manegment section.ppt
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Transcript of manegment section.ppt
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Management session
on bladder cancerBy:- mesfin semunigus
Lidiya chanyalew
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Identification
Name Yaya Ahmed
Age 60
Sex M
Religion muslim
Ethnicity Oromo
Occupation Farmer
Address combolcha,oromia
Admission date 15/05/04
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Chief compliant
reddish urine discoloration of 04 months
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?
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History of present illness
The patient was relatively health 4 month back at whichtime he fall to ground on his abdomen while he was
walking.
Following the accident he has no history of loss ofconsciousness, abdominal pain, distention & no loss ofdesire to urinate.
After a day, he started to notice reddish discoloration of
the urine which was intermittent at onset. it is painless& he passes through out the stream.
But at the end it become frank red.
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Cont
He has hesitence, nocturia of 2x and sense ofincomplete urination
The patient has no difficulty on micturation,dysuria, incontinency, frequency or urgency.
He has veggie type of supra pubic & bilateralflunk pain which is non radiating.
He has no extremity or face swelling.
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He has no chest pain , cough, hemoptosis. Nobone pain.
No history of vomiting, diarrhea, constipation,yellowish eye discoloration & skin pruritis.
He has associated symptoms dizziness, vertigo,easily fatigability, loss of appetite & lostunspecified amount of weight.
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He has smoking history 3 pack year
He has no personal & family history of DM,hypertension, cardiac disease, asthma
8 years back abdominal surgery was done for acompliant of chronic vomiting (??GOO)
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Physical exam
General appearance
chronic sick looking, not in cardio-pulmonary distress.
V/S
stable
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HEENT
pink conjunctiva and non icterous sclera.
poor dental hygiene and dental care.
LNs ; no LAP RS;no flaring of analzy, cyanosis, use of accececary
muscles.
central trachea, no mass or tenderness
resonant percussion note
vesicular breath sound. no added sound.
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CVS;
all superficial accessible arteries palpable
JVP ;not raised.pericardium
quite, apical impulse not visible PMI is
at 5th
ics MCL.S1 & S2 heard no murmur, nogallop.
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Abdominal exam Inspection; shaphoid ,move with respiration, hernial sites
are free. There is vertical midline surgical scar.
Auscultation; normoactive bowel sound, no brow heard
Palpation; no tenderness no mass, organomegaly ispalpated
Percussion:-tympanic percussion note
PR Intact anal sphincter tone. no blood, ulcer Normal sized prostate, rubbery inconsistence,
Rectal mucosa move over it,
Medial sulcus is palpable & upper border is reachable.
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GUS: no CVA & supra pubic tenderness
MSS: no joint deformity,
Integmontery: no rash, edema CNS: conscious, oriented to time, place &
person
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Investigation
Hct 38,
Blood group B+
Cr 0.96
BUN nornal
SGPT & SGOT normal
u/a Albumin; +1
Bld; +4
Microscopy ; too muchRBCs/HFM
u/s : irregular soft tissuemass in the bladder.
CXR
IVP
Cyctography
Cyctoscopy Urine cytology
Flow metery
CT of pelvic
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