URINARY RETENTION and CYSTOSTOMY | MRKH

URINARY RETENTION and CYSTOSTOMY

Acute retention of urine is an indication for emergency drainage of the bladder. If the bladder cannot be drained through the urethra, it requires suprapubic drainage.

Treatment of chronic retention is not urgent. Arrange to refer patients with chronic urinary retention for further management.

MALE URETHRAL ANATOMY

Urethra: 20cm long from bladder neck to the external meatus.

-Prostatic urethra

-Membranous urethra

-Penile urethra

Emergency drainage

Emergency drainage of the bladder in acute retention may be undertaken by:

 Urethral catheterization  Suprapubic puncture  Suprapubic cystostomy.

Urethral catheterization or bladder puncture is usually adequate, but cystostomy may become necessary for the removal of a bladder stone or foreign body, or for more prolonged drainage, for example after rupture of the posterior urethra or if there is a urethral stricture with complications.

If a catheter’s balloon fails to deflate, inject 3 ml of ether into the tube leading to the balloon. This will rupture the balloon. Cut it off and remove it. Prior to removing the catheter, irrigate the bladder with 30 ml of saline.

I- URETHRAL CATHETERIZATION IN THE MALE PATIENT

Technique

1-Reassure the patient that catheterization is atraumatic and usually uncomfortable rather than painful. Explain the procedure.

2- Wash the area with soap and water, retracting the prepuce to clean the furrow between it and the glans. Put on sterile gloves and, with sterile swabs, apply a bland antiseptic to the skin of the genitalia. Isolate the penis with a perforated sterile towel. Lubricate the catheter with generous amounts of water soluble gel.

3-Check the integrity of the Foley catheter balloon and then lubricate the catheter with sterile liquid paraffin (mineral oil). If you are right-handed, stand to the patient’s right, hold the penis vertically and slightly stretched with the left hand, and introduce the Foley catheter gently with the other hand (Figure 9.1).

At 12–15 cm, the catheter may stick at the junction of the penile and bulbous urethra, in which case angle it down to allow it to enter the posterior urethra. A few centimeters further, there may be resistance caused by the external bladder sphincter, which can be overcome by a gentle pressure applied to the catheter for 20–30 seconds. Urine escaping through the catheter confirms entry into the bladder.

Advance the catheter 5 to 10 cm before inflating the balloon. This prevents the balloon inflating in the prostatic urethra.

4-If the catheter fails to pass the bulbous urethra and the membranous urethra, try a semi-rigid coudé catheter. 5-Pass a coudé catheter in three stages. With one hand, hold the penis stretched and, with the other hand, hold the catheter parallel to the fold of the groin. Introduce the catheter into the urethra and bring the penis to the midline against the patient’s abdomen as the “beak” of the catheter approaches the posterior urethra. Finally, position the penis horizontally between the patient’s legs as the catheter passes up the posterior urethra over the lip of the bladder neck. At this point, urine should flow from the catheter.

If you fail to pass a catheter, proceed to filiforms and followers (Figure 9.2) or use a Foley catheter with a guide. If these procedures are unsuccessful, abandon them in favour of suprapubic puncture. Forcing the catheter or a metal bougie can create a false passage, causing urethral bleeding and intolerable pain, and increasing the risk of infection.

Fixation of the catheter

1-If you are using a Foley catheter, inflate the balloon with 10 –15 ml of sterile water or clean urine (Figure 9.2). Partially withdraw the catheter until its balloon abuts on the bladder neck.

2-If the catheter has no balloon, knot a ligature around the catheter just beyond the external meatus and carry the ends along the body of the penis, securing them with a spiral of strapping brought forward over the glans and the knot (Figures 9.3, 9.4, 9.5).

