student project

Study Guide The Urinary System and Disorder Block

~ CURRICULUM ~

Aims :

1. Comprehend the biologic function of urogenital system to pathological process of urinary system disorders.

2. Apply and interpret special studies in diagnosis urogenital system disorders, including laboratory and imaging examination.

3. Diagnose and manage patient with common urogenital system disorders

4. Diagnose and refer special patient with urogenital system disorders

5. Plan patient, family, and community education about urogenital system disorders

Learning Outcome

1. Describe the functional structure of urigenital system and its general clinical implications.

2. Comprehend the pathological basis underlying the symptoms and signs of urogenital system disorders.

3. Recognize the potential uses of common diagnostic and therapeutic procedure in urogenital system disorders.

4. Manage urogenital system disorders:

1. Diagnose and manage independently uncomplicated urinary tract infection, including uncomplicated pyelonephritis.

2. Diagnose and manage independently phymosis and paraphymosis.

3. Diagnose, give initial treatment, and refer some urogenital system disorders

5. such as acute and chronic glomerulonephritis, renal colic, kidney rupture, bladder rupture, urethra rupture, acute kidney injury, chronic kidney disease, acute tubular necrosis, prostatitis, and priapismus.

4. Diagnose and refer some urogenital system disorders such as, horse shoe kidney, kidney tumor, nephrotic syndrome, symptomatic polycystic kidney, epydidimitis, urothelial carcinoma, benign prostate hyperplasia, and prostate cancer, common penile tumor, hipospadia, and epispadia.

Manage secondary hypertension

6.

Diagnose and refer secondary hypertension, especially renal hypertension

Implement patient education in the prevention and early detection of common urinary system disorders.

Curriculum content

1. Functional structure of urogenital system

2. Pathological basis of urogenital system disorders

3. Symptom and sign of urogenital system disorders

4. Physical examination, laboratory investigation and imaging studies in urogenital system disorders

5. Interpret and utilize results of Physical examination, laboratory investigation and imaging studies

6. Rational drug use in urogenital system disorders

7. Management of urogenital system disorders

8. Clinical procedure in urogenital system disorders

9. Communicate and apply basic principle in the prevention, and rehabilitation of urogenital system disorders

Udayana University Faculty of Medicine, DME 1 | P a g e


~ PLANNERS TEAM ~

NO

1

2

NAME

DR. dr. A A Gde Oka, Sp.U

(Coordinator) dr. I Wayan Juli Sumadi, Sp.PA

(Secretary)

3 Prof. dr. K. Tirtayasa, MS, AIF

4 dr. I A Ika Wahyuniari, M.Kes

5

Prof. DR. dr. Mangku Karmaya,

M.Repro

6 Prof. DR. dr. K. Suwitra, SpPD (KGH)

7 dr. Made Adi Tarini, Sp.MK

8 DR. dr. Wiradewi Lestari, Sp.PK

9 dr. IGAP Nilawati, Sp.A(K)

10 dr. I Gst Ayu Artini, M.Sc

11 dr. Gede Wirya Kusuma Duarsa, Sp.U

12 dr. Sri Laksminingsih, Sp.Rad

DEPARTMENT

Urology

Pathology

Physiology

Histology

Anatomy

Internal Medicine

Microbiology

Clinical Pathology

Pediatric

Pharmacology

Urology

Radiology

~ LECTURERS ~

NO NAME

1 Prof. DR. dr. K. Suwitra, SpPD (KGH)

2 Prof. dr. K. Tirtayasa, MS, AIF

3 dr. I A Putri Wirawati, Sp.PK

4 dr. G A P Nilawati, Sp.A

5 Prof. DR. dr. N. Mangku Karmaya,

M.Repro

6 dr. A A Gde Oka, Sp.U

7 dr. Jodhi Sidarta L, SpPD (KGH)

8 dr. Ni Wayan Winarti, Sp.PA

9 dr. G. Wirya K Duarsa, SpU, M.Kes

10 dr. I Wayan Sugiritama, M.Kes

11 dr. I Gst Ayu Artini, M.Sc

12 dr. A A Wiradewi Lestari, Sp.PK

13 dr. Sri Laksminingsih, Sp.Rad

14 dr. Made Adi Tarini, Sp.MK

DEPARTMENT

Internal Medicine

Physiology

Clinical Pathology

Pediatric

Anatomy

Urology

Internal Medicine

Pathology Anatomy

Urology

Histology

Pharmacology

Clinical Pathology

Radiology

Microbiology



~ FACILITATORS ~

Regular Class (Class A)

No

1

2

3

4

5

6

7

8

9

10

Name dr. Ida Bagus Wirakusuma,

MOH dr. Kadek Agus Heryana,

Sp.An dr. Ketut Agus Somia,

Sp.PD-KPTI dr. Ketut Rai Purnami, Sp.PD dr. Komang Andi Dwi Saputra

, Sp.THT-KL dr. I Kadek Swastika , M Kes dr. Kumara Tini, Sp.S dr. Made Agus Hendrayana ,

M.Ked dr. Luh Putu Ratna Sundari,

M.Biomed dr. I Gusti Ayu Artini , M.Sc

English Class (Class B)

Group

A1

A2

Departement Phone

Venue

(2 rd floor)

Public Health 08124696647 2nd floor:

R.2.09

Anasthesi 081338568883 2nd floor:

R.2.11

Interna

A3

A4

Interna

08123989353 2nd floor:

R.2.12

0818350703 2nd floor:

R.2.13

A5

A6

A7

A8

A9

A10

ENT

Parasitology

081338701828/

081338701878

2nd floor:

R.2.14

08124649002 2nd floor:

R.2.15

Neurology 081238701081 2nd floor:

R.2.16

Microbiology 081339158241 2nd floor:

R.2.20

Fisiology 0361-7860532 2nd floor:

R.2.21

Pharmacology 08123650481 2nd floor:

R.2.22

No

1

2

Name dr. I Dewa Ayu Inten Dwi

Primayanti, M.Biomed dr. Made Ratna Saraswati,

Sp.PD-KEMD-FINASIM dr. Made Sudarmaja, M.Kes

3

4 dr. Made Widhi Asih, Sp.Rad

5

6

7

8

9

10 dr. I G A Sri Darmayani,

Sp.OG dr. Putu Ayu Asri Damayanti ,

M Kes dr. Ni Kadek Mulyantari ,

Sp PK dr. I Wayan Niryana, Sp.BS,

M. Kes. dr. Ni Luh Putu Ratih

Vibriyanti Karna, Sp.KK dr. Ni Made Adi Tarini,

Sp.MK

Group

B1

B2

B3

B4

Departement

Fisiology

Interna

Phone

Venue

(2 rd floor)

081337761299 2nd floor:

R.2.09

08123814688 2nd floor:

R.2.11

Parasitology 08123953945 2nd floor:

R.2.12

Radiology 081916442626 2nd floor:

R.2.13

B5

B6

B7

B8

B9

B10

DME 081338644411 2nd floor:

R.2.14

Parasitology 085338565783 2nd floor:

R.2.15

Clinical

Pathology

Surgery

08123647413

08179201958

2nd floor:

R.2.16

2nd floor:

R.2.20

Dermatology 081337808844 2nd floor:

R.2.21

Microbiology 081338675344 2nd floor:

R.2.22



III

12-05-2015

12.30-13.00

~ TIME TABLE ~

REGULAR CLASS

DAY/DATE

I

08-05-2015

TIME ACTIVITY

08.00-09.00 Macroscopic Anatomy of The

Urinary System

08.00-10.00 Individual Learning

10.00-11.00 Practical Session (Anatomy):

Group A1-A5

11.00-12.30 SGD 1

Break


Group A6-A10

14.00-15.00 Plenary

II

11-05-2015

08.00-09.00

09.00-10.00

Microscopic Anatomy of The

Urinary System

Individual Learning

10.00-11.00 Practical Session (Histology):

Group A1-A5

11.00-12.30 SGD 2

12.30-13.00 Break


Group A6-A10

14.00-15.00 Plenary

08.00-09.00 The function of the urinary system:

10. Urine formation

11. Urine micturition


10.30-12.00 SGD 3

IV

13-05-2015

12.00-13.00 Student Project

13.00-14.00 Break

14.00-15.00 Plenary session

08.00-09.00 The kidney as water, electrolyte and acid-base balance controller


10.30-12.00 SGD 4

V

18-05-2015


13.00-14.00 Break


08.00-09.00 Pathogenesis of Glomerular and Tubulointerstitial Injury


10.30-12.00 SGD 5

VENUE

3.02

-

Anatomy

Lab

Discussio n room

-

Anatomy

Lab

3.02

3.02

PIC

Mangku

Karmaya

-

Mangku

Karmaya

Facilitators

-

Mangku

Karmaya

Mangku

Karmaya

Sugiritama

-

Histology

Lab

Discussio n room

-

Histology

Lab

3.02

3.02

-

Sugiritama

Facilitators

-

Sugiritama

Sugiritama

Tirtayasa

-

Discussio n Room

-

-

3.02

3.02

-

Facilitators

-

-

Tirtayasa

Tirtayasa

-

Discussio n Room

-

-

3.02

3.02

-

Discussio

-

Facilitators

-

-

Tirtayasa

Winarti

-

Facilitators



VI

19-05-2015


13.00-14.00 Break


08.00-09.00 Urinary System Disorders in

Children:

Nephrotic syndrome

PSAGN

UTI in Children


10.30-12.00 SGD 6

12.00-13.00 Student Project n Room

-

-

3.02

3.02

-

-

Winarti

Nilawati

-

Discussio n Room

-

-

Facilitators

-

VII

20-05-2015

13.00-14.00 Break


08.00-09.00 Uncomplicated and complicated Urinary tract infection


10.30-12.00 SGD 7


13.00-14.00 Break


VIII

21-05-2015

08.00-09.00

10.30-12.00

Urolithiasis (with and without colic); Urethral Stricture


SGD 8


IX

23-05-2015

13.00-14.00 Break


08.00-09.00 Common Neoplasm in

Urinary System: Renal tumors, bladder tumors.


