Student

Medical Student's Life

Most of us,i mean medical students entering the medicine life  with so many dreams in their heart.Some really wanted to be a doctor while some are don't. They came here  because their parents forces them,for the name of 'Dr' and many other reasons. But, what actually happen there...during their life as a medical student..While in the lecture hall..i was wondering what was the problem here..why everything look so lame..i felt like i lost something...life looks dull here..waiting when i can go back to Malaysia...i asked my friends..what they feel being here...how was their experiences as a medical  student here..and the replies were:

Student A:
so..screwed up...should have checked where ---- is in the world map before I applied here.but in the map also there won't be any thing that this place is such a f-- up place.. :)


Student B:
"I discover the divine joy of my life after coming here.I still recall that memorable day,when I first stepped on this land the exhilaration aura itself was enough for me to hyperventilate with enormous satisfaction and quickly bond with this amazing country with yet non-sobbing heart."

#note the inverted comma 

Student C:
I became from a sweet to a mean person .I don't recognize  myself anymore.The environment of this place ,for god sake is setting to me.the worst decision of my life was to choose ---- to do medicine.It is the worst place to pursue to MBBS.


Student D:
As a medical student here,my experience here has just been tough luck whether it's the institution nor lectures or fellow local peers who were nothing close to molding a good medical practitioner .Lecturer were just condemning and downgrading where only humiliation and low-self esteem left in us. Institution has no system whether its the record of student ,tuition fees nor the syllabus .Even the  ---- was clueless of the problems students bring forward to him.It maybe a renowned college here in ----- but it's nowhere near international standard .As for the country,unstable politics ,never ending rallies and bloody riots -It already sound like a 'heavenly ' place.Even my first day at registration in college we were out due to bomb sear.-i guess that sums it all about this place. 



Student E:
-sadness
-torture 
-abusing(child abuse)  :/..'buffalo is classified as child'
-mentally challenged 
          

Student F:
-humiliation 
-find true love..'who is that??'
-insulted 
-gender bias ..'to make it more accurate i think its country bias'
-supplement and no complement.,.'those who smart will know what it means'
-never ending course 
-no handsome lecturer ..'too bad,i guess everyone knows that this comment definitely from a girl'
-no holidays


Student G:
life become lifeless.no entertainment .leading a boring life.ongoing problems in college.found good friends.
the saddest part is living away from parents.but i found love too.so i guess its not that bad..'all the best'


Student H and I:
'very good experience' 
'very cooperative local friends'
'we are tough in english medium 
'less exam to attend '
'variety food of ----'
'lecturer are very friendly'
#note the inverted comma 



Student J:
-disappointment because my hope and dream vanished just like that after i came here
-regret.i should choose any other studies which i'm capable to
-psychologically disturbed due to the situation that i'm facing here every single moments
-stress because my life is really lifeless and i'm too much with problems

and those are few expectation from the student:

-a neat management system system
-more attention toward people who cant follow especially foreigners who having major problem here
-respect as a human 
-a good teacher and student relation 
-no discrimination 

Honestly ,i do felt the same...its not fun studying here..the system was totally out..No semester  break,no study break..no any official holidays here.Only a day break in a week..No time table,class syllabus..nothing here!!!if ask,everybody says they have...but where???i have never seen it before..Classes  will be taken in Bengali..i never blame some good lecturer who took the whole class in English ..but it's totally bullshit to learn their language.When i learnt their language,many of them speak the local dialect which was way to hard to learn nor speak.. Then what for i paid so much and came here...simply study everything by my own,then do my exam and the bonus will be get scolded from the lecturer ..How great my life as a medical student...I thought college life will be the happiest moment in life ,but it really sucks here..Its a college.Not a prison.Many people here never realize it.When go for wards,instead of teaching,they suddenly ask question.Is this the way of teaching?? Well done  .I'm very sure that when i'm out from here...and when i turn back and look.,..this 5 year will be the worst time of my life..nothing thrilling here..no competition..no games..no proper water supply ,electricity problem..most of the time food poisoning..and etc...what a great college life i'm having here..

