Methodological Instructions to Lesson ¹ 4 for Students
(Practical - 6 hours)
Theme: 1. Injuries to the kidney and ureter.
2. Injuries to the bladder and urethra.
3. Acute diseases of scrotum organs.
Aim: To study symptoms and principles of treatment injuries of kidneys, ureter and injuries to
the bladder and urethra. To study symptoms, signs, principals of treatment of the patients with
acute diseases of scrotum.
Professional Motivation:
For the last time as a result of increasing of accidents and urbanization we have augmentation
of closed renal injuries. Indirect ("contrecoup") injury, caused by falling from a height and
landing on the feet or buttocks, is less common.On rare occasion, acute abdominal muscle
contraction have caused a hydronephrotic kidney to burst. As to B.S.Hetman, 78 % of the
patients with acute diseases of scrotum organs are young men at the age from 20 to 25. It is
known that in some cases acute epididimitis is complicated by orchitis that can lead a man to
infertility.
Methods of practical work. The practical part of the session 9-00 to 12-00
During the examination of patients the students have to keep the
following comunicative algoritms:
Collecting the complains and anamnesis of patients with Injuries to the kidney and ureter,
injuries to the bladder and urethra, acute diseases of scrotum organs:
1. kind face, smile
2. gentle voice
3. greeting and aquointance, expression of interest, respect and care
4. collecting of complains and anamnesis
5. explaining of the results of examination
6. explaining of actions (hospitalisation, examinations) that are planned to be done in the
future
7. finishing of the dialog
Physical methods of examination of patients with Injuries to the kidney and ureter, injuries to
the bladder and urethra, acute diseases of scrotum organs:
1. kind face, smile
2. gentle voice
3. greeting and aquointance, expression of interest, respect and care
4. explaining to the patient what kind of examination is planned and getting his agreement
5. makig a contact with patient and trying to gain his trust
6. warning about the possible unpleasant feelings during the examination
7. getting ready for the examination (clean warm hands, cutted nails,
warm phonendoscope, using of screen if it is needed)
8. performing of the examination (demonstration of the clinical skill)
9. explaining of the results of examination
10.
finishing of the dialog
Informing the results of the patients examination:
1. kind face, smile
2. gentle voice
3. greeting and aquointance, expression of interest, respect and care
4. correct and easyunderstanding explaining of the examination results to the patient
5. drawing the patient to the dialog (comparing of results of given examination with the
previous ones, findig out if your explanations are understood)
6. finishing of the dialog
Planning and prognosing of the results of the treatment:
1. kind face, smile
2. gentle voice
3. greeting and aquointance, expression of interest, respect and care
4. correct and easyunderstanding explanation of the necessarity of the prescribing
treatment
5. drawing the patient (accent on the peculiarities of taking the medicine, the duration of
taking the medicine, possible side effects; make sure if everything is clear)
6. finishing of the dialog
Informing about the prognosis of treatment:
1. kind face, smile
2. gentle voice
3. greeting and aquointance, expression of interest, respect and care
4. orrect and easyunderstanding explanation of the supposed results of the prescribing
treatment
5. drawing the patient (accent on the importance of the continual treatment, keeping of the
prescribed scheme of treatment; make sure if everything is clear)
6. finishing the dialog
Theme No 1. Injuries to the kidney and ureter.
Students' Independent Study Program.
I.
Objectives for Students' Independent Studies.
You should prepare for the practical class using the existing textbooks and lectures. Special
attention should be paid to the following:
1. General clinical symptoms of the renal injury.
2. Classification of the injuries to kidney and ureter .
3. Diagnosis of the injuries to kidney.
4. Indications for the surgical treatment of closed renal injuries (nephrectomy, nephropexy) and
injuries to the ureter.
Key words and phrases: injuries to the kidney and ureter, surgical treatment of closed
renal injuries and the injuries to the ureter.
II. Test and Assignments for Self-assesment:
Task 1. Prove and formulate clinical diagnosis.
Student takes complains, disease and life history of the patient, physical examination,
detects main clinical signs of the closed renal ruptures, forms diagnostic program,
formulates diagnosis.
Questions for the student:
1. What are the clinical symptoms of the closed renal ruptures?
2. What are the methods of examination of the patients with the closed renal ruptures?
3. What is the medical tactics in the patients with the closed renal ruptures?
Task 2. Prove and formulate clinical diagnosis.
Student takes complains, disease and life history of the patient, physical examination,
detects main clinical signs of the ruptures of ureter, forms diagnostic programme,
formulates diagnosis.