10.30-12.00 SGD 9


-

3.02

3.02

-

3.02

3.02

-

Nilawati

Suwitra and

Team

-

Discussio n Room

-

-

3.02

3.02

-

Facilitators

-

-

Suwitra and

Team

AA Gde Oka

-

Discussio n Room

-

-

Facilitators

-

-

AA Gde Oka

AA Gde Oka

-

Discussio n Room

-

-

Facilitators

-

X

25-05-2015

13.00-14.00 Break


08.00-09.00 Urinary tract trauma (rupture of the kidney and urinary tract)


-

3.02

3.02

-

-

AA Gde Oka

AA Gde Oka

-



XI

26-05-2015

10.30-12.00

13.00-15.00

14.00-15.00

08.00-09.00

SGD 10

12.00-13.00 Student Project Presentation

1 (Horse Shoe Kidney)

Break

Plenary

Acute Kidney Injury


10.30-12.00 SGD 11

XII

27-05-2015


2 (Symptomatic Polycystic

Kidney)

13.00-14.00 Break

14.00-15.00

08.00-09.00

09.00-10.30

10.30-12.00

Plenary session

Chronic Kidney Disease

Individual Learning

SGD 12


3 (Hemodialysis)

13.00-14.00 Break


XIII

28-05-2015

08.00-09.00 Renal hypertension


10.30-11.30 Drug Use in Renal Disorders:

Diuretics; Urinary Antiseptic

11.30-13.00 SGD 13

-

3.02

3.02

-

Discussio n Room

3.02

-

Suwitra and

Team

Suwitra and

Team

-

Facilitators

-

3.02

3.02

Suwitra and

Team

-

Suwitra and

Team

Jodi SL

-

3.02

-

Artini

XIV

29-05-2015

13.00-14.00 Break


08.00-09.00 Common Prostate Disorders:

Prostatitis, BPH, Prostate

Cancer


10.30-12.00 SGD 14

Discussio n Room

3.02

Facilitators

AA Gde Oka

-

3.02

3.02

-

Discussio n Room

3.02

-

AA Gde Oka

Suwitra and

Team

-

Facilitators

Suwitra and

Team

Discussio n Room

-

3.02

3.02

Facilitators

-

Jodi SL, Artini

G. Wirya K.

Duarsa

-

Discussio n Room

3.02

-

Facilitators

AA Gde Oka

XV

01-06-2015


4 (Urodinamic examination and Uroflowmetry)

13.00-14.00 Break


08.00-09.00 Common penile disorders:

Epispadia, hypospadia, phimosis, paraphimosis,

-

3.02

-

Artini

G. Wirya K.

Duarsa


Study Guide The Urinary System and Disorder Block epididimitis, prostatitis, priapismus and Common tumor of the penis


10.30-12.00 SGD 14


5 (Micturating Cystigraphy)

13.00-14.00 Break


XVI

03-06-2015

08.00-09.00 Anamnesis and Physical

Examination in Urinary

System Disorders (Lecture &

Demonstration)


10.00-11.00 Urethral catheterization,

Clear intermittent catheterization, suprapubic punctie (Lecture &

Demonstration)

11.00-12.00 Break

12.00-14.00 Skills Training

XVII

04-06-2015

14.00-15.00

08.00-09.00

09.00-10.00

Free Training

Urinalysis

Individual Learning

10.00-11.00 Urethral Swab, Urine Culture and Sensitivity Test

11.00-12.00 Break


14.00-15.00 Free Training

-

Discussio n Room

3.02

-

Facilitators

-

3.02

3.02

G. Wirya K.

Duarsa

-

G. Wirya K.

Duarsa

Suwitra and

Team

-

3.02

-

Skills Lab

2 nd Floor

Skills Lab

2 nd Floor

3.02

-

3.02

Facilitators

-

Wirawati/Wirade wi

-

Adi Tarini

-

Skills Lab

2 nd Floor

Skills Lab

2 nd Floor

3.02

-

AA Gde Oka

Facilitators

-

G. Wirya K.

Duarsa

XVIII

05-06-2015

08.00-09.00 Circumcision, Prostate

Palpation, Bulbocavernosus reflex (Lecture and

Demonstration)



6 (Urine Cytology)

11.00-12.00 Break



XIX

08-06-2015

08.00-09.00

09.00-10.00

BNO and IVP

Individual Learning

-

3.02

-

Skills Lab

2 nd Floor

Skills Lab

2 nd Floor

3.02

-

-

Juli Sumadi

Facilitators

-

Laksminingsih

-




7 (Pathological aspect of

BPH and Prostate Cancer)

11.00-12.00 Break

12.00-14.00

14.00-15.00

Skills Training

Free Training

XX

09-06-2015


8 (The role of USG in diagnosis Urinary system disorders)


9 (The role of CT Scan in diagnosis Urinary system disorders)


3.02 Winarti

-

Skills Lab

2 nd Floor

Skills Lab

2 nd Floor

3.02

-

Facilitators

-

Laksminingsih

3.02

-

Laksminingsih

-

11.00-12.00 Break


10 (Renal Funtion Test (BUN,

SC))


-

3.02

Skills Lab

2 nd Floor

XXI

11-06-2015

XXII

12-06-2015

10.00-11.40

ENGLISH CLASS

DAY/DATE TIME

I

08-05-2015

Preparation Day

Final Examination

ACTIVITY

09.00-10.00 Macroscopic Anatomy of The

Urinary System

Computer

Room

VENUE

3.02



Group B1-B5


Group B6-B10

13.00-14.30 SGD 1

-

Anatomy

Lab

Anatomy

Lab

Discussion room

14.30-15.00 Break -

-

Wirawati/Wirade wi

-

Team

PIC

Mangku Karmaya

-

Mangku Karmaya

Mangku Karmaya

Facilitators

-

15.00-16.00 Plenary 3.02

3.02 II

11-05-2015

09.00-10.00 Microscopic Anatomy of The

Urinary System

Mangku Karmaya

Sugiritama



10.00-11.00 Individual Learning - -

III

12-05-2015


Group B1-B5


Group B6-B10

13.00-14.30 SGD 2

14.30-15.00 Break

15.00-16.00 Plenary

09.00-10.00 The function of the urinary system:

Urine formation

Urine micturition


11.30-12.30 Break

12.30-14.00 SGD 3

Histology

Lab

Histology

Lab

Discussion room

-

3.02

3.02

-

-

Discussion

Room

-

3.02

3.02

Sugiritama

Sugiritama

Facilitators

-

Sugiritama

Tirtayasa

-

-

Facilitators

-

Tirtayasa

Tirtayasa IV

13-05-2015



09.00-10.00 The kidney as water, electrolyte and acid-base balance controller


11.30-12.30 Break

12.30-14.00 SGD 4

V

18-05-2015



09.00-10.00 Pathogenesis of Glomerular and Tubulointerstitial Injury


11.30-12.30 Break

12.30-14.00 SGD 5

-

-

Discussion

Room

-

3.02

3.02

-

-

Discussion

Room

-

-

Facilitators

-

Tirtayasa

Winarti

-

-

Facilitators

VI

19-05-2015



09.00-10.00 Urinary System Disorders in

Children:

Nephrotic syndrome

PSAGN

-

3.02

3.02

-

Winarti

Nilawati



UTI in children

VII

20-05-2015


11.30-12.30 Break

12.30-14.00 SGD 6



09.00-10.00 Uncomplicated and complicated Urinary tract infection


11.30-12.30 Break

12.30-14.00 SGD 7



-

-

Discussion

Room

-

3.02

3.02

-

-

Facilitators

-

Suarta/Nilawati

Suwitra and team

-

-

Discussion

Room

-

3.02

3.02

-

-

Facilitators

-

Suwitra/AA Gde

Oka

AA Gde Oka VIII

21-05-2015

09.00-10.00 Urolithiasis (with and without colic), urethral stricture


11.30-12.30 Break

12.30-14.00 SGD 8

IX

23-05-2015



09.00-10.00 Common Tumors in Urinary

System: Renal cancer, bladder cancer


11.30-12.30 Break

12.30-14.00 SGD 9

-

-

Discussion

Room

-

3.02

3.02

-

-

Facilitators

-

AA Gde Oka

AA Gde Oka

X

25-05-2015



09.00-10.00 Urinary tract trauma (rupture of the kidney and urinary tract)


1 (Horse Shoe Kidney)


12.30-14.00 SGD 10

XI

26-05-2015

14.00-15.00 Break


09.00-10.00 Acute Kidney Injury


-

-

Discussion

Room

-

-

Facilitators

-

3.02

3.02

3.02

-

AA Gde Oka

AA Gde Oka

AA Gde Oka

-

Discussion

Room

-

3.02

3.02

3.02

-

Facilitators

-

AA Gde Oka

Suwitra and team

Suwitra and Team



2 (Symptomatic Polycystic

Kidney)


12.30-14.00 SGD 11

XII

27-05-2015

14.00-15.00 Break


09.00-10.00 Chronic Kidney Disease


3 (Hemoadialysis)


12.30-14.00 SGD 12

-

Discussion

Room

-

Facilitators

-

3.02

3.02

3.02

-

Suwitra and team

Suwitra and team

Suwitra and Team

-

Discussion

Room

-

Facilitators

14.00-15.00 Break


09.00-10.00 Renal Hypertension XIII

28-05-2015


11.00-12.30 Drug Use in Urinary System

Disorders: Diuretics; Urinary

Antiseptic

12.30-14.00 SGD 13

-

3.02

3.02

-

-

-

Suwitra and team

Jodi SL

-

Artini

XIV

29-05-2015

14.00-15.00 Break


09.00-10.00 Common prostate disorders:

Prostatitis, BPH, Prostate

Cancer

Discussion

Room

-

3.02

3.02

Facilitators

-

Jodi SL, Artini

G. Wirya K.

Duarsa


4 (Urodinamic examination and Uroflowmetry)


12.30-14.00 SGD 14

14.00-15.00 Break


3.02 AA Gde Oka

-

Discussion

Room

-

3.02

-

Facilitators

-

G. Wirya K.

Duarsa

G. Wirya K.

Duarsa

XV

01-06-2015

09.00-10.00 Common penile disorders:

Epispadia, hypospadia, phimosis, paraphimosis, epididimitis, prostatitis, priapismus and Common tumor of the penis


5 (Micturating Cystigraphy)


12.30-14.00 SGD 14

3.02

-

Discussion

Room

G. Wirya K.

Duarsa

-

Facilitators



14.00-15.00 Break


XVII

04-06-2015

09.00-10.00 Urinalysis


11.00-12.00 Urethral Swab, Urine Culture and Sensitivity Test

12.00-13.00 Break


-

3.02

-

G. Wirya K.

Duarsa

Suwitra and Team XVI

03-06-2015

09.00-10.00 Anamnesis and Physical

Examination in Urinary

System Disorders (Lecture &

Demonstration)


11.00-12.00 Urethral catheterization,

Clear intermittent catheterization, suprapubic punctie (Lecture &

Demonstration)

12.00-13.00 Break



3.02

-

3.02

-

AA Gde Oka

-

Skills Lab

2 nd Floor

Skills Lab

2 nd Floor

3.02

-

3.02

Facilitators

-

Wirawati/Wiradew i

-

Adi Tarini


-

Skills Lab

2 nd Floor

Skills Lab

2 nd Floor

3.02

Facilitators

-

G. Wirya K.

Duarsa

XVIII

05-06-2015

09.00-10.00 Circumcision, Prostate

Palpation, Bulbocavernosus reflex (Lecture and

Demonstration)



6 (Urine Cytology)

12.00-13.00 Break


-

3.02

-

Juli Sumadi

XIX

08-06-2015


09.00-10.00 BNO and IVP



7 (Pathological aspect of

BPH and Prostate Cancer)