Aftercare 

 If the catheterization was traumatic, administer an antibiotic with a gram negative spectrum for 3 days 

 Always decompress a chronically distended bladder slowly 

 Connect the catheter through a closed system to a sterile container (Figure 9.6) 

 Strap the penis and catheter laterally to the abdominal wall; this will avoid a bend in the catheter at the penoscrotal angle and help to prevent compression ulceration 

 Change the catheter if it becomes blocked or infected, or as otherwise indicated. Ensure a generous fluid intake to prevent calculus formation in recumbent patients, who frequently have urinary infections, especially in tropical countries.

Hello Friend

 Hello Friend 

I'm really tired of life. It's really so weird from my studying right now even I'm not yet a complete medical student. I think We are lives on the same earth but so very different. It like one word that some people say " Same Same but Different". In nowadays, I stay at that word. I'm not punishing my family that I grew up in a poor family. But my family really help me a lot by sending money, home and support me everything.

Thank you so much. Don't be give up everyone. Push yourself to become stronger and strong 

First Time Work at Public hospital

 

Hello Friends, Today is the productive day that I start to sta at a public hospital.

In order to start the day with a fresh life being. 

At 5:00am morning, Weak up early to start the day I always clean my face with the freshwater and take a shower, have breakfast, and also read a book a little bit for preparation work at the hospital.

At 7:30am, It is the time that we start work at the hospital. sometimes that we think that is late to work but we can't do anything and can't change the schedule. We hope this little blog helps you a lot to grow your day in an early day.

by 11:30 am I came back from the hospital to prepare for an online class at 1pm until 5:30pm. It is a little bit short but the professor can improve a lot. by the way, I really tire in full of day for visite hospital and study. 

At 6:00pm, dinner time with myself. I really sad about this time because I live far away from my parent. Everything I do it a lot. 

after I finish dinner. I thought about what I did last morning and review the lesson again for remembering. The most important at night is I really try to write the new lesson for tomorrow. and making a question to ask the professor.

Bye-bye see you next blog 

My First Experience Presentation About Myxedema and Myxedema Coma

Hello Friends, My name's Royal. I'm a 4years medical student in Cambodia of IU.
Today, I'm going to share with you about myxedema. In these contents, I divide into 10 parts.
1. Definition of Myxedema
2.Epidemiology of Myxedema
3.Etiology of Myxedema
4.The factor of Myxedema coma
5.Pathophysiology of Myxedema
6.Signs and symptoms of Myxedema
7.Differential diagnosis of Myxedema
8.Diagnosis of Myxedema
9.Complication of Myxedema
10.Treatment
11.Prognosis of Myxedema
Before I'm going to talk about Myxedema. I will late you know Why I decide to write this topic? because I already research on many websites. They said this disease is so rare all over the world but I hope can see it at one time. If you see kind of this disease: don't forget to comment on my blog and late me know. 
If you read this as a medical student or a doctor don't forgive me If I'm wrong. Feel Free leave me a comment and Email also
1.Definition: Myxedema is skin and tissue disorder usually due to severe prolonged hypothyroidism.
Note: I make sure to understand two meaning difference between myxedema and myxedema coma(Crisis)
Myxedema refers to a swelling of the skin and soft tissue that occurs in the hypothyroid patients.
Myxedema coma occurs when the body's compensatory responses to hypothyroidism are overwhelmed by precipitating factors such as infection.
2.Epidemiology:
(rare) One study reports 200 cases in American: between 1953 and 1996.
The prevalence of myxedema is still unknown.
The Mortality rates: 30% to 60%
All hypothyroidism patients are female more than males to have myxedema four times and 80% of myxedema coma occur in females.
Myxedema is likely to have on both sexes, women, and men.
Ages: 60years and older.
3.Etiology
Myxedema from both hyperthyroid and hypothyroid conditions.
Hypothyroidism can be caused by Hashimoto's thyroiditis, surgical removal of the thyroid(thyroidectomy), and rarer conditions.
Hyperthyroidism is associated with pretibial myxedema and exophthalmos. in pretibial myxedema have 1-4% of patient with graves' disease.
4.Factors Known to precipitate Myxedema coma:
Burns(severe Hypothermia): late to brief period of bradycardias and more than 4 hours can lead to respiratory failure.
Gastrointestinal tract hemorrhage: cause by coagulopathy and microcytic anemia( Vit.B12 deficiency)
Infection: Pneumonia, Influenza, UTI/Urosepsis, Sepsis
Medication: Amiodarone(Cordarone), Anesthesia(in emergency cases), Beta-blockers, Diuretics
Stroke, Surgery, Trauma
5.Pathophysiology:
Results from the accumulation or increased amounts of hyaluronic acid and chondroitin sulfate in the dermis in both lesions and normal skin.
Describe a specific form of cutaneous and dermal edema secondary to increase the connective tissue component.
Connective fiber are separated by an increase amount of protein and mucopolysaccharides include glycosaminoglycans(Hyaluronic acid and chondroitin sulfate)
Protein-Mucopolysaccharides complex binds water to produce Non-pitting edema around eyes, hands, feet, and heart) leading to myxedema.
6.Signs and symptoms:
History: Taking the history of hypothyroidism, may have developed hypothyroidism after thyroidectomy or iodine therapy for hyperthyroidism.
Symptoms: fatigue, weight gain, cold intolerance, constipation, and dry skin, maybe elicited.
Patients have a depressed mental state with lethargy, delirium, or coma.
symptoms of precipitating illness can be seen such as infection(commonly pneumonia) stroke, myocardial infarction, trauma, or heart failure.
Physical Examination: Physical findings may include the following:
Hypothermia, Hypotension, Bradycardia, Decrease pulse pressure, normal systolic pressure and elevated diastolic pressure, Decreases respiratory rate, Periorbital puffiness, Macroglossia, coarse or thinning hair, small thyroid, slow respiratory rate, signs of pleural effusion, soft or distant heart sounds, diminished apical impulse and pericardial effusion.
Abdominal distension(ascites), Diminished or absent bowel sounds(ileus), Bladder distension, Cold extremities, non-pitting edema if upper and lower extremities, cool, pale, dry, scaly and thick skin, dry, brittle nails, ecchymoses, purpura, confusion, stupor, slow speech, delayed reflexes, seizures and coma.