Questions for the student:
4. What are the clinical symptoms of the ruptures of ureter?
5. What are the methods of examination of the patients with the ruptures of ureter?
6. What is the medical tactics in the patients with the ruptures of ureter?
Break 12-00 to 12-30
Seminar discussion of of theoretical questions 12-30 to 14-00
1. Etiology and pathogenesis of acute epididymitis.
2. Symptoms and clinical course of acute epididymitis.
3. Acute epididymitis diagnosis.
4. Therapy of acute epididymitis.
5. Symptoms and clinical course of acute orchitis.
6. Diagnosis of acute orchitis.
7. Differential diagnosis of acute orchitis.
9. Treatment of acute orchitis.
10. Clinical signs of testis torsion.
11. Diagnosis of testis torsion.
12. Differential diagnostic of testis torsion.
13. Principles oftestis torsion treatment.
Break 14-00 to 14-15
The independent work of students 14-15 to 15-00
-
analysis tasks licensed test examination "Step 2"
evaluation of students who have not passed the day before the test control
system "Moodle"
- date the student practical skills of the entry in the book matrykulyari.
Multiply choice. Choose the correct answer/statement:
1. In patient with closed renal rupture and shock the emergency measures are:
A. Nephrectomy.
B. Nephropyelostomy.
C. Treat shock and hemorrhage.
D. Infusion of the opiates.
E. Treatment of the secondery infection.
Real life situations to be solve:
A. The patient was brought to the hospital with multiple traumas. In the left lumbar region
hematoma was found. Hematuria. Pulse 94/min, blood pressure 105/70 mm Hg. What is the
initial diagnose? What methods of examination are necessary in this case?
III. Answers to the SeIf-Assesment.
1Ñ.
A- closed renal rupture; urography and excretory urography are useful.
Students Practical Activities:
Student must know:
1. Classification of the ruptures of kidneys.
2. Symptoms and clinical course of the ruptures of kidneys.
3. Diagnosis of the ruptures of kidneys.
4. Differential diagnosis of the renal ruptures.
5. Conservative treatment of the renal ruptures.
6. Surgical treatment of the ruptures of kidneys.
7. Symptoms and clinical course of the ruptures of ureter.
8. Diagnosis of the ruptures of ureter.
9. Differential diagnosis of the ruptures of ureter.
7.
Principles of treatment of the renal ruptures.
Students should be able to:
1. Detect main clinical signs of the ruptures of kidney and ureter .
2. Define necessary quantity and sequence of patients examination: physical, laboratory,
roentgenological, endovesical.
3. Should be able to detect signs of the ruptures of kidney and ureter on excretory urograms,
retrograde ureteropyelograms etc.
4. Form diagnostic program for the patient with rupture kidney and ureter.
5. Prove and formulate clinical diagnosis.
6. Spend differential diagnosis.
7. Prove conservative treatment and indications for the surgical treatment.
Theme No 2: Injuries to the bladder and urethra.
Students' Independent Study Program.
I.
Objectives for Students' Independent Studies.
You should prepare for the practical class using the existing textbooks and lectures. Special
attention should be paid to the following:
1. General clinical symptoms of the bladder and urethra injuries.
2. Diagnosis of the bladder and urethra injuries
3. Indications for the consrevative and surgical treatment of the injuries to the bladder and
urethra.
Key words and phrases: injuries to the bladder and urethra, intraperitoneal rupture, fractured
pelvis, surgical and conservative measures of the treatment.
II. Tests and Assignments for Self-assesment:
Task 1. Prove and formulate clinical diagnosis. Student takes complains, disease and life
history of the patient, physical examination, detects main clinical signs of the ruptures of the
bladder, forms diagnostic program, formulates diagnosis.
Questions for the student:
1. What are the clinical symptoms of the ruptures of the bladder?
2. What are the methods of examination of the patients with the ruptures of the bladder?
3. What is the medical tactics in the patients with the ruptures of the bladder?
Task 2. Prove and formulate clinical diagnosis.
Student takes complains, disease and life history of the patient, physical examination,
detects main clinical signs of the ruptures of urethra, forms diagnostic programme,
formulates diagnosis.
Questions for the student:
4. What are the clinical symptoms of the ruptures of urethra?
5. What are the methods of examination of the patients with the ruptures of urethra?
6. What is the medical tactics in the patients with the ruptures of urethra?
Multiply choice. Choose the correct answer/statement:
1. What disease may be found by Zeldovich test?
A. Rupture of the bladder.
B. Rupture of the liver.
C. Rupture of the urethra.
D. Rupture of the kidney.
E. Rupture of the ureter.
Real life situations to be solved.
A. Patient K., 34 years old, crashed by car. At the causality ward fracture of the pelvis was
found. Urethrorrhage. What is the previous diagnosis? What methods of examination is
indicated in this case?
III. Answers to the Self-Assesment:
1A.
A- suspitio on the fracture of the urethra;
retrograde urethrocystograohy.
Students Practical Activities:
Student must know:
1. Classification of injuries to the bladder.
2. Symptoms and clinical course of the injuries to the bladder.
3. Diagnosis of the injuries to the bladder.
4. Differential diagnosis of the injuries to the bladder.
5. Conservative treatment of the bladder injuries.
6. Surgical treatment of the bladder injuries.
7. Symptoms and clinical course of the urethra injuries.
8. Diagnosis of the urethra injuries.
9. Differential diagnosis of the urethra injuries.
10. Principles of treatment of the urethra injuries.
Students should be able to:
1. Detect main clinical signs of the injuries to the bladder and urethra .
2. Define necessary quantity and sequence of patients examination: physical, laboratory,
roentgenological, endovesical.
