Interviewing a patient with the urinary system problems

Doctor: Are you having any trouble with your waterworks?

Mr Jones: Well, I do seem to have to go to the toilet more often than I used to.

Doctor: How often is that?

Mr Jones: It depends, but sometimes it's every hour or even more often.

Doctor: What about at night? Do you have to get up at night?

Mr Jones: Yes. Nearly always two or three times.

Doctor: Do you get any burning or pain when you pass water?

Mr Jones: No, not usually.

Doctor: Do you have any trouble getting started?

Mr Jones: No.

Doctor: Is the stream normal? I mean is there still a good strong flow?

Mr Jones: Perhaps not quite so good as it used to be.

Doctor: Do you ever lose control of your bladder? Any leaking or dribbling?

Mr Jones: Well, perhaps a little dribbling from time to time.

Doctor: Have you ever passed blood in the urine?

Mr Jones: No, never.

frequency	frequent passing of urine
dysuria	burning or scalding pain in the urethra when passing urine
nocturia	urination at night
urgency	urgent need to pass urine
hesitancy	difficulty starting to pass urine
urinary incontinence	involuntary passing of urine
haematuria	macroscopic blood in the urine

Urinalysis

Urinalysis is the analysis of urine. Simple screening tests of the urine are carried out with reagent strips, for example Clinistix for the detection of glucose. More detailed tests are carried out in a laboratory on a specimen of urine. Typical specimens are a midstream specimen (MSU) and a catheter specimen (CSU). Microscopic examination may reveal the presence of red blood cells, pus cells, or casts. Casts are solid bodies formed by protein or cells.

Plus signs are used in case notes to indicate abnormal findings. A small amount (+) is described as a trace. For a large amount (+++), the words gross or marked can be used, for example gross haematuria. When there is nothing, the word nil is common.

 

Coeliac disease

 

Coeliac disease is a disease of the small intestine caused by sensitivity to gluten. It can present at any age but in infancy it appears after weaning on to cereals containing gluten. The clinical features include diarrhoea, malabsorption and failure to thrive. There may be signs of malnutrition and there may be some abdominal distension Thee is delayed growth and delayed puberty, leading to short stature in adulthood.

sensitivity to = having a negative reaction to

weaning = changing the diet from milfe only to solid foods

clinical futures = the symptoms and signs of a disease

malabsorption = poor absorption

malnutrition. = poor diet (nutrition)

thrive = grow strongly

distension = swelling

delayed = later than expected

failure = when something that is expected does not happen

stature = size, especially height

 

Kidney Diseases

There are three structures of the kidney which are susceptible to disease: the glomeruli, the tubules and the blood vessels. However, it is rare that only one of these structures is affected; what happens to one frequently affects the others as well.

The disease in which the glomeruli are particularly involved is called glomerulo-nephritis. It may be acute or chronic, the first frequently leading to the second. It is often a sequel1 to such a childhood infectious disease as scarlet fever. In glomerulo-nephritis, the glomeruli become clogged with exudate and cell debris so that the blood no longer flows through them. Here a clearance lest is useful; it will show that much smaller quantities of filtrate are being formed than normally. The glom­eruli being still open become permeable to protein and albuminuria becomes very marked. This leads to edema.

Diseases involving the tubules are called nephroses. They are usually caused by poisons of various kinds, such as mercury, bismuth, uranium, or carbolic acid. Some degree of tubular degeneration occurs, however, in such diseases as diabetes, malaria and pernicious anaemia, and also in traumatic shock. Finally, athero-sclerosis of the kidney may occur, reducing the total blood flow through the kidney’s blood vessels.

What happens to the kidneys when incompatible blood has been used in a transfusion? Hemolysis of red cells occurs, of course, and the liber­ated hemoglobin circulates in the blood. Passing through the kidney, hemoglobin (although its molecular weight is 68,000) passes through the membrane into the tubules. If the amount is small, reabsorption occurs, but in the amounts increased after an incompatible transfusion the hemo­globin, passing through the tubules, is precipitated. This blocks the tu bules; they cease to function and finally die. Patients having received the wrong type of blood can often be saved if the blood is thoroughly alkalin- ized; an alkaline filtrate is formed and thus prevents precipitation.