Urinary Catheterization

Urinary Catheterization

Indication

-relief of acute urinary retention

-monitoring of urine output during critical illness

-drainage of urine and surgical debris following urological surgery 

-urodynamics studies

-intravesical drug instillation

long term catheterization for:

-incomplete emptying of the bladder due to neurological disorder or spinal cord damage

-bladder outlet obstruction in whom surgery is not possible

-intractable urinary incontinence

Contraindication

-abdominal or pelvic trauma 

-immediately following open prostatectomy

-epididymitis 

-haematuria ,urethral obstruction,discharge or pus

MALE URINARY CATHETERIZATION 

-sit the patient on the absordent pad ,ensuring they are not unduly exposed

-wash hands,put on apron and open the dressing pack

-open the remaining equipment onto the sterile dressing pack

-put on 2 pairs of sterile gloves

-clean  the outside of the foreskin and retract

-cleanse urethral meatus and penis,swabbing away from the urethral orifice

-arrange the sterile drape and place so that the penis passes through the hole in the drape 

-remove the outer pair of sterile gloves

-using a gauze swab hold the penis gently and laterally behind glans in vertical position

install approximately 10ml anaesthetics gel,warm the patient that slight stinging may be experienced(maybe reduce by chilling the gel)

-gently pinch the tip of the penis for atleast 1 min before attempting to pass the catheter 

-position the sterile bowl to catch urine and tear the top of the protective sleeve around the catheter ,leaving the remainder in place to act as a sterile covering

-using a sterile gauze swab hold the penis in an upright position 

-the catheter should pass easily and urine should flow within a few seconds,continue to advance to ensure that the balloon is within the bladder

-inflate the balloon with the  correct amount of sterile water

-withdraw the catheter gently until slight resistance is felt

-if appropriate ,a urine specimen can be collected for bacterial examination at this point

-attach the catheter to a closed drainage system

-it is essential that the foreskin is replaced back over the glands

-dispose all the equipment as per local infection control policy

-record the following in the patient 's records:the reason for catheterization.size of catheter ,amount of water in the balloon,gel used,any complication 

FEMALE URINARY CATHETERIZATION 

-identify and expose the urethral meatus by separating the labia minora

-cleanse the urethral orifice and surrounding area with cleansing solution (as above):cleansing should be carried out form the superior area in one downward motion

-it may be necessary to use the index finger of the hand not being used to hold the catheter to landmark the position of the urethra,in relatiom to the vagina

-once confident that the catheter is in the urethra ,advance it approximately 7-9cm or until urine flow commences ,then advance it further 2cm.

by lakdhes

ref:davidson

GENERAL AND SYSTEMIC EXAMINATION

Clinical Examination: Steps Of Taking Patient History (Medicine)

Clinical Examination: Steps Of Taking Patient History (Medicine)

A.GENERAL EXAMINATION

1.Appearance-how the patient look like,his state

2.Decubitus-the position of a patient, they first state the part of the body on which the patient is resting . For example, the right lateral decubitus would mean that the patient is lying on his or her right side.

3.Body Build

4.Nutritional status

5. Anaemia

6.Cyanosis

7.Jaundice

8.Clubbing

9.Koilonychia - also known as spoon nails. A nail disease that can be a sign of hypochromic anemia, especially iron-deficiency anemia.Koilonychia literally means "spoon nails." It refers to abnormally thin nails (usually of the hand) which have lost their convexity, becoming flat or even concave in shape. In a sense, koilonychia is the opposite of nail clubbing.

10.Leukonychia-also  known as white nails, is a medical term for white discoloration appearing on nails. The most common cause is injury to the base of the nail (the matrix) where the nail is formed, or by a diet low in potassium.

