Clinical Chemistry Case Study - Genitourinary and Diabetes PDF

Clinical chemistry case study Genitourinary symptoms Diabetes mellitus References: This Chapter is based on Harrison's Principles of Internal Medicine, 19 edition, by Dennis Kasper et al, Chapter 417, Page 2399, unless cited otherwise Genitourinary symptoms Pain: Pain...

Clinical chemistry case study Genitourinary symptoms Diabetes mellitus References: This Chapter is based on Harrison's Principles of Internal Medicine, 19 edition, by Dennis Kasper et al, Chapter 417, Page 2399, unless cited otherwise Genitourinary symptoms Pain: Pain within the genitourinary tract usually arises from obstruction or inflammation. Referred pain is common. Acute inflammation of parenchyma produces severe pain and fever e.g. pyelonephritis, prostatitis and epididymo-orchitis. Tumors usually do not cause pain unless they produce obstruction or Genitourinary symptoms Renal pain: Renal or flank pain is a visceral pain that results from obstruction of urine flow with distension of the collecting system or the renal capsule. Pain due to inflammation is dull, aching and steady. It is felt in the posterior renal (costo- vertebral) angle, below the last rib and lateral. Pain may radiate anteriorly toward the umbilicus. Genitourinary symptoms Ureteric pain: A ureteral stone is the most common cause leading to hyperperistalsis and ureteral colic which is severe, colicky, intermittent pain that occurs in waves. Patients with ureteral colic are usually moving around in agony, and holding the flank while patients with intraperitoneal pathology prefer to lie motionless. Ureteral colic is usually accompanied by renal pain due to distension of the renal pelvis. Genitourinary symptoms Ureteric colic (contd.): Pain is originating at the costo- vertebral angle and radiating around the trunk into the lower quadrant of the Renal pain is felt in the posterior abdomen, or costo-vertebral angle and radiates anteriorly towards the possibly into the umbilicus (grey). Ureteral colic anterior aspect ofdistribution and referral is upper thigh and illustrated in black. Genitourinary symptoms Bladder pain: Acute urine retention: The sudden inability to urinate in spite of the desire to do so. Pain is severe, bursting, felt in the suprapubic area. The bladder is full and over-distended due to complete obstruction. Chronic retention is painless and dribbling is noted as overflow incontinence. Cystitis: Suprapubic burning pain. Genitourinary symptoms Prostate pain: It is due to acute inflammation. Localized in the perineum and referred to lower back and rectum. Acute prostatitis is associated with fever, frequency, dysuria or acute retention and tenesmus. Urethral pain: Burning during micturition is usually due to inflammation or a stone. Genitourinary symptoms Testicular pain: Primary pain is due to acute epididymo- orchitis, torsion of the testis or trauma. In patients with testicular discomfort and a normal scrotal examination, renal or retroperitoneal disease should be considered. Referred in renal or ureteric colic. Hydrocele, varicocele and testicular tumor may be associated with scrotal discomfort.. Genitourinary symptoms Penile pain: Pain in the flaccid penis is usually due to bladder or urethral inflammation or a stone. Priapism: Painful, persistent, purposeless penile erection. Causes include: sickle cell disease, pelvic tumors, pelvic infections, genital trauma, spinal cord trauma and medications (alprostadil , fluoxetine, prazosin, clozapine, warfarin, heparin) Genitourinary symptoms Dysuria: confirm weather painful micturition (uralgia) or difficult micturition (voiding difficulty) Uralgia is typically from urethral, bladder or vaginal inflammation (e.g. UTI, prostatitis, STDs/urethritis, vaginitis, and vulvitis, Stones, urethral lesions) Voiding difficulty is a sign of outflow obstruction, eg from an enlarged prostate, or urethral stricture Genitourinary symptoms Other features of outflow obstruction: straining to void, poor stream, urinary retention, and incontinence (lack of voluntary control over urination), hesitancy (difficulty starting micturition). Genitourinary symptoms Frequency differentiate increased urine production (eg diabetes mellitus and insipidus, polydipsia, diuretics, alcohol, renal tubular disease, adrenal insufficiency) from frequent passage of small amounts of urine (eg in cystitis, urethritis, neurogenic bladder), or bladder compression or outflow obstruction (pregnancy, bladder tumour, enlarged Genitourinary symptoms Polyuria: Increased urine volume >3L/24h. Causes: Over-enthusiastic IV fluid therapy; diabetes mellitus & insipidus, hypercalcemia, psychogenic polydipsia, polyuric phase of recovering acute tubular necrosis. Oliguria is defined as a urine output of