12.00-13.00 Break


-

Skills Lab

2 nd Floor

Skills Lab

2 nd Floor

3.02

-

3.02

Facilitators

-

Laksminingsih

-

Winarti

XX

09-06-2015




8 (The role of USG in

-

Skills Lab

2 nd Floor

Skills Lab

2 nd Floor

-

3.02

-

Facilitators

-

-

Laksminingsih


Study Guide The Urinary System and Disorder Block diagnosis Urinary system disorders)


9 (The role of CT Scan in diagnosis Urinary system disorders)

12.00-13.00 Break

3.02

-

Laksminingsih

-


10 (Renal Funtion Test

(BUN, SC))

3.02

14.00-16.00 Free Training Skills Lab

2 nd Floor

PREPARATION DAY

Wirawati/Wiradew i

-

XXII

11-06-2015

XXI

12-06-2015

FINAL EXAMINATION

~ STUDENT PROJECT ~

No Group

1 A1, B1 Horse Shoe Kidney

Topic

2 A2, B2 Symptomatic Polycystic Kidney

3 A3, B3 Hemodialysis

4 A4, B4 Urodinamic examination and Uroflowmetry

5 A5, B5 Micturating cystigraphy

6 A6, B6 Urine Cytology

7 A7, B7 Pathological aspect of BPH and Prostatic

Carcinoma

8 A8, B8 The role of USG in diagnosis Urinary system disorders

9 A9, B9 The role of CT Scan in diagnosis Urinary system disorders

Renal Function Test (BUN, SC) 10 A10,

B10

PIC

AA Gde Oka

Suwitra and Team

Suwitra and Team

AA GdeOka

AA GdeOka

Juli Sumadi

Winarti

Sri Laksminingsih

Sri Laksminingsih

Wirawati/Wiradewi

~ ASSESSMENT METHOD ~

Assessment will be carried out on June 12, 2014. There will be 100 questions consisting mostly of Multiple Choice Questions (MCQ) and some other types of questions. The minimal passing score for the assessment is 70. Other than the examination score, your performance and attitude during group discussions and your study project will be considered in the calculation of your average final score.



~ LEARNING PROGRAMS ~

Lecture 1 - 2:

Macroscopic and Microscopic Structure the

Urinary System

ABSTRACTS

The urinary system (urinary tract) consists of two kidneys, two ureters, a urinary bladder, and the urethra. The kidney is subdivided into cortex and medulla. The kidney is made up by subunits called uriniferous tubule. The uriniferous tubule consists of the nephron and the collecting tubule that is functional unit of the kidney. It modifies the fluid passing through it to form urine. Beside its’ excretion function, kidney also involve in controlling blood pressure.

This function is provided by juxtaglomerular apparatus, which consists of juxtaglomerular cell, extraglomerular mesangial cell and macula densa cell. This complex secretes hormones and contains receptors that can modify vasoconstriction and vasodilatation of blood vessels.

Urine enters the renal pelvis, a structure that connects the kidney with ureter. The ureters that consist of mucosa, muscular coat, and fibrous outer coat deliver urine from the kidneys to urinary bladder. The urinary bladder is an essentially organ for storing urine until it is ready to be voided. It’s wall consists of mucosa, lined by transitional epithelium that is thin in full bladder, but thicker when contracted. Urine will be excreted from urinary bladder through the urethra. The urethra of male and female have different structure. In male the urethra is divided into three parts, urethra pars prostatica, urethra pars membranasea and urethra pars cavernosa. In female, the urethra is shorter and covered by transitional epithelium and stratified squamous epithelium.

SGD 1

Macroscopic Anatomy of Urinary System

Trigger Case

A 30 years old man came to the doctor with flank pain since 2 days. One week before he fell while he was riding a bike and he didn’t feel any flank pain. His friends suggested that he have to see the doctor, they afraid there is something wrong in his kidney. His friends also suggest drinking much water. After drinking much water, the frequency of urination is increasing and he has very clear urine. He never feels any pain when urinate. On physical examination, the doctor didn’t find any disturbance either on his kidney or urinary tract. The patient asks the doctor to explain about: where is the kidney taking place, why the frequency of urination and urine volume increasing if we drink much water? If you as a doctor, please explain to the patient.

Learning Task :

1. Explain the location of urinary system in the abdominal region and its vasculature and innervations!

2. Draw the anatomical structure of urinary tract!

3. Draw the vasculature and innervations of urinary tract!



SGD 2

Microscopic Anatomy of Urinary System

Trigger Case 1

A male patient came to the doctor with complaint of generalized swelling, especially around his eyes, feet, and hands. From examination there were albuminuria and hipoalbunemia. After complete examination, the doctor diagnosed the patient with nephrotic syndrome which damage glomeruli.

Learning Task

1. Differentiate the microscopic structure of cortex and medulla of the kidney!

2. Explain the structure of the functional unit of the kidney! Explain about the structures that participate in filtrating process!

3. Explain the microscopic structure of the juxtaglomerular apparatus and its function!

4. Why in the case above, albumin is present in the urine?

Trigger case 2

A 60 years old man complained with abdominal colic and uncontinuous flow of urination.

From abdominal ultrasonography (USG), the doctor found stone in urinary bladder. After urinalysis, there are bloods in urine (hematuria).

Learning task

1. Explain the microscopic structure of ureter! Which structure is mainly involved in passing down urine from kidney to urinary bladder? Why urine could not regurgitate from the bladder back into ureters?

2. Explain the microscopic structure of urinary bladder! Why urine does not pass into the underlying lamina propria?

Lecture 3-4:

The Function of Urinary System

The kidneys perform their most important functions by filtering the plasma and removing substances from the filtrate at variable rate, depending on the need of the body. Ultimately, the kidneys “clear” unwanted substances from the filtrate (and therefore from the blood) by excreting them in the urine while returning substances that are needed back to the blood.

All process in urine formation takes place in the nephrons as the functional unit of the kidneys. A nephron consists of glomerulus, Bowman’s capsule, proximal tubule, loop of

Henle descending limb, loop of Henle ascending limb, distal tubule. Some distal tubules of nephrons empty their product into cortical and medullary collecting tubules and then to collecting duct and all collecting ducts empty into to renal pelvis. Each kidney in the human contain about 1 million nephrons, each of it capable to forming urine.

The glomerular filtrates (water, ion, nitrogen waste and organic solute) along the proximal tubule are reabsorbed into the interstitial space and blood. The components of reabsorbed filtrate are water, glucose and protein.

In the loop of Henle descending limb, the filtrate is less dilute due to high permeability of tubule cell to water. So the water reabsorbed more in this part of tubule. Meanwhile the filtrate is more diluted due to more NaCl and no water is reabsorbed at ascending limb of


Study Guide The Urinary System and Disorder Block loop of Henle. Concentrated filtrate is also resulted from the counter-current exchange of vasa recta in the renal medulla.

Along the distal tubule, the filtrate is more concentrated due to more reabsorption than secretion process. It is also influenced by anti diuretic hormone (ADH) and aldosteron hormone. The rate of reabsorption or secretion at distal tubule depends upon the body internal environment to maintain homeostasis.

Urine as the last result of all process of filtrate (through filtration, reabsorption and secretion) along the renal tubules, then empty into renal pelvis. Through the right and left ureter the urine is collected in the bladder. Muscle contraction of the bladder push out the urine through the urethra.

The glomerular filtrates (water, ion, nitrogen waste and organic solute) along the proximal tubule are reabsorbed into the interstitial space and blood. The components of reabsorbed filtrate are water, glucose and protein.

In the loop of Henle descending limb, the filtrate is less dilute due to high permeability of tubule cell to water. So the water reabsorbed more in this part of tubule. Meanwhile the filtrate is more diluted due to more NaCl and no water is reabsorbed at ascending limb of loop of Henle. Concentrated filtrate is also resulted from the counter-current exchange of vasa recta in the renal medulla.

Along the distal tubule, the filtrate is more concentrated due to more reabsorption than secretion process. It is also influenced by anti diuretic hormone (ADH) and aldosteron hormone. The rate of reabsorption or secretion at distal tubule depends upon the body internal environment to maintain homeostasis.

The result of all process is urine. Through the right and left ureter the urine is collected in the bladder. Muscle contraction of the bladder push out the urine through the urethra.

Learning Task :

SGD 3

The function of urinary system: urine formation and micturition process

Learning Tasks:

1. Explain that the glomerular filtration rate (GFR) of kidneys depend on the variability of some forces

2. Explain how the autoregulation of glomerular filtration rate and renal blood flow

3. Explain the process and related substances such as water and electrolytes that take place along the proximal tubule of nephron

4. Explain the process and related substances such as water and electrolytes that take place along the loop of Henle of nephron

5. Explain the process and related substances such as water and electrolytes that take place along the distal tubule of nephron

6. Explain the process and related substances such as water and electrolytes that take place along the collective tubule of nephron

7. Normally the urine cannot backflow from bladder to ureter. Please describe the rule of muscles of ureter in urine flow

8. What nerves are involved in micturition and describe the mechanism and rule of bladder muscles, sphincter and nerves that involved in urination process.



SDG 4

The Kidneys as water, electrolyte and acid-base balance controller

Learning Tasks

1. Explain the concept of countercurrent multiplier system and countercurrent exchange

2. Explain the osmoreceptor- anti diuretic hormone feedback system

3. Explain the process in kidneys to conserve the fluid osmolarity and sodium concentration of body fluid

4. Explain the potassium excretion and potassium concentration in the extracellular fluid that is controlled by kidneys

5. What are the causes of acidity of body fluid?

6. What can you define the body in acidosis or alkalosis condition

7. Explain some buffers system in the body and what are their function

8. Explain the renal correction of acidosis condition and alkalosis condition.

Lecture 5:

Pathogenesis of Glomerular and

Tubulo-Interstitial Injury

Pathogenesis of Glomerular Injury

Glomerular diseases constitute some of the major problems in nephrology. The glomeruli may be injured by a variety of facilitatorstors and in the course of a number of systemic diseases. Some systemic diseases often affect glomeruli and causing glomerulopathy, termed secondary glomerulonephritis. It’s different with primary glomerulonephritis in which the kidney is the predominant organ involved.

Although we know little of etiologic agent and triggering events, it is clear that immune mechanisms, both humoral and cell-mediated immune reactions, underlie most forms of primary glomerulonephritis and many of the secondary glomerular disorders.

Two form of antibody-associated injury have been established: 1). Injury by antibodies reacting in situ within the glomerulus, either with insoluble fixed (intrinsic) glomerular antigens or with molecules planted within the glomerulus, and 2). Injury results from deposition of circulating antigen-antibody complexes in the glomerulus. In addition, there is experimental evidence that cytotoxic antibodies directed against glomerular cell components may cause glomerular injury. These pathways are not mutually exclusive and all may contribute to injury.

Injuries induced by these immune responses will lead the activation of many cells and mediators, resulting in functional and structural alteration of the glomeruli, followed by alteration of tubulointerstitial components.