11. Oedema

12.Dehydration

13.Neck Vein

14.Thyroid gland

15.Lymph nodes-main lymph node sites:

-cervical

-axillary

-epitrochlear

-inguinal

16.Skin condition

17.Any abnormal finding on body-such as lump.Characteristic that should be observe in case of lump:

-size

-position

-consistency

-tenderness

-attachment

-edge

-surface

-shape

-pulsation

-thrill,bruit

-transillumination

18.Pulse

19.Temperature

20.Respiration

21.Blood Pressure

General Examination According to Site:

1.Eye-upper sclera-jaundice

        -lower sclera-anaemia

2.Mouth-lips-cyanosis,tobacco stain

             -tongue-upper-anaemia

                       -lower-jaundice

                       -fungus,cyanosis

3.Hand-nails-Koilonychia

                  -Leukonychia

                   -clubbing

                   -beau's line-deep grooved lines that run from side to side on the fingernail

4.Leg-oedema(at ankle and in case of bedridden patient,oedema should be also check at sacrum   area)

SYSTEMIC EXAMINATION

Systemic examination is divided into their own system but the main things to do here is:

1.Inspection-see with your eyes

2.Palpation-touch with hand and feel

3.Percussion-striking one finger with another(for dull or abnormal sound detection)

4. Auscultation-listening to the internal sounds of the body, usually using a stethoscope

Examination of Cardiovascular System:

a.pulse-rate,rhythm.symmetry ,R-F delay,collapse ,character ,volume

b.blood pressure-lying and standing

c.Jugular venous pressure

d.examination of pericardium

   1.Inspection

    -shape of pericardium

    -apex beat

    -any visible pulsation

   2.Palpation

    -apex beat-position and character

    -any thrill present or absent

    -left parasternal heave ( precordial impulse that may be felt (palpated) in patients with cardiac or respiratory disease)

     -palpation of the heart sound

     -carotid shudder

  3.Percussion -not done

  4.Auscultation

  -heart sound

   -any murmur present

   -any added sound

Examination of Peripheral Vascular System

a.all peripheral pulses:present or absent,normal volume

b.bruit over the femoral artery :present or absent

c.features of arterial insufficiency

     -color of skin

     -capillary features in toe

     -leg raising test

d.features of venous insufficiency

      -varicose vein :absent

      -features of deep vein thrombosis :absent

Examination of Respiratory System

A.FRONT OF CHEST

a.inspection

   -size and shape of chest

   -apex beat:visible or not,position

   -any deformity/swelling /visible intercostal abnormalities , accessory muscle movement

   -movement of the chest

    -respiration :rate,rhythm,pattern

b.palpation

    -position of trachea

    -apex beat

    -expansibility of chest

    -vocal fremitus

c.percussion

   -percussion note

   -area of superficial cardiac dullness

   -upper border of liver

d.auscultation

   -breath sound

   -any added sound

    -vocal resonance

B.TO BACK OF CHEST

a.inspection

   -any abnormal features

   -any scar mark

   -movement of chest

b.palpitation

   -expansibility

   -vocal fremitus

c.percussion

   -percussion note

d.auscultation

   -breath sound

   -any added sound

   -vocal resonance

Examination of The Alimentary System

Parts:

A.Oral Cavity

B.Abdominal area

C.Genitalia

A.oral cavity

   -lips            

   -buccal mucosa

   -gum            

   -tongue

   -teeth          

   -palate

   -oropharynx

   -breath odour

B.abdomen

  1.Inspection

     -size and shape of abdomen

    -position of umbilicus

    -movement with respiration

    -any swelling

    -any visible vein

    -any visible peristalsis

    -any scar mark/striae /pigmentation /hair distribution

    -hernial orifice (cough test)