3. Should be able to detect signs of the injuries to the bladder and urethra on cystograms,
urethrograms etc.
4. Form diagnostic program for the patient with the injuries to the bladder and urethra.
5. Prove and formulate clinical diagnosis.
6. Spend differential diagnosis.
7. Prove conservative treatment and indications for the surgical treatment.
Theme No3: Acute diseases of scrotum organs.
Students' Independent Study Program.
I.
Objectives for Students' Independent Studies.
You should prepare for the practical class using the existing textbooks and lectures. Special
attention should be paid to the following:
1. Etiology and pathogenesis of acute epididimitis and acute orchitis.
2. General clinical symptoms ,acute diseases of scrotum organs.
3. Proving and formulation of clinica diagnosis.
Key words and phrases: Acute epididymitis, acute orchitis, testis torsion, conservative
treatment, surgical therapy.
II. Tests and Assignments for Self-assesment:
Task 1. Prove and formulate clinical diagnosis. Student takes complains, case and life history
of the patient, physical examination, detects main clinical signs of acute diseases of scrotum
organs (orchitis, epididymitis, orchoepidtdymitis, testis torsion), forms diagnostic program,
formulates diagnosis.
Questions for the student:
1. What are the clinical symptoms of acute epididymitis?
2. What are the clinical symptoms of acute orchitis?
3. What are the clinical signs of testis torsion?
4. What are the main methods of the patients with orchoepididymitis examination?
Task 2. To make differential diagnosis.
Student makes differentional diagnosis of orchoepididymitis, using complains, disease and
history, physical examination, laboratory and diaphanoscopy signs.
Questions for the student:
1. What diseases is it necessary to make differential diagnosis with ?
2. What is the medical tactics in patients with orchoepididymitis?
3. What is the medical tactics in patients with spermatic cord torsion?
Multiply choice. Choose the correct answer/statement:
1. In case of testis torsion is indicated:
A. Antibacterial therapy.
B. Urgent operation.
C. Non-urgent operation.
D. Block of spermatic cord.
E. Desintoxication and antimicrobal therapy.
2. In case of purative epididymitis is indicated:
A. Suspensorium wearing.
B. Urgent operation.
C. Planned operation.
D. Epididyectomy.
E. Winkelmann's operation.
Real-life situations to be solved:
A. Boy of 8 years old was brought to hospital with complaints of acute pain in right part of
scrotum that appeared urgent (after physical training lesson). On examination right orchis
enlarged on 4 cm, is very painful. What is the diagnosis? What are the tactics of treatment?
B. In patient 74 years old at the 8th day after prostatectomy appeared acute pain in left part of
scrotum, increased temperature to 39,2°C. Objective: left part of scrotum enlarged, hyperertiic,
tenderness. Palpated enlarged, very painful epididymis with orchis. For 4 days was held
antimicrobal therapy, improvement isn't preasent. Blood count: leucocyte - 18,0 G/l, leucocyte,
related to stab neutrophile - 24 %, erythrocyte sedimentation rate - 34 mm/h. Diagnosis? What
are therapuetical tactics?
III. Answers to the Self-assesment:
1B; 2- D.
A- torsion of right orchis, urgent operation;
B-Acute purative orcho epididymitis from the left side, hemicastration is indicated.
Students Practical Activities:
Student must know:
1. Etiology and pathogenesis of acute epididymitis.
2. Symptoms and clinical course of acute epididymitis.
3. Acute epididymitis diagnosis.
4. Therapy of acute epididymitis.
5. Symptoms and clinical course of acute orchitis.
6. Diagnosis of acute orchitis.
7. Differential diagnosis of acute orchitis.
9. Treatment of acute orchitis.
10. Clinical signs of testis torsion.
11. Diagnosis of testis torsion.
12. Differential diagnostic of testis torsion.
13. Principles oftestis torsion treatment.
Students should be able to:
1. Detect from case history main clinical signs of acute diseases of scrotum organs.
2. Define necessary quantity and sequence of patients examination: physical, laboratory,
endovesical.
3. Define therapy plan for the patients with orchoepididymitis, testis torsion.
4. Use diaphanoscopy and diagnostic punction of scrotum organs in examination of patients.
References:
a) basic literature:
1. Donald R. Smith, M.D. General Urology, 11-th edition, 1984.
2. O.F.Vozianov, O.V.Lyulko. Urology.- Kyiv: Vischa shkola, 1993.
3. Materials Preparation for practice
4. Training materials for lectures
5. Presentations lectures
b) supplementary literature:
1. Scientific Foundations of Urology. Third Edition 1990. Edited by Geoffrey D. Chisholm and
William R. Fair, MD. Heinemann Medical Books, Oxford.
2. Urinary Tract Infection and Inflamation / Jackson E. Fowler, JR. MD. Year Book Medical
Publishers, Chicago 1989.
Prepared by:
Assistant Professor Mysak A.I.