UTI in children
All children should be investigated after a single episode of UTI, this is because VUR occurs in 1–2% of the asymptomatic pediatric population but in 30–40% of children with a UTI and is apparent in 90% of children with renal scarring on an IVU.
All children should be investigated after a single episode of UTI, this is because VUR occurs in 1–2% of the asymptomatic pediatric population but in 30–40% of children with a UTI and is apparent in 90% of children with renal scarring on an IVU.
A straddle injury will cause damage to the bulbar urethra:
The bulbar urethra is crushed upwards onto the pubic bone, typically with significant bruising. In the days of sailing ships, the common cause was falling astride a spar (a wooden pole in the ship) and the modern equivalent is seen among workers losing their footing on scaffolding. Cycling accidents, loose manhole covers and gymnasium accidents astride the beam account for a number of cases.
Almost certainly King William I of England died in 1087 following a ruptured bulbar urethra. It was written that ‘his horse reared in fright at a blazing timber and threw its ponderous rider against the iron of his saddle’, suggesting that he ruptured the urethra on the saddle’s pommel.
He subsequently developed urinary retention and sepsis secondary to infection of the haematoma and he died some days after the accident.
The bulbar urethra is crushed upwards onto the pubic bone, typically with significant bruising. In the days of sailing ships, the common cause was falling astride a spar (a wooden pole in the ship) and the modern equivalent is seen among workers losing their footing on scaffolding. Cycling accidents, loose manhole covers and gymnasium accidents astride the beam account for a number of cases.
Almost certainly King William I of England died in 1087 following a ruptured bulbar urethra. It was written that ‘his horse reared in fright at a blazing timber and threw its ponderous rider against the iron of his saddle’, suggesting that he ruptured the urethra on the saddle’s pommel.
He subsequently developed urinary retention and sepsis secondary to infection of the haematoma and he died some days after the accident.
Lab Rats In Lab Coats
A straddle injury will cause damage to the bulbar urethra: The bulbar urethra is crushed upwards onto the pubic bone, typically with significant bruising. In the days of sailing ships, the common cause was falling astride a spar (a wooden pole in the ship)…
Sailing ships, William the conqueror, and bulbar urethral injuries🍻
Bulbar urethral injury
• Suspect urethral injury after blunt perineal trauma when the man cannot void, when there is perineal bruising and when there is blood at the urethral meatus.
• Diagnosis is made by retrograde urethrography using water-soluble contrast.
• The safest initial management is to insert a suprapubic catheter.
• Beware of urinary extravasation and sepsis in the perineal haematoma.
• Delayed urethroplasty is the preferred definitive management of complete disruptions
• Suspect urethral injury after blunt perineal trauma when the man cannot void, when there is perineal bruising and when there is blood at the urethral meatus.
• Diagnosis is made by retrograde urethrography using water-soluble contrast.
• The safest initial management is to insert a suprapubic catheter.
• Beware of urinary extravasation and sepsis in the perineal haematoma.
• Delayed urethroplasty is the preferred definitive management of complete disruptions
Pelvic fracture urethral disruption injury
• Suspect the diagnosis in cases of pelvic fracture, when the patient has not voided and when there is blood at the urethral meatus.
• If the diagnosis is suspected, a water-soluble urethrogram is needed to confirm the diagnosis.
• Initial management is insertion of a suprapubic catheter.
• Immediate surgical exploration is needed if there is coexisting rupture of the bladder.
• Delayed anastomotic urethroplasty is the preferred definitive management Results.
• Suspect the diagnosis in cases of pelvic fracture, when the patient has not voided and when there is blood at the urethral meatus.
• If the diagnosis is suspected, a water-soluble urethrogram is needed to confirm the diagnosis.
• Initial management is insertion of a suprapubic catheter.
• Immediate surgical exploration is needed if there is coexisting rupture of the bladder.
• Delayed anastomotic urethroplasty is the preferred definitive management Results.
الفكرة باختصار هي أنّ غالبًا:
Straddle injury = bulbar urethral injury.
Pelvic fracture = urethral disruption (complete rupture of membranous urethra).
واختلاف ثاني هو أنّ الـ bulbar injury عادةً نعالجها مباشرةً لأنها ناتجة من straddle injury (تعتبر إصابة بسيطة نسبيًا).
بينما الـ membranous disruption غالبًا تكون بسبب كسر بالحوض بسبب حادث خطير (مثل حادث سيارة) لهذا نعالج المشاكل الأخطر عند المريض وبعدها يلا نرجع للـ urethra.
Straddle injury = bulbar urethral injury.
Pelvic fracture = urethral disruption (complete rupture of membranous urethra).
واختلاف ثاني هو أنّ الـ bulbar injury عادةً نعالجها مباشرةً لأنها ناتجة من straddle injury (تعتبر إصابة بسيطة نسبيًا).
بينما الـ membranous disruption غالبًا تكون بسبب كسر بالحوض بسبب حادث خطير (مثل حادث سيارة) لهذا نعالج المشاكل الأخطر عند المريض وبعدها يلا نرجع للـ urethra.
الـ Disruption يعني أنّ الـ urethra إنفصلت تمامًا وصارت قطعتين يفصل بينهن hematoma اللي بعدين تتحول لـ fibrosis.
Short-term stress & anxiety do cause a short-term increase in blood-glucose. This is because of the increase in cortisol & catecholamines (hyperglycemic hormones) in situations of fear & stress.
But short-term stress DOES NOT cause new-onset diabetes.
But short-term stress DOES NOT cause new-onset diabetes.
Lab Rats In Lab Coats
Acrolein
It's like the Hitler of bladder cancer
It's a carcinogen that exists in:
• cigarette smoke.
• It's the same compound that causes the smell of burned fat (when you burn the oil while frying potatoes).
• is a metabolite of cyclophosphamide that gets excreted in the urine and causes hemmorrhagic cystitis.
• cigarette smoke.
• It's the same compound that causes the smell of burned fat (when you burn the oil while frying potatoes).
• is a metabolite of cyclophosphamide that gets excreted in the urine and causes hemmorrhagic cystitis.
هالشي يفسر ليش التدخين يسبب سرطان المثانة، وليش الـ cyclophosphamide اللي يستخدموه بصفته علاج للسرطان وأمراض المناعة الذاتية، همين يسبب سرطان المثانة.
Hemorrhagic cystitis (hematuria + suprapubic pain) can be seen usually in cancer patients since they are on cyclophosphamide (which is metabolised to acrolein).