  2.Palpation

    a.superficial palpation

       -skin temperature

       - muscle  guard and rigidity

       -swelling :felt /not felt

    b.deep palpation

       -left kidney

       -spleen

       -liver

       -gall bladder

       -urinary bladder

       -aorta

       -para-aortic lymph nodes

       -murphy's sign:present/absent

       -McBurney's sign:tender/absent

    c.percussion

      -percussion note

      -shipping dullness

      -fluid thrill

    d. auscultation

     -bowel sound

     -renal bruit

     -hepatic bruit/splenic  rub

C.genitalia

    -external examination

    -per rectal examination :not done

    -per vaginal examination:not done

Examination of Nervous System

A.Higher Cortical Function

  -conscious/unconscious:grading(Glasgow Coma Scale)

  -appearance ,behaviour .cooperation

  -emotional state

  -delusion and hallucination

  -orientation in place and time

  -memory

  -intelligence

B.Speech and language

C.Examination of Cranial Nerves

  Olfactory I

 Optic II

  Oculomotor III

  Trochlear IV

  Trigeminal V

  Abducents VI

  Facial VII

  Auditory (vestibulocochlear) VIII

  Glossopharyngeal IX

  Vagus X

  Spinal Accessory XI

  Hypoglossal XII

a.Olfactory nerve

  -smell:intact/absent/decrease /accelerate

b.Optic nerve

  -acuity of vision:right/left  (  6/6 )

  -field of vision

  -color of vision

  -ophthalmoscopic examination

c.Oculomotor nerve , Trochlear nerve,Abducent nerve

  -movement of eyeball

  -light reflex :direct /indirect

  -accommodation reflex

d.Trigeminal nerve

  -facial sensation

  -motor function

  -corneal reflex

  -jaw jerk

e.Facial nerve

  -motor function

  -sensory function(taste)

f.Auditory (vestibulocochlear) nerve

  -hearing test

  -turning fork

  -positional nystagmus

 -walking in a straight line

g.Glossopharyngeal and Vagus nerve

   -nasal voice :present/absent

   -drinking test :check deglutition movement

   -palate reflex

   -gag reflex

   -to say Ah...

h.Accessory nerve(spinal)

  -strength sternocleidomastoid

  -strength trapezius 

i.Hypoglossal nerve

-tongue:shape ,spastic , fasciculation, tremor

-movement and strength of tongue

Examination of Motor Function

1.Bulk of muscle

2.Tone of muscle

3.Strength of muscle

4.Any involuntary movement

5.Coordination of movement :upper limb and lower limb

6.Reflex

  a.Superficial Reflex

     -plantar reflex:right and left

     -abdominal reflex :right and left

  b.Deep Reflex

     -knee jerk

     -ankle jerk

     -supinator jerk

     -biceps jerk

     -triceps jerk

  c.Clonus

    -ankle clonus

    -Patellar clonus

  d.Gait

Examination Of Sensory System

1.pain

2.touch

3.temperature

4.sense of position

5.sense of vibration

Examination Of Cerebellar Function Test

1.head position

2.speech

3.eye: nystagmus

4.intention tremor and past pointing :finger nose test

5.rebound phenomenon

6.Dysdiadochokinesia

7.heel knee shin test

8.pendular  knee jerk

9.gait

SIGN OF MENINGEAL IRRITATION

1.neck rigidity

2.Kernig's sign

3.Brudzinski's sign.

OPHTHALMOSCOPIC EXAMINATION

Examination Of Genitourinary System

1.Bladder :palpable/not palpable

2.Kidney:palpable/not palpable

3.Renal angle:tender/no tender

4.Genitalia examination

5.Urine(bed side test)-protein

                                  -sugar

Examination Of Locomotor System

1.vertebrae

2.joints

3.skull

Lastly...

1.Salient features-something like a summary of your case

2.Provisional diagnosis -your opinion about the case finding

3.Differential diagnosis-how to differentiate between disease with same symptoms

4.Investigation(Suggestion)-about the case

5.Clinical diagnosis -make confirmation

6.Treatment-prescribe drugs

by Lakdhes

reference:Macleod’s,Hamilton’ Bailey’s Demonstration of physical Sign in Clinical Surgery ,CMC lecture.