Pathogenesis of Tubular/Interstitial Injury

Most forms of tubular injury also involve the interstitium; therefore, diseases affecting these two components are discussed together. Two major forms of this process are: 1).

Ischemic or toxic tubular injury, leading to Acute Tubular Necrosis (ATN) and acute renal failure, and 2). Tubulointerstitial nephritis. In this lecture, we stress on ATN and certain tubulointerstitial nephritides.

ATN is a clinicopathologic entity characterized morphologically by destruction of tubular epithelial cells and clinically by acute diminution or loss of renal function. It can be caused by a variety of conditions, including ischemia, toxin, acute tubulointerstitial nephritis,


Study Guide The Urinary System and Disorder Block urinary obstruction, etc. Based on its etiopathogenesis, the ATN can be grouped into two patterns, i.e. ischemic ATN and nephrotoxic ATN.

Tubulointerstitial nephritis characterized histologically by inflammation of tubules and interstitium. Pyelonephritis is the most common type of tubulointerstitial nephritis, commonly caused by infection. Toxins and drugs are other important causes. It can produce renal injury in at least three ways: 1). Trigger an interstitial immunologic reaction, exemplified by the acute hypersensitivity nephritis induced by such drugs as methicillin, 2). Those may also cause acute renal failure, and 3). Cause subtle but cumulative injury to tubules that take years to become manifest, resulting in chronic renal insufficiency.

SGD 5

Pathogenesis of glomerular and tubulo/interstitial injury

Trigger Case 1

A 50 year old man has suffered from nephrotic syndrome since 3 months ago. Renal biopsy revealed diffuse capillary wall thickening by light microscopy. Immunoflurescence examination showed diffuse granular IgG and C3 deposits, located subepithelium (electron microscopy). No evidence of underlying systemic disease. This patient was diagnosed getting membranous glomerulopathy.

Learning Task

1. Mention classification of primary glomerular diseases!

2. Mention some diseases commonly induce glomerular injury (secondary glomerulopathy)!

3. Explain the pathogenesis of human membranous glomerulopathy!

4. Explain the differences between in situ immune complex deposition and circulating immune complex deposition!

5. Mention one best known type of glomerular disease which induced by circulating immune complex deposition!

6. Describe four major tissue reactions found in glomerulopathy!

Trigger Case 2

A 60 year old man suffers from cardiac infarction and has been admitted since a week ago.

Yesterday the nurse noted his urine production decreased, 250mL/24 hours. This oligouria is continuing until this day. Laboratory examination revealed increase of serum urea nitrogen and creatinin.

Learning Task

1. Discuss the mechanism responsible for oligouric state in this patient!

2. Explain about pathogenesis of acute kidney injury (AKI)!

3. What is the difference between AKI and tubulo-interstitial nephritis?

4. Mention some causes of tubule-interstitial nephritis!



Lecture 6:

Common Kidney Diseases in Children

(Acute Poststreptococcal Glomerulonephritis and Nephrotic Syndrome), UTI in Children

Post Streptoccocal Acute Glomerulonephritis

Hematuria defined as the excretion in urine of abnormal amounts of red blood cells (RBCs).

The presence of at least 5 RBCs in the urine was considered abnormal. It occurs with a prevalence of 0.5-2.0% among school aged children.

The child who exhibits gross hematuria needs prompt evaluation. The urinalysis should be repeated in the child who has the combination of microscopic hematuria, without proteinuria, normal blood pressure, and normal renal function. If the hematuria persist, further evaluation is appropriate.

Acute glomerulonephritis (AGN) is a syndrome characterized by the abrupt onset of macroscopic hematuria and edema. The majority of instances of AGN appear to be postinfectious, and a number of bacterial and viral infections have been etiologically incriminated. The most common recognized clinical picture follows group A,



-hemolytic streptococcus infections.

So the term used in this report is poststreptococcal acute glomerulonephritis (PSAGN).

Only certain nephritogenic strains of streptococci have been associated with PSAGN.

The more common sporadic variety of PSAGN usually follows type 12 streptococcal infection of the pharynx. Epidemics of the disorder have been linked to several strains causing either throat or skin infections.

PSAGN predominantly affects children between the ages of 2 and 10 years, with a slight predominance of males. Typically, children with PSAGN present with sudden onset of painless gross hematuria, and some edema is usually present. Hypertension is a common feature of PSAGN and may lead to hypertensive encephalopathy. The laboratory findings of

PSAGN include increased of ASTO titre and decreased serum complement C3. Urinalysis in most scenarios shows hematuria, proteinuria, and abnormal sediment including erythrocyte cast.

In adult from 15% to 30% of patients with PSAGN had been reported to progress to a chronic state while estimation in children have generally ranged from approximately 5% to

10%. The chronicity of PSAGN can be predicted if the microscopic hematuria, proteinuria, and a low serum complement C3 level are present for a period exceeding than six months after initial onset of illness. It is prudent to follow the patients with PSAGN until the proteinuria normalizes and microhematuria has disappeared in the urinalysis.

Nephrotic Syndrome

Nephrotic syndrome is primarily a pediatric disorder and is 15 times more common in children than adults. The incidence is 2-3/100,000 children per year, and the vast majority of affected children will have steroid sensitive with minimal change disease. The characteristic features of nephritic syndrome are heavy proteinuria (> 40 mg/m 2 /hour in children), hypoalbuminemia (< 2.5 g/dL), edema, and hyperlipidemia.

Most children (90 %) with nephrotic syndrome have a form of the idiopathic nephritic syndrome. The causes of idiopathic nephritic syndrome include minimal change disease



(85%), mesangial proliferation (5%), and focal segmental glomerulosclerosis (10%). The remaining 10% of children with nephrotic syndrome have secondary nephritic syndrome related to glomerular diseases such as membranous nephropathy or membranoproliferative glomerulonephritis.

The underlying abnormality in nephritic syndrome is an increase permeability of the glomerular capillary wall, which leads to massive proteinurioa and hypoalbuminemia. The cause of the increase permeability is not yet fully understood.

Although the mechanism of edema formation in nephrotic syndrome is incompletely understood, it seems likely that, in most instances, urinary protein loss lead to hypoalbuminemia, which lead to decrease in the plasma oncotic pressure and transudation of fluid from the intravascular compartment to the interstitial space.

The diagnoses of nephrotic syndrome based on clinical manifestation that usually present with edema which initially noted around the eyes and in the lower extremities. With the time, the edema became generalized with the development of ascites, pleural effusions, and genital edema. Anorexia, irritability, abdominal pain, and diarrhea are common; hypertension and gross hematuria are uncommon.

The urinalysis reveals 3+ or 4+ proteinuria; microscpic hematuria may be present in

20% of children. Urinary protein exceeds > 40 mg/m 2 /hour in children. The serum albumin level is generally less than 2.5 g/dL and the serum cholesterol and triglyceride levels are elevated. C3 and C4 levels are normal.

Treatment of children with the first episode of nephrotic syndrome and mild to moderate edema may be managed as outpatient. Children with onset of nephrotic syndrome between 1 and 8 year of age are likely to have steroid responsive minimal change disease; therefore, steroid therapy may be initiated without renal biopsy. The majority of children with steroid-responsive nephritic syndrome have repeated relapses, which generally decreased in frequency as the child grows older.

SGD 6

Common Kidney Diseases in Children

Trigger Case 1

Three years old boy was admitted to the outpatient clinic with swollen on both eyelids and followed on both legs. No symptom like this previously. Urination was decreased with cloudy yellow color since swelling was begun. Make the diagnosis, treatment and education for this patient.

Learning Task:

1. What are the diagnosis and differential diagnosis for this case?

2. Explain the characteristic features of Nephrotic syndrome?

3. Explain edema mechanism for this case?

4. Describe the laboratory investigation to diagnosed Nephrotic Syndrome?

5. Explain techniques of proteinuria examination

6. Provide initial management of nephrotic syndrome

7. Comprehend the complication of nephrotic syndrome

Trigger Case 2

A 12-year-old female present with three days history of the red urine and puffiness of her face. The patient was having fever and sore throat in previous 2 week. Examination reveals minimal puffiness with pitting edema of the lower limbs. Her blood pressure is140/100 mmHg with pulse 88 bpm. Chest, cardiovascular and abdominal examination are normal.



Learning Task:

1. Diagnosis and differential diagnosis for this case?

2. Describe characteristic features of PSAGN

3. Describe the laboratory investigation to diagnose PSAGN

4. Explain the mechanism of hypertension in PSAGN and it complication?

5. Provide initial management for this case

6. List the complication of PSAGN

Lecture 7:

Urinary Tract Infection:

Uncomplicated and Complicated

Urinary tract infection (UTI): a documented episode of significant bacteriuria (i.e. an infection with a colony count of > 100,000 organisms per ml) that may affect the upper urinary tract

(pyelonephritis, renal abscess) or lower urinary tract (cystitis), or both. UTI is a very common condition in general practice (usually E. coli). Ascending infection (most UTI) is caused in this way (bacteria from gastrointestinal tract colonize lower urinary tract). Haematogenous spread is an infrequent cause of UTI (seen in intravenous drug users, bacterial endocarditis and tuberculosis).

Clinical features of Upper urinary tract infection are fever, rigors/chill, flank pain, malaise, anorexia, costovertebral angle and abdominal tenderness; and lower urinary tract infection are dysuria, frequency, urgency, suprapubic pain, haematuria, scrotal pain

(epididymo-orchitis) or perineal pain (prostates).

Principles of management are to treat the infection with an appropriate antibiotic based on urine culture results and deal with any underlying cause (e.g. relieve obstruction).

High fluid intake should be encouraged and potassium citrate may relieve dysuria. Uppertract UTIs, epididymo-orchitis and prostatitis require intravenous antibiotic therapy. Agents commonly used: gentamicin, cephalosporin or co-trimoxazole. Cystitis and uncomplicated lower UTIs can be managed with oral antibiotics. Agents commonly used are trimethroprim, ampicillin, nitrofurantoin, and cephalosporin. An abscess will require drainage either radiologically or surgically. If there is a poor response to treatment, consider unusual urinary infections: tuberculosis (sterile pyuria), candiduria, schistosomiasis, C. trachomatis, N. gonorrhoeae.

The complications of urinary tract infection are bacteraemia and septic shock, chronic and xanthogranulomatous pyelonephritis, renal and perinephric abscesses.

Learning task 7

Case 1

Seventy years old man referred from primary health care with recurrent lower urinary tract symptoms (LUTS) since 5 years. He had history of antibiotic treatment, and passed urethral stone 10 years ago. Urinalysis revealed Leucocyturia, erythrocyturia, and bacteriuria.



