إعلان
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لحظة من فضلك!
أهلا بكم
مشاريع 
هدية {وَإِذَا سَأَلَكَ عِبَادِي عَنِّي فَإِنِّي قَرِيبٌ أُجِيبُ دَعْوَةَ الدَّاعِ إِذَا دَعَانِ فَلْيَسْتَجِيبُواْ لِي وَلْيُؤْمِنُواْ بِي لَعَلَّهُمْ يَرْشُدُونَ} الفعاليات القادمة
استطلاع الرأي إلى أي مدى تعتبر أنّ الدراسة النظريّة للطبّ في كليتنا ستخدمك سريرياً في المستقبل؟ أعتبر أنّ الفائدة معدومة في ظل النظام التدريسيّ الحالي. 28% الفائدة كبيرة جداً، وهي أساس التميز العملي. 6% الأمر نسبي، يختلف من طالب لآخر، ومن مادة لأخرى. 67% عدد الأصوات: 240 أهلاً بك ! تفضل الإبحار |
A 40 year old lady with urinary incontinence
Ghufran - الجمعة, 2008-04-18 05:48 |
الوصف الكامل Background: A 40 year-old female G5,P5 came to the clinic complaining of urine leakage. The story of incontinence started 4 ms ago after 2 month of her pregnancy which was terminated on time by NVD (normal vaginal delivery). She said that the incontinence was mild at first and was accompanied by special doings like coughing, laughing.. But Now it's getting worse and she has it even when just standing. She denies urgency or hesitancy at the mean time but they happened once at the beginning of her last pregnancy. She denies wetting in supine position.
PMH is unremarkable. She is during menses now. She is not taking any medications. Her older sister had a similar problem. Surgical hx is negative. Based on the above hx, what is ur DDx? What's the most likely dx? What u wanna do next? الشكوى الرئيسية CC: القصة المرضية HPI: الأجهزة الأخرى ROS: السوابق المرضية الشخصية PMH: السوابق المرضية العائلية FMH: الوضع الصحي والاجتماعي SH: الفحص السريري Clinical Exam: التشخيص التفريقي DD: الاستقصاءات Investigations: التدبير Managment: كتابة حرة وطرح موضوع النقاش!: Based on the above hx, what is ur DDx? What's the most likely dx? What u wanna do next?
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بظن انه سلس جهدي سببه الولادات المتعددة .
غير متأكدة اذا كان العلاج الدوائي والفيزيائي (كيغل ) يكفيها.
ممكن نعمل فحص الجهد فحص بالوضعية النسائية + مثانة ممتلئة ويراقب الطبيب الصماخ البولي ويطلب من المريضة السعال خروج البول يشخص السلس الجهدي أو اختبار حامل القطن.
تنظير الاحليل والمثانة لاحقا لتحري الحصيات والاورام والرتوج
تخطيط جريان البول ومخطط ضغوط المثانة وهذه الاستقصاءات كافية لتشخيص 90% من المرضى.
العلاج جراحي بظن لانه السلس شديد يحدث بالوقوف
What about the ddx? U just mention the likely dx?
Making a ddx is essential in every case even if the case is clear. By this way u won't miss any dx….
I didn't tell u about her Physical exam.
Anyway, her general PE was within normal. Her BMI is 30.
Pelvic exam showed no obvious abnormalities. DRE is done with normal sphincter tone and no other abnormalities. Stree test was positive.
I will complete with work-up after u tell me ur ddx, if u would……
SUI
-Urge Incontinence (which usually causes hesitancy & urgency). some pts may be accustomed to thes symptoms and will ignore them
mixed Incontinence
total Incontinence (which causes Incontinence in all positions and it's unlikely here)
overflow Incontinence (also unlikely 4 the same previous cause)
Transient Incontinence (which accompanies other medical conditions. one of which is bladder infection that she had before, but the duration of symptoms here is not compatible)
neurologic bladder (unlikely coz her general PE doesn't suggest any disease, no hx of DM, normal sphincter tone))
pelvic prolapse may accompany SUI as they have smiliar etiology but the pelvic exam was normal. pelvic prolapse when symptomatic causes heavy sensation, infections, incontinence.......
work up should include urinalysis, urine culture, urodynamic studies, imaging studies, & others if needed.
managment may include:
Kegel exercises and pelvic floor exercies
weight loss may help
MED like adrenergic agonists (e.g.ephedrine), antidepressants (e.g.Duloxetine
Surgery if the above failed or when the pt want it as a rapid solution
usually Stess incontinence is more likely 2 need Surgery than urge incontinence which managed medically