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.
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
- - 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)
- DM, HTN, Thyroid disease
- Pulmonary TB (bladder TB)
- Recurrent UTI or stone disease in the past (squamous cell carcinoma of bladder)
- Socioeconomic status
- Mariatal status, number of children
- DM, HTN, Thyroid
- Any malignancy in family
Medical and surgical history
- Recent treatment
- - the events after hospital admission
- - any past medial history
- Surgical history
- - any past surgeries
Pt was sitting comfortably in bed with ____ French 2 way Foley’s catheter in situ containing yellowish urine.
Pt was conscious, alert, cooperative.
Built and cachexic
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
- 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
- General note - tympanic/dull
- Upper liver dullness, Liver span
- Renal angle percussion - resonant/dull
- Bilateral lumbar regions (for any mass)
- Bowel sound
- Bruit (of renal artery)
- Anal tone
- - Consistency
- - Surface
- - Median groove
- - Rectal mucosa over prostate
B/L equal air entry with normal vesicular breath sound with no added sound.
- Grossly intact
- Spine normal
- Pt has normal hearing (Alport syndrome)
Differential diagnosis of Hematuria
- Upper urinary tract urothelial cancer
- TB Urinary Bladder