Task

If you a doctor in small city (in Indonesia, type B hospital) and not so far from top referral hospital (type A Hospital):

1. What is the need to be complete diagnosed?

2. What is the proper medical treatment

3. When should you refer the patient to referred hospital (type A hospital)?

Case 2

A 40 years-old man has been suffering current lower abdominal pain during urination since 1 year. Cloudy urine and sometime the urine colours were red. On digital rectal examination

(DRE) do not fine any pathology. The result of laboratory test are: BUN and SC in normal limit (10.0 mg%, and 0.5 mg%), urinalysis revealed erythrocyturia, leucocyturia, and bacteriuria with significant urine culture (E. Coli count 100, 000 cfu/ml). Plain abdominal photo (BNO/BOF) result saw radio opaque picture 20 mm in size at pelvic cavity.

1. What is possible diagnosis?

2. Give some example treatment, if you are a doctor in primary health care practice!

3. What are possible treatments to do at referred hospital?

Lecture 8:

Urinary Calculi (Urolithiasis) and Urethral

Stricture

Urolithiasis is a frequent clinical problem. The calculi may be form at any level in the urinary tract, can be bilateral, but frequently unilateral. The favored sites for their formation are within the renal calyces and pelvis, and in the bladder.

There are four main types of calculi: (1) Calcium containing calculi, (2) Struvite calculi,

(3) Uric acid stone, and (4) Cystine stone. An organic matrix of mucoprotein is present in all calculi.

Although there are many causes for initiation and propagation of stone, the most important determinant is an increased urinary concentration of the stone constituents, such that it exceeds their solubility in urine (supersaturation). A low urine volume in some metabolically normal patients may also favor supersaturation.

Clinical features of urolithiasis: calyceal stones may be asymptomatic; staghorn calculi present with loin pain and upper tract UTI; ureteric colic: severe colicky pain radiating from the loin to title groin and into the testes or labia associated with gross or microscopic haematuria; bladder calculi present with sudden interruption of urinary stream, perineal pain and pain at the tip of the penis. The management including pain relief for ureteric colic; pethidine, Voltarol, high fluid intake, 80% of ureteric stones pass spontaneously: stones < 4 mm in diameter almost always pass; stones > 6 mm almost never. Indications for intervention: kidney stones: symptomatic, obstruction, staghorn; ureteric stones: failure to pass, large stone, obstruction, infection; bladder: all stones.



Learning Task 8

Case 1

A 50 years-old woman has been getting colicky pain since 2 hours. On the physical examination he has right flank mass and pain full during palpation and percussion.

Leucocyturia, erythrocyturia and bacteriuria in urin analysis.

Learning Task

If you a doctor in small city (in Indonesia, type B hospital) and not so far from general hospital (type A hospital):

1. What are differential diagnoses of this case?

2. Whatare the radiologic examination need to definitive diagnose?

3. Whatare the initial management of this case?

4. When are you going to referral a patient to referred hospital (RS type A)?

Case 2

Forty years old man referred from primary health care with lower urinary tract symptoms

(LUTS) since 5 years. He had history of antibiotic treatment, and passed urethral stone 10 years ago. Urinalysis revealed leucocyturia, erythrocyturia and bacteriuria.

Learning Task

If you a doctor in small city (in Indonesia, type B hospital) and not so far from general hospital (type A hospital):


2. Whatare the radiologic examination need to definitive diagnose?

3. Whatare the initial management of this case?


Case 3

Twenty years old man referred from primary health care with lower urinary tract symptoms

(LUTS) since 2 years. He had history straddle/saddle injury 3 years ago.

Learning Task

If you a doctor in small (in Indonesia, type B hospital) and not so far from general hospital

(type A hospital):

1.

2.

What are differential diagnoses of this case?

Whatare the radiologic examination need to definitive diagnose?

When are you going to referral a patient to referred hospital (RS type A)? 3.

Lecture 9:

Common Neoplasm in Urinary System:

Renal tumors, bladder tumors.

Because of the diverse connotations of the term, it is necessary to define BPH as microscopic BPH, macroscopic BPH, or clinical BPH. Microscopic BPH represents histologic evidence of cellular proliferation of the prostate. Macroscopic BPH refers to enlargement of the prostate resulting from microscopic BPH. Clinical BPH represents the LUTS, bladder dysfunction, hematuria, and urinary tract infection (UTI) resulting from macroscopic BPH.

Abrams (1994) has suggested using the more clinically descriptive terms benign prostatic enlargement (BPE), BOO, and LUTS to replace BPH.



The histologic diagnosis of prostate cancer is made, in the majority of cases, by prostate needle biopsy. Prostate cancer rarely causes symptoms until it is advanced. Thus, suspicion of prostate cancer resulting in a recommendation for pros-tatic biopsy is most often raised by abnormalities found on digital rectal examination (DRE) or by serum prostatespecific antigen (PSA) elevations. Although there is controversy regarding the benefits of early diagnosis, it has been demonstrated that an early diagnosis of prostate cancer is best achieved using a combination of DRE and PSA. Transrectal ultrasound (TRUS)-guided, systematic needle biopsy is the most reliable method, at present, to ensure accurate sampling of prostatic tissue in men considered at high risk for harboring prostatic cancer on the basis of DRE and PSA findings.

Both benign and malignant tumors occur in the kidney. The benign tumors rarely cause clinical problems while malignant tumors are of great importance clinically and deserve considerable emphasis.

The common malignant tumors of the kidney are Renal Cell Carcinoma (RCC), Wilm tumor and urothelial carcinoma of renal pelvis. RCC occurs most often in older individual, usually in the sixth and seventh decade of life. Morphologically, RCC is divided into four major types, i.e. clear cell carcinoma, papillary carcinoma, chromophobe renal carcinoma and Bellini duct carcinoma. Wilmtumor usually occur in children. Urothelial carcinoma originates from urothelium of the pelvis, and it often clinically apparent within a relatively short time because they lie between the pelvis and by fragmentation produce noticeable hematuria

Learning Task 9

Case 1

Seventy years old man was referred from primary health care with left flank mass since 2 years. He had no history of haematuria, and febrile. Urinalysis revealed leucocyturia, erythrocyturia and bacteriuria.

Learning Task


(type A hospital):

1.

2.

3.



When are you going to referral a patient to referred hospital (RS type A)?

Case 2

Seven years old boy was reffered from primary health care with left flank mass since 1 year.

He had no history haematuria, and febrile. Urinalysis revealed leucocyturia, erythrocyturia and bacteriuria.

1.

2.

3.

Learning Task


(type A hospital):




Case 3

Sixty years old man was referred from primary health care with painless gross haematuria since 2 years. He had history of antibiotic treatment, and did not found any stone on plain abdominal X ray and ultrasound examination.



Learning Task


(type A hospital):


2.

3.



Lecture 10:

Urinary tract trauma

(Rupture of the kidney and urinary tract)

Of all injuries to the genitourinary system, injuries to the kidney from external trauma are the most common. It is essential to obtain as many details of the injury as possible; for example, depending on whether the cause is blunt or penetrating trauma, the approach to evaluation and management is quite different.

Blunt renal injuries most often come from motor vehicle accidents, falls from heights, and assaults. Perhaps the most important information to obtain in the history of the injury is the extent of deceleration involved. Rapid deceleration can cause vascular damage to the renal vessels, resulting in renal artery thrombosis, renal vein disruption, or renal pedicle avulsion. In high-velocity-impact trauma, multiple-organ injury is likely to be associated.

Penetrating renal injuries most often come from gunshot and stab wounds. The gunshot to the upper abdomen or lower chest should alert the physician to renal injury; of all patients sustaining renal trauma in a large reported series, renal gunshot wounds occurred in approximately 4.0% (McAninch et al, 1993 ). Important factors in assessing a gunshot wound initially are weapon characteristics and bullet ballistics.

Ureteral injuries after external violence are rare, occurring in less than 4% of cases of penetrating trauma and less than 1% of cases of blunt trauma. During wartime in the past century, 3% to 15% of urologic injuries have involved the ureter, with an average of 5% over reports from World War II up to modern conflicts. In the nonmilitary setting, a similar incidence of ureteral injuries is caused by civilian gunshot injuries. These patients often have significant associated injuries and a devastating degree of mortality that approaches one third. Associated visceral injury is common, predominantly small (39% to 65%) and large

(28% to 33%) bowel perforation. Significant percentages (10% to 28%) of patients with ureteral injuries also have associated renal injuries. A smaller percentage (5%) has associated bladder injuries.

Ureteral injuries can occur after a multitude of surgical procedures but largely result from surgeries in the pelvis (such as hysterectomy) and retroperitoneum (such as major vascular replacement). One report, which reviewed 13 previously published studies, concluded that hysterectomy was responsible for the majority (54%) of surgical ureteral injuries. Next most common was colorectal surgery (14%), followed by pelvic surgery such as ovarian tumor removal and transabdominal urethropexy (8%), and followed lastly by abdominal vascular surgery (6%). One series reported that repeat cesarean section can also result in a large number of ureteral injuries, in this case up to 23% of the reported ureteral injuries at one hospital (Ghali et al, 1999 ). The total incidence of ureteral injury after gynecologic surgery is reported to be between 0.5% and 1.5%, and after abdominoperineal colon resection it ranges from 0.3% to 5.7%. Open urologic procedures, because they often occur in proximity to the ureters, were also responsible for a significant number (21%) of reported ureteral injuries in one series.



The urinary bladder is generally protected from external trauma because of its deep location in the bony pelvis. Most blunt bladder injuries are the result of rapid-deceleration motor vehicle crashes, but they also occur with falls, crush injuries, assault, and blows to the lower abdomen. Whereas disruption of the bony pelvis tends to tear the bladder at its fascial attachments, bone fragments can also directly lacerate the organ. Bladder laceration may also arise from penetrating trauma or various iatrogenic surgical complications and may occur spontaneously in patients with altered sensorium, such as those who are intoxicated or have neuropathic disease.

Learning task 11

Case 1

Twenty years old man reffered from primary health care with gross haematuria and history of fall from manggo tree 5 meters in high, 4 hours before hospitalize. Bruise and palpable pain on left side flank.

Learning Task


(type A hospital)


2. What are the radiologic examinations need to definitive diagnose?

3. What is the initial management of this case?


Case 2

A 22 years-old man has been suffering from urethral bloody discharge and pain on lower abdominal region since he had motor cycle accident 5 hours ago. On physical examination found that he has bruising and mass lower abdominal region area.

Learning Task


(type A hospital)What are differential diagnosis of this case?

5. What are the radiologic examinations need to definitive diagnose?

6. What is the initial management of this case?


Lecture 11 & 12:

Acute Kidney Injury & Chronic Kidney

Diseases

The syndrome of acute renal failure (ARF) is defined as a reduction of glomerular filtration rate (GFR) that is often reversible. The syndrome may occur in three clinical settings: (1) as an adaptive response to severe volume depletion and hypotensiuon with structurally ang functionally intact nephrons, (2) in response to cytotoxic insults to the kidney when both renal structure and function are abnormal, and (3) when the passage of urine is blocked. Thus

ARF may be classified as prerenal, intrinsic, or postrenal.

