Urosurgery 21 Bladder Carcinoma Long case

  1. Chief complains -
    • Age of patient -
    • Sex -
    • Address -
    • Occupation -

    • •  Passage of blood in urine for .. year 
    • • Swelling in abdomen or loin for………….. months/years.
    • • Passage of blood in urine for………….. months/years.
    • • Increased frequency of micturition for………….. months/years.
    • • Difficulty in passing urine for………….. months/years.
    • • General symptoms like fever, anorexia, weight loss for………….. months/years.
  2. HOPI
    The patient was apparently well before this episode of illness which started 1 year back when he had

    • Passage of blood in urine
    • - Insiodious in onset
    • - Profuse
    • - Blood mixed with urine through out the micturition.
    • - H/o passage of clots in urine.
    • - Shape of clot - amorphous or Vermiform 
    • - Pain during passage of urine (stone)


    • Features of LUTS
    • - FUN WISW

    • History of incontinence
    • - true or false
    • - type of incontinence 

    • Fever 
    • - UTI,
    • - RCC, Wilms tumor

    • Rule out malignancy
    • - Weight loss
    • - Anorexia
    • - Malena, Hematemesis, 

    • Other causes of hematuria -
    • - Sore throat, Skin rashes,  limbs or face swelling (PSGN)
    • - Petechiae, Purpura, Ecchymosis (Bleeding tendency)
    • - H/o trauma or catheterization before the start of blood in urine.
    • -  Pain and swelling in the abdomen and loin (nephritic syndrome, nephrotic syndrome).
    • - Pyuria or lithuria (Stone disease, UTI)


    • Risk factors for bladder cancer
    • -  Exposure to textile, rubber, dye, petroleum industries nor has radiation exposure.

    • Rule out metastasis
    • - Jaundice (to liver)
    • - Bladder habit (GI malignancy infiltrating bladder)
    • - Chest pain, shortness of breath, cough, hemoptysis (chest involvement)
    • - Headache, LOC or any focal neurological deficit (CNS metastasis)
  3. Past history
    • DM, HTN, Thyroid disease
    • Pulmonary TB (bladder TB)
    • Recurrent UTI or stone disease in the past (squamous cell carcinoma of bladder)
  4. Personal history
    • Smoking 
    • Alcohol
    • Diet 
    • Sleep
    • Socioeconomic status 
    • Mariatal status, number of children
  5. Family history
    • DM, HTN, Thyroid 
    • Any malignancy in family
  6. Medical and surgical history
    • Recent treatment
    • - the events after hospital admission
    • - any past medial history 

    • Surgical history 
    • - any past surgeries
  7. Allergic history
    any allergy
  8. O/E :
    Pt was sitting comfortably in bed with ____ French 2 way Foley’s catheter in situ containing yellowish urine.

    Pt was conscious, alert, cooperative.

    Performance status 

    Built and cachexic 

    BMI

    Vitals 

    PICCLED
  9. Abdominal examination  - Inspection
    • - Shape - scaphoid, distended, flat
    • - Umbilicus
    • - All quadrants moving with respiration
    • - Skin over the abdomen
    • - Scar
    • - Pigmentation
    • - Venous prominence
    • - Swelling on the abdomen and B/L loin
    • - Hernial sites
    • - External genitalia - Penis and meatus, scrotum, testis
  10. Abdominal palpation
    • Superficial palpation - 
    • - Local rise in temperature 
    • - Tenderness 
    • - Obvious swelling

    • Deep palpation 
    • - Tenderness 
    • - Liver 
    • - Spleen
    • - Kidney and renal angle tenderness 
    • - Bladder
    • - Palpation of testis, penis and spermatic cord
  11. Percussion
    • General note - tympanic/dull
    • Upper liver dullness, Liver span 
    • Renal angle percussion - resonant/dull 
    • Bilateral lumbar regions (for any mass)
  12. Auscultation
    • Bowel sound
    • Bruit (of renal artery)
  13. DRE
    • Anal tone
    • Prostate
    • - Consistency
    • - Surface
    • - Median groove
    • - Rectal mucosa over prostate
  14. Chest examination
    B/L equal air entry with normal vesicular breath sound with no added sound.
  15. CVS examination
    S1S2M0
  16. Neurological examination
    • Grossly intact
    • Spine normal
    • Pt has normal hearing (Alport syndrome)
  17. Provisional diagnosis
    Carcinoma UB
  18. Differential diagnosis of Hematuria
    • BEP 
    • RCC
    • Upper urinary tract urothelial cancer
    • TB Urinary Bladder
Author
prem77
ID
331157
Card Set
Urosurgery 21 Bladder Carcinoma Long case
Description
Bladder cancer
Updated