7.Diagnosis
Taking history and PE
Laboratory studies: Thyroid function test: TSH, Free Thyroxine(T4), Free Triiodothyronine(T3)
Adrenal Function Test: Serum Cortisol: very low below 3mcg/dl or high above 20 mcg/dl (normal 10-20mcg/dl)
Hyponatremia with low serum osmolality
Hypoglycemia
CBC
Imaging studies: Chest X-ray: signs of cardiomegaly, pericardial effusion, congestive heart failure or pleural effusion.
other tests: ECG: Bradycardia
8.Differential Diagnosis
Hypothermia, Hypoventilation syndrome, Septic shock
9. Treatment: is to see a doctor to treatment depending on location and protocol. but if you have hypoxygenation to ventilation as soon as possible and need serum for hyponatremia.
In my advice to need to see the doctor as soon as possible don't keep your health get worse.
10.Complication:
Respiratory failure, Myocardia ischemia, Renal Failure, Sepsis, GI hemorrhage, Coma.
11.Prognosis
The mortality rate:70-80%(in the past)
The mortality rate: 20%( last 10-15 years)
Recognized earlier
Receiving intensive supportive care
Treated with thyroxine early in the course of illness

How to Pass Exam for Into Medical School In Cambodia?(International University of Cambodia)

How to Pass Exam for Into Medical School In Cambodia? (International University of Cambodia)

Hello Friends, I'm Royal. I'm a years4 medical student in Cambodia. Today, I'm going to share about how can I pass the exam for Medical school. There are 5tips to learn from Khmer medical students.

Before I jump to the detail about this topic. I would like to describe what is subject to the exam? and how many subjects we have an exam for medical school in Cambodia. To pass medical school in Cambodia is really easy but you need to learn the Khmer language first before starting to apply. If you are the nationality of Cambodia, you need to pass the high school and nation medical school also a foreigner. The subject that we should focus on the exam is Chemistry, Maths, and Biology.