Chronic kidney disease (CKD) is characterized by a progressive course with ongoing loss of kidney function. Once the glomerulous filtration rate (GFR) falls below about half of normal, kidney function tends to decline even if the initial insult of kidney has been


Study Guide The Urinary System and Disorder Block eliminated. This phenomenon has been defined as progression of CKD and typically moves through phases from initial diminution of renal reserve to mild, moderate, and severe reduction of GFR, then kidney failure ultimately requiring renal replacement therapy (end stage renal disease).

Learning Task 11

Case 1

36 year old man is admitted for an increased serum creatinine level. He has been taking intravenous antibiotics at home for the past 2 weeks for osteomyelitis caused by

Staphylococcus aureus.

He reports no change in his urine output. On physical examination, his blood pressure was 124/76 mmHg and his pulse was 82 beats per minute while he was supine and 126/74 mmHg 86 beats per minute while he was standing. He has a diffuse red maculopapular rash on his trunk and limbs. The remainder of the examination is normal. His serum creatinine level is 2,4 mg/dl today and it was 1,0 mg/dl a week ago. Other blood laboratory findings include the following: WBC count 11.000/ml; sodium 142 mmol/L; potassium 4,2 mmol/L; and blood urea nitrogen 34 mg/dl. His urine showed a sodium level of

54 mmol/L and creatinine level of 39 mg/dl. The urinalysis with dipstick testing showed +1 protein; the microscopic analysis showed 5-10 leucocytes/HPF(high power field). And an occasional leucocytes cast. Kidney ultrasound showed no hydronephrosis.

Learning Task

1. What is the most likely diagnosis for this patient’s AKI? Give your reason! a. AKI (acute kidney injury) as a result of acute interstitial nephritis b. Chronic kidney diseases as a result of diabetes c. AKI as a result of acute tubular necrosis (ATN) d. AKI as a result of prostate diseases

Explain your answer! What kind of abnormality findings was found in the patient supports your conclusion?

2.

3.

Case 2

Explain the pathophysiology!

Explain the management for this patient!

79 year old white man comes to emergency unit with the symptom: not being able to urinate this day. He recently saw his primary care physician for an upper respiratory infection, and began taking diphenhydramine (anti-histamine) for relief the nasal congestion. He reports a history that is significant for benign prostatic hyperplasia (BPH) and hypertension. A Foley catheter was placed, with the return of 1200 ml of urine. Urinalysis was within normal limit.

His blood urea nitrogen (BUN) level was 21 mg/dl and his creatinine level was 1,5 mg/dl

(base line creatinine level, 1.0 mg/dl).

Learning Task

1. What is the most likely diagnosis for this patient? a. Pre renal as a result of hypovolemia b. Intra renal as a result of ATN c. Intra renal as a result of acute interstitial nephritis d. Post renal as a result of obstruction

Explain your answer! What kind of abnormality findings was found in the patient supports your conclusion?

2. Explain the pathophysiology!

3. Explain the management for this patient!



Learning task 12

Trigger Case

A 63-year-old African-American woman with type 2 diabetes mellitus and hypertension for last 17 years is seen in the clinic for worsening feet edema. Her history reveals that she underwent laser surgery for diabetic retinopathy. Her medications include metoprolol

(50 mg twice daily), hydrochlorothiazide (25 mg daily), and insulin. On physical examination her blood pressure is 148/88 mmHg, and pulse rate is 85 beats/min. She has (+) 2 pedal edema. Laboratory tests show a serum creatinine level of 0,7 mg/dl and

BUN level of 32 mg/dl. The glycosylated hemoglobin level is 7,5 %. Urine testing shows

+4 proteins by dipstick.

Learning Task

1. Describe the classification of chronic kidney disease!

2.

3.

4.

Which of the following statements is true? a. This patient does not have CKD (chronic kidney disease) b. This patient has stage 1 CKD c. This patient has stage 2 CKD d. This patient has stage 3 CKD

Explain your answer! What kind of abnormality findings was found in the patient that supports your conclusion?

Explain the pathophysiology!

Which of the following facilitatorstors is not likely to increase the progression of CKD for this patient? a. Female gender b. (+) 4 proteinuria c. Blood pressure of 144/88 mmHg d. Glycosylated hemoglobin level of 7.5 %.

Explain your answer!

Describe the management of chronic kidney disease according to the class/stage!

Explain the rational management for the patient above!

5.

6.

Lecture 13:

Renal Hypertension

Renovascular hypertension is the most common cause of secondary hypertension in the

United States. Renovascular hypertension is an elevation of blood pressure due to activation of the renin-angiotensin system in the setting of renal artery occlusive diseases. The diagnosis of renovascular hypertension can be made only if blood pressure improves following intervention, thereby making renovascular hypertension a retrospective diagnosis.

The presence of anatomic renal artery stenosis is not synonymous with renovascular hypertension. Progressive and occlusive renovascular disease may lead to impaired kidney function, termed “ischemic nephropathy”.

Learning Task 13:

1. Describe the pathophysiology of Renovascular hypertension

2. Explain the type of endocrine hypertension

3. Describe the principle management for the patient with secondary hypertension



Lecture 14:

Drug use in renal disorders

Diuretics

Urinary antiseptics

Kidney performs a number of essential functions in the body including clearance of waste product, drug or other substances, control of volume status, maintenance of electrolyte and acid base balance. Renal impairment (disorders) frequently alters the pharmacokinetic and pharmacodynamic of certain drugs. Absorption, bioavailability, protein binding, distribution volume and clearance (metabolism) of several drugs can be affected, as well as pharmacodynamic processes. Alterations in pharmacokinetic and pharmacodynamic of drugs in renal disorders (diseases) potentially cause increased risk of adverse drug reaction. In addition, multiple medical problems in patient with kidney disease frequently result in polypharmacy and consequently increased drug interaction.

Careful attention should also be taken for drug use in renal disease. Many drugs potentially cause drug-induced renal disease, thus their uses in renal impairment should be avoided or the dosage should be adjusted. Drug-induced renal disease may result from immunological or non immunological process, and may affect pre renal, renal or post renal. Dosage adjustment in renal disorders commonly required for drugs which eliminated mainly by renal excretion or drugs with narrow safety margin.

Diuretic is group of drugs that increase the secretion of urine (water, electrolytes and waste products) by the kidney. Diuretics inhibit renal sodium reabsorption by several mechanisms.

Each type of diuretic acts upon a single anatomic segment of the nephron, which has a distinctive transport function. There are several types of diuretics available recently, carbonic anhydrase inhibitors, loop diuretics, thiazides, potassium sparing diuretics, and osmotic diuretics.

Urinary antiseptics are oral drugs that are rapidly excreted into the urine and act there to suppress bacteriuria. Types of urinary antiseptic available are nitrofurantoin, nalidixic acid and methenamine.

SELF-DIRECTED LEARNING

Basic knowledge must be known:

1. The role of kidney on drug disposition

2. The pharmacokinetic and pharmacodynamic changes of drugs in renal disorders

3. Types of drug-induced renal disease and the pathophysiological mechanism

4. Drug dosage adjustment in renal disorders

5. Mechanism of action, clinical indication, adverse effects of several types of diuretics

6. Types of urinary antiseptics, the mechanism of action and adverse effects


SCENARIO 1

A 38 years old man was admitted to emergency unit due to bloody urine and flank pain since last week. Patient had history of hypertension since 4 years. Physical examination revealed

BP=180/100 mmHg, edema (+) in both lower extremities, anemia (+), t =38˚C. Laboratory result revealed WBC= 13.0; Hb= 8.5; BUN= 201; SC= 16.4. Doctor decided to give several drugs to manage patient’s disease. One of the medications planned to be given was antibiotic.



TASK 1

1. From the scenario above, what is the most appropriate antibiotic for this patient?

Explain the reason.

2. What are the principal factors should be considered before giving antibiotic treatment for patient with chronic kidney disease?

3. If patient required any analgesic medication, what analgesic would be the safest one?

4. Mention types of antibiotic and analgesic that potentially induced renal injury/disease and the type of renal injury/disease might be resulted from it.

5. Mention the basic concepts of drug dosage adjustment in chronic kidney disease

SCENARIO 2

A 40 years old man was admitted to emergency unit due to swelling on both legs since 2 weeks before. After complete physical and laboratory examination patient was diagnosed as having chronic kidney disease. Doctor decided to give furosemide for relieving the oedema.

After several days of furosemide treatment, patient was suffered from hypokalemia.

TASK 2

1. How does furosemide exert its action?

2. When used chronically, what adverse effects would possibly occur?

3. How was the possible mechanism of hypokalemia result from furosemide treatment?

4. What is the effect of concurrent NSAID treatment in patient receiving furosemide?

Lecture 15&16

Prostate & Male Penile Disorders

Disorder of male genital system include penis (malformation, inflammation, neoplasm), scrotum, testis (cryptorchidism, inflammation, neoplasma), epididymis, prostate (prostatitis,

BPH, carcinoma) and sexual transmitted diseases.

Malformations of the penis are hypospadia, epispadia, priapism, peyronie disease.

Hypospadia is more common than epispadia. These malformations may result in lower urinary tract problem and failure to impregnate women.

Inflammatory condition of the penis that unrelated to STDs is called balanitis and posthitis. In phimosis, where prepuce cannot be retracted, smegma is deposited between glans penis and prepuce. Therefore most cases of phimosis accompanied by balanoosthitis. When phimosis is forcibly retracted it may result in paraphimosis. In this condition, the circulation to the glans penis may be strangulated by the stenotic prepuce. This may cause congestion, swelling and pain. In severe case, urinary retention may occur.

Carcinoma of the penis is the most neoplasm occurs in the penis. Some predisposition factors are pimosis, BXO and chronic irritation. It is believed that smegma and infection of

HPV (type 16 & 18) have an important role in the occurrence of carcinoma of the penis.

Microscopically carcinoma of the penis is squamous cell carcinoma.


Man 68 years old come with lower abdominal pain and unable to void since one day ago. He suffered from Lower urinary tract symptoms since 6 months ago.

1. What is the possible diagnosis of this patient?

2. What are the anamnesis, signs, symptoms and examination to support the diagnosis?

3. What is your planning to complete the diagnosis?

4. What is your planning treatment of this patient?




A 34- years- old man, came with complaint of unable to void since 2 days ago. He also complains of weak urinary flow and terminal dribbling since last 2 months. He had history of urethral discharge due to sexual transmitted diseases. No complaint on erectile capability.

He has a good general condition, composmentis, normal blood pressure 120/80, pulse

88x/minutes, uncircumcised, narrow MUE. Normal scrotal finding, right testicle normal.

Questions:

1. What is the possible diagnosis of this patient?

2. What are the anamnesis, signs, symptoms and examination to support the diagnosis?

3. What is your planning to complete the diagnosis?

4. What is your planning treatment of this patient?

Questions:

5. What is the most possible diagnose of your patients?

1.

2.

3.

4.

5.

6.

6. If you are in doubt, the best diagnostic tool that you propose?

7. What is the treatment of your patient?

SELF ASSESSMENT

SELF ASSESSMENT 1

(Macroscopic structure of the Urinary system)

Drawing and describe the topography of kidneys

Drawing and describe the vascularisations of kidneys

Drawing and describe the innervations of kidneys

Drawing the profile of uriniferous tubules

Drawing the anatomical structure of urinary tract

Drawing the vasculature and innervations of urinary tract


(Microscopic structure of the urinary system)

1. E xplain the kidney disorders in relation with it’s microscopic structure!

2. How is the relation between Bowman’s capsule and glomerulus?

3.

4.

Differentiate afferent and efferent glomerular arteriole!

Explain the epithelium of proximal tubule, Henle’s loop, and distal tubule!

5.

6.

What is filtration barrier in renal corpuscle!

Explain about podocyte, mesangial cells and its function!

7. Explain about two types of nephron and cell types composing the thin limbs of

Henle’s loop?

8. Explain three regions of collecting tubules!

9. What is renal interstitium?

10. Explain the urinary tract disorders in relation with it’s microscopic structure!

11. The structure that separates transitional epithelial from underlying lamina propria is….

12. The structure of fibrous outer coat of ureter at its prox imal and distal terminal is…

13. The function of plaque regions of the transitional epithelial cell plasmalemma is…..

14. What is the microscopic structure of the triangular region of the bladder?

15. Explain the two layers of lamina propria of the bladder!

16. What is gland of Littre?




(The function of the urinary system)

1. Explain the pressures that involved in filtration process

2.

3.

Describe the myogenic response in autoregulation of GFR

Describe the tubulo-glomerular feedback in autoregulation of GFR

4.

5.

Describe the hormonal and autonomic nerve factor in autoregulation

Describe the process of water, electrolyte and other solute along the proximal, loop of

6.

7.

8.

9.

Henle, distal and collective tubules of nephrons

Describe the rule of muscles of ureter in urine flow

Describe the rule of muscles of bladder and sphincter internal and external of urethrae

Describe the nerve that involved in micturition process

Describe the counter-current concept in relation to maintain the difference of tissues osmolarity between cortex and medulla of kidneys

10. Explain the rule of anti diuretic hormone (ADH) in kidneys to maintain the body fluid balance

11. Explain the aldosterone hormone to maintain the electrolytes balance

12. Explain the mechanism of water and electrolytes excretion that influenced by diuretic drug

13. Describe the mechanism for producing concentrated and dilute urine excretion

14. Describe what is the meaning of acidosis condition and alkalosis condition

15. Describe the buffers and their function in the body

16. Describe the renal correction in acidosis and alkalosis condition


(Pathogenesis of the glomerular and tubulointerstitial injury)

State whether the statement is true or false!

1. Goodpasture syndrome is characterized by membranous glomerulonephritis induced

2.

3. by circulating antigen-antibody complex deposition within glomeruli.

Glomerular disease associated with immune response to streptococcal infection is commonly showed acute diffuse glomerulonephritis.

Podocytes alteration in minimal change disease can be detected by histomorphology

4.

5. examination.

The distribution of tubular necrosis in ischemic ATN and nephrotoxic ATN is similar.

Acute hypersensitivity nephritis induced by methicillin usually associated by subtle and cumulative injury to tubules.


Common kidney diseases in children

1.

2.

3.

4.

5.

Assessment for proteinuria

Describe the term of remission, relapse, steroid dependent and steroid resistant in nephrotic syndrome

What is the most form of Nephrotic syndrome in children?

Explain the monitoring for the hospitalized patient with Nephrotic Syndrome?

Is it possible to give furosemide for edema in Nephrotic Syndrome? Explain your answer.

6.

7.

8.

Explain the time and percentage of response for steroid therapy in Nephrotic

Syndrome?

Describe differentiation of glomerular and extra glomerular hematuria.

List the source of infection and bacterial strain in PSAGN

9. Pathophysiology of APSGN

10. Monitoring for inpatient PSAGN



11. Follow up for outpatient PSAGN

12. Clinical and laboratory evaluation

13. When is the symptom and laboratory resolves

14. Prognosis of PSAGN?


(Complicated and Uncomplicated Urinary tract infection)

1.

2.

3.

How to do a complete anamnesis (history talking) by fundamental four and secrete seven in complicated UTI?

How to do a complete diagnosis (primary, scondary and complication) by history talking, physical, X ray and ultrasound) in complicated UTI?

How to do the proper medical management in complicated UTI?

4. How to do the education in complicated UTI, if a patien is going to reffered hospital and surgical management?


(Urolithiasis and urethral stricture)

Self Assessment Urolithiasis

1. How to do a complete anamnesis (history talking) by fundamental four and secrete seven in renal, ureteral, bladder and urethral stone?

2. How to do a complete diagnosis (primary, secondary and complication) by history talking, physical, X ray and ultrasound examination in renal, ureteral, bladder and urethral stone?

3. How to do initial management in renal, ureteral, bladder and urethral stone?

4. How to do education in renal, ureteral, bladder and urethral stone, if a patient going to do to referred hospital and surgical management?

Self Assessment Urethral stricture

1. How to do a complete anamnesis (history talking) by fundamental four and secrete seven in urethral stricture?

2. How to do a complete diagnosis (primary, secondary and complication) by history talking, physical, X ray examinations) in urethral stricture?

3. How to do education in urethral stricture, if a patient going to do to referred hospital and surgical management?


(Common neoplasm of the urinary tract and related structure)

1. How to do a complete anamnesis (history talking) by fundamental four and secrete seven in kidney and bladder neoplasma?

2. How to do a complete diagnosis (primary, secondary and complication) by history talking, physical, X ray examinations) in kidney and bladder neoplasma?

3. How to do education in kidney and bladder neoplasma, if a patient going to do to referred hospital and surgical management?


(Urinary tract Trauma)

1. How to do a complete anamnesis (history talking) by fundamental four and secrete seven in renal, ureteral, bladder and urethral trauma?

2. How to do a complete diagnosis (primary, secondary and complication) by history talking, physical, X ray and ultrasound examination in renal, ureteral, bladder and urethral trauma?

3. How to do initial management in renal, ureteral, bladder and urethral stone?

4. How to do education in renal, ureteral, bladder and urethral trauma, if a patient going to do to referred hospital and surgical management?




(Acute kidney injury)

1. Explain about acute kidney disease and its classification!

2. Explain about the RIFLE criteria!

3. Explain the pathophysiology of acute kidney disease due to gastroenteritis with dehidration?

4. Explain the management of acute kidney disease?

5. Can you describe the compication of acute kidney injury?


(Chronic kidney disease)

1. Describe the classification of Chronic Kidney disease

2. Explain the pathophysiology of hypertension in cronic kidney disease?

3. Explain the pathophysiology of anemia in cronic kidney disease?

4. Describe the management of Chronic Kidney disease according to the classification


Secondary hypertension

Secondary Hypertension

1. In a patient with bilateral renal artery stenosis, drugs that inhibit ACE inhibitors or that block angiotensin receptors can have a negative impact of renal function. Which renal function can be made worse?

A. The ability to secrete renin

B. The ability to concentrate urine

C. Glucose-reabsorbing ability

D. Glomerular filtration

2. Which of the following clinical symptoms and signs is not seen in patient with primary hyperaldosterinism

A. Edema of the angkles

B. Weakness of the muscle

C. Systolic blood pressure of more than 180 mmHg

D. Muscle cramps

3. A physician is practicing in a third world region with no radiology or nuclear medicine support and a laboratory that can only measure blood counts, electrolytes and simple blood chemistries. A young patient with hypertension who has no family history of hypertension presents to the clinic. Which of the following tests would the physician request to investigate the possibility that the patient has primary hyperaldosteronism?

A. Serum sodium concentration

B. Serum and 24-hour urine potassium

C. 24-hour urine sodium and creatinine

D. Urine sodium concentration and pH


1. Mention several drugs that potentially induce renal disease

2. Mention the possible mechanisms of drug-induced renal disease

3. Mention pharmacokinetic and pharmacodynamic changes possibly occur in renal disease.

4. What are the basic concepts of dosage adjustment in patient with renal disease?

5. How is the mechanism of action for each type of diuretics?

6. What is the effect of each class of diuretics in acid base balance and serum potassium level?



7. Why spironolactone would not cause potassium wasting?

8. What other adverse effects might occur in diuretic treatment?

9. Mention some clinical indications of diuretics.

10. Mention types of urinary antiseptics.

11. How is the mechanism of urinary antiseptic action?

12. What are the adverse effects of each type of urinary antiseptic?

SELF ASSESSMENT 15&16

1.

2.

3.

4.

5.

6.

7.

What is the definition of phimosis and paraphimosis, priapismus and peyronie disease?

What is the definition and the management of urethral stricture?

What is the complication of the long term phimosis and poor hygiene of the male external genital?

What is the definition and aetiology of hypospadia?

What is the caused and complication than can be caused by balanopostitis?

What is the correlation between phymosis and penile cancer?

How is the management of penile cancer?

BASIC CLINICAL SKILLS

In general, patients with kidney diseases usually come with non specific symptom. They usually come with hematuria, foamy urine, abnormality of the urine volume (poliuria, oligouria, anuria), or disturbance in micturition process. Another symptom also not infrequently, such as edema, fatigue, pale, nausea and vomiting. Edema starts from face and spread to all of the body. They also come with flank pain (renal colic and ureter colic). The patient with severe kidney destruction may come with shortness of the breath as the result of lung edema or acidosis.

Sign that frequently seen in kidney diseases including anemia, hypertension, and edema. If a patient come to seek the treatment with nausea, vomiting, fatigue, hypertension and edema always think that the most possibility is chronic kidney diseases. Renal colic is a severe pain at right or left lumbal region and referred to genital region. Also accompanied by percussion pain at costovertebral angle.

Test for kidney patient include routine laboratory test, imaging, and biopsy.

Laboratory test, including, routine hematology, urinalysis, ureum/BUN, creatinine, electrolyte

(K, Na), uric acid serum, urine volume, in special scenario, blood gas analysis, total protein and albumin, calsium, anorganik phosphate maybe required. Another examination should be done based on their indication. Clearence creatinine test is important in measuring glomerular filtration rate. Imaging examination including BNO, IVP, Ultrasonography, CT

Scan and , retrograde pielography. Urine cytology and renal biopsy can be done based on indication.

One of the necessary laboratory examination is the examination of the microbiology laboratory. To be able to produce accurate data from the microbiological examination, the specimen quality is a factor that must be considered. A good quality specimen is needed to assist in establishing a reliable diagnosis. Improper management of specimens, both in terms of collection, storage, or transportation, can lead to failure in finding the cause of microorganisms. Interpretation of result culture and susceptibility testing must be tailored according to the patient at risk and the specimen type submitted. There are three things that should be considered in cases of urinary tract infections are the colony count of microorganisms growing in culture, measurement of pyuria and presence or absence of symptoms (dysuria and frequency). Knowledge of the normal flora in the area genetalia are also required similarly with microorganisms that are often the causes of urinary tract infections are very helpful in determining the culture of an agent causing the infection or merely contamination only.



Anamnesis and Physical Examination in Urinary System and Male Genital

System Disorders

Learning task

Title

Objective

Competency

(bold letter)

Instruction for the students

: Anamnesis and physical examination in lower urinary tract disorders

: Student can do structured anamnesis and physical examination in lower urinary tract disorders

: 1. Anamnesis skill

2.

3.

Physical examination skill

Skill in clinical procedure or interprate data from laboratory finding and/or imaging to making a diagnosis or diferensial diagnosis

4.

5.

Management

Patient education and communication

6. Profesional behaviour

: Clinical scenario 1:

A-25-year old man come to the primary health care service with pain during urination.

Clinical Scenario 2:

A-40-year old man come to the primary health care service with fever and flank pain.

Clinical scenario 3:

Two years old boy came with complaint of left scrotal enlargement since he was born

For each clinical scenario:

Do the role play, one student as a doctor and one student as a patient

Task:

1.

2.

Do the anamnesis and physical examination!

Mention your diagnosis dan minimum 1 diferensial diagnosis!



Check List

Skills 0

Anamnesi s

Mahasiswa tidak melakukan anamnesis

1 2 3

Mahasiswa melakukan anamnesis, hanya menanyakan tentang keluhan utama saja

Mahasiswa melakukan anamnesis, menanyakan Basic

7 dan fundamental

4 tapi tidak lengkap.

Mahasiswa melakukan anamnesis, menanyakan

Keluhan utama, basic 7 dan fundamental 4 dengan lengkap.

Bob ot

3

Sk or

Pemeriks aan fisik, meliputi

Vital sign dan status lokalis

Mahasiswa tidak melakukan pemeriksaan fisik

Mahasiswa melakukan pemeriksaan fisik, tapi sebelum dan setelah kontak dengan pasien tidak cuci tangan

Mahasiswa melakukan cuci tangan sebelum dan setelah kontak dengan pasien dan mahasiswa melakukan dengan tidak lengkap atau tidak benar pemeriksaan fisik berikut:

Mahasiswa melakukan cuci tangan sebelum dan setelah kontak dengan pasien dan mahasiswa melakukan dengan lengkap dan benar pemeriksaan fisik berikut:

3

1.

2.

Vital sign

Pemeriks aan status lokalis:

Palpasi bladder

1. Vital sign

Pemeriks aan status lokalis:

Palpasi bladder

Menentuk an diagnosis

Mahasiswa tidak bisa membuat diagnosis

Mahasiswa membuat diagnosis namun tidak lengkap

Mahasiswa membuat diagnosis dengan benar namun tidak bisa membuat diferensial diagnosis

Mahasiswa membuat diagnosis dengan benar dan bisa membuat minimal satu diferensial diagnosis yang benar

2

Komunika si edukasi pasien dan perilaku profesion al

Mahasiswa tidak melakukan semua hal berikut:

1.

2. menguca pkan salam, perkenala n

Melakuka n kontak mata dengan pasien dan berempati

Mahasiswa hanya melakukan 1 dari hal berikut:

1.



Mahasiswa melakukan 2-3 dari hal berikut:

1.



Mahasiswa melakukan semua hal berikut:

1.



1



3.

4. menjelas akan dan meminta ijin untuk melakuka n perasat, memperh atikan kenyama nan pasien

3.


3.


3.


Total

Global Rating Score (lingkari): tidak lulus, borderline, lulus, superior

Urethral Catheterization

Learning task

Title

Objective

Competency

(bold letter)


: Urethral Catheterization

: Student is competent to perform Urethral Catheterization on maniquine.

: 1. Anamnesis skill

2.

3.

Physical examination skill

Skill in clinical procedure or interpret data from laboratory finding and/or imaging to making a diagnosis or differential diagnosis

4.

5.

Management

Patient education and communication

6. Profesional behaviour

: Clinical Scenario:

A 60 years old male patient, come to Primary Health Care Center with unable to urinate.

Instruction:

Perform Urethral Catheterization on this patient.

Instruction for the facilitators

: 1.

2.

3.

Facilitator will allow student to perform urinary catheterization on mannequin in sequence.

Facilitator must observe and evaluate each of student performance with checklist provided below.

Facilitator must give feedback to each student based on their individual performance and also encourage each student to give feedback to their own performance.



CATHETERIZATION CHECK LIST

Male

No Skills

1 Introduce your self, explain what you would like to do and obtain concent

0

2 Hand washing before and afterprocedure

3 Lie the patient comfortably with his legs slightly separated

4 Choose a catheter, open the catheterization pack, pour antiseptic into the reciever and put on gloves

5 Clean the penis throughly, retract the prepuce and clean around the meatus

6 Drape, so that only penis is in sterile field

7 Hold the penis with a gauze swab; squeeze anaesthetic/lubricant jelly into the urethra and occlude it with pressure from the gauze

8 Advance the catheter tip from its sleeve and introduce to urethra, Advance the catheter using a “no touch technique”, or with sterile forceps, until the end arm of the catheter is up to the meatus

9 Inflate the baloon: inject about 5ml of water and check that it does not cause pain before fully inlating it

10 Attach the bag, gently extend the catheter into position, reposition the prepuce

11 Record the volume of urine in the bag (residual volume)

Total Score

Total Score

Final score = --------------- x 100 =

22

Score

1 2



Female

No Skills

1 Introduce your self, explain what you would like to do and obtain concent

2 Hand washing before and after procedure

3 Lie the patient comfortably with his legs slightly separated

4 Choose a catheter, open the catheterization pack, pour antiseptic into the reciever and put on gloves

5 Clean the vulva

6 Drape, so that only vulva is in sterile field

7 Advance the catheter tip from its sleeve and introduce to urethra, Advance the catheter using a “no touch technique”, or with sterile forceps

8 Inflate the baloon: inject about 5ml of water and check that it does not cause pain before fully inlating it

9 Attach the bag, gently extend the catheter into position, reposition the prepuce

10 Record the volume of urine in the bag (residual volume)

Total Score

Total Score

Final score = --------------- x 100 =

20

0

Score

1 2



Urinalysis

Learning Task 1

1. There are 5 urinalysis results provided. Analyze and conclude each of it?

2. Explain correctly and completely the technique of urine collection?

Learning task 2

Title

Objective

Competency

(bold letter)


: Anamnesis , physical examination and interpret data from urinalysis in urinary system disorders

: Student can do structured anamnesis, physical examination and make a right interpretation from urynalisis in lower urinary tract disorders

: 1.

2.

3.

Anamnesis skill

Physical examination skill

Skill in clinical procedure or interprate data from laboratory finding and/or imaging to make a diagnosis or

4.

5.

6.

7. diferensial diagnosis

Making diagnosis and diferential diagnosis

Management


Profesional behaviour

: Clinical scenario:

A-25-year old man come to the primary health care service with pain during urination.


Task:

1.

2.

3.


Ask the facilitator if you need laboratory examination or imaging!

Make a diagnosis from all data that you have collected!



Lembar Check List

Aspek yang dinilai

0

Anamnesis Mahasiswa tidak melakukan anamnesis

Pemeriksaa n fisik

Melakukan interpretasi urinalysis


Mahasiswa tidak mampu menginterpretasi dengan benar hasil pemeriksaan urinalysis

-

1



2


7 dan fundamental


Mahasiswa melakukan cuci tangan sebelum dan setelah kontak dengan pasien dan mahasiswa melakukan dengan tidak lengkap pemeriksaan fisikberikut:

1. Vital sign

2. Pemeriksa an bladder

-

3


Basic 7 dan fundamental 4 dengan lengkap.

Mahasiswa melakukan cuci tangan sebelum dan setelah kontak dengan pasien dan mahasiswa melakukan dengan lengkap pemeriksaan fisikberikut:

1. Vital sign

2. Pemeriksa an bladder

Mahasiswa mampu menginterpretasi dengan benar hasil pemeriksaan urinalysis

Bob ot

3

3

3

Sko r

Menentuka n diagnosis

Komunikasi edukasi pasien dan perilaku profesional



1. mengucap

2. kan salam, perkenala n

Melakuka n kontak

3. mata dengan pasien dan berempati menjelasa kan dan

4. meminta ijin untuk melakuka n perasat, memperha tikan kenyaman an pasien


4.


1. mengucapk

2. an salam, perkenalan

Melakukan kontak mata dengan

3. pasien dan berempati menjelasak an dan meminta ijin untuk melakukan perasat, memperhati kan kenyamana n pasien



1. mengucap

2.

3.


Melakuka n kontak mata dengan pasien dan berempati menjelasa kan dan meminta ijin untuk melakuka n perasat, memperha tikan kenyaman an pasien

Mahasiswa membuat diagnosis dengan benar dan bisa membuat diferensial diagnosis yang benar


1. mengucap

2.

3.


Melakuka n kontak mata dengan pasien dan berempati menjelasa kan dan meminta ijin untuk melakuka n perasat, memperha tikan kenyaman an pasien

Total


Imaging in Urinary System Disorders

1

1



Learning task 1

Title

Objective

Competency

(bold letter)


: Anamnesis , physical examination and interpret data from abdominal

X-ray (BOF/BNO) in urinary system disorders.

: Student can do structured anamnesis, physical examination and make a right interpretation from BOF/BNO in urinary tract disorders


2. Physical examination skill

3. Skill in clinical procedure or interprate data from laboratory finding and/or imaging to make a diagnosis or

4. diferensial diagnosis


5.

6.

Management


7. Profesional behaviour


A 40 years-old male patient has been getting colicky pain since 2 hours.


Task:

1.

2.

3.


Ask the facilitator if you need laboratory examination or imaging!





Aspek yang dinilai

0


Pemeriksaan fisik



Mahasiswa tidak mampu menginterpretasi

-

1



2 3

Mahasiswa melakukan anamnesis, menanyakan Basic 7 dan fundamental 4 tapi tidak lengkap.


1.

2.

Vital sign

Pemeriksaan palpasi ginjal dan bladder

-




1.

2.

Vital sign

Pemeriksaan palpasi ginjal dan bladder

Mahasiswa mampu menginterpretasi dengan benar foto X-

Ray abdomen (BOF)

Bob ot

3

Skor

3

3

Menentukan diagnosis


Total



1. menguc apkan salam, perkenal an

2. Melakuk an kontak mata dengan pasien dan

3.

4. beremp ati menjela sakan dan meminta ijin untuk melakuk an perasat, memper hatikan kenyam anan pasien



1. mengucap kan

2. salam, perkenala n

Melakuka

3.

4. n kontak mata dengan pasien dan berempati menjelasa kan dan meminta ijin untuk melakuka n perasat, memperha tikan kenyaman an pasien


Mahasiswa melakukan

2-3 dari hal berikut:

1. mengucapkan

2. salam, perkenalan

Melakukan kontak mata dengan pasien dan

3.

4. berempati menjelasakan dan meminta ijin untuk