1. Chemistry: 5 Exercise and 15 questions.

2. Maths: 20 Excercise +questions

3.Biology: 5Exercise and 17question.

All the questions and exercises are from the ministry of health in Cambodia and also update every year. Usually is from grate 12 in high school.

4 Habits That Will Change Your Life Better AS The Medical Students

Hello Friend, Welcome back to my News Blog

Today, I'm going to talk about 5Habits That always change my life better as a medical student.

If your new here, I'm Royal. I'm a years4 medical student in IU of Cambodia.

Nowadays, The bad situation of Covid-19 in all over the world become more and more wired for people's work, study, and Bussiness.

So Today I share about the 5 habits that I always do persistency in my daily life to you.

If you follow me on my career along time you will know me a lot. Thank you for coming here to read and watch my video on youtube.

1. Start A Dialy Gratitude Practice: Dialy Gratitude Practice is really hard to achieve but if you do it persistence without thinking of your action will get more things done. So before I gratitude practice everyday life, I make a plan. So I create a schedule to wake up at 5am in the morning routine to read the book before I'm going to school and start my work.if you want to achieve your dream. you should be making a schedule because your dream not to succeed in two days, 1 month, 1 year, but you need 10years to succeed. Make a schedule every day, every week, and make a schedule in your whole life.

2. Stop complaint: If you are a co-worker or student stop complaining about the job, assignment, to say that, to say those, complaint another co-worker. Stop everything and focus on your career and just do what you want, Don't complain about other people.

3. Set up your goal: start to plan your dream, start to write down in your notebook, and think about what you want to be? ask yourself what is your dream? so many people in the world wake up in the morning and spend a lot of time play on social media. but if you have a goal,  you already set up and you try to achieve your goal. you will know about when you wake up and know what to do!

4. Start your action: Now, you have a plan, schedule but if you do not make your activity, How is it a success? Like I said above just do it, stop thinking about other people complain about you because they don't about you and they don't know what your plan! They will congrats to you when you succeed.

A day in the life of the Medical student In Cambodia|Royal

A day in the life of the medical student in Cambodia

Hello Friends, I'm Royal.I'm a years4 medical student in IU. Today, I'm going to talk about my productivity in the life of a medical student.

Usually, I wake up at 5am in the morning to review my lesson for study in the next 2houre. Hey, But sometimes I really lazy too much about waking up at 5am because this time I'm interested in my time to sleep but in order to become a doctor. I push myself to study at this time because I won't waste my time so much on bed.

After, I review the lessons 1:30 hours, Now is 6:30am. I take a bath to make my body clean and after that I make a little breakfast give energy to me to study online 5hours from 7am until 12am in the Covid-19 situation because Normally, I study in class at that time and talked to my friends but now study online, stay at home a whole day but I still enjoy with my lesson and making the video for youtube like this. If you not to subscribe to my channel pleases click this SUBSCRIBE to keep talk latter and stay contact.

After, I finish an online class at 12am. I take rest a little bit and then make some eggs with rice and drink coffee give me more energy to study after launch. I spend 6hours to research my lesson after finished online class in the morning because I do not yet remember and understand the lesson well. 

During 6hours for restudy, I separate into two parts the first 3hours for dermatitis. I read for a book related to dermatology and take some notes on flashcards to make sure I remember this lesson next 3houre. I'm really tired. I make some coffee by myself and some snacks to release my stress until 6pm.

I'm not going anywhere because COVID-19 so I do exercise at home 30minute, watch a movie and have dinner.

Now's. 8:30pm. I study English because my English language is not yet good at all. I spend 1:30houre to study online from youtube until 10pm. On-time to go to edit my video. I work on this youtube channel 3hour per day to edit and upload to my youtube channel to help motive study and the video kind of study with me, or a day in the life medical study.

If you interest in my content, please give me a like and subscribe to watch in the next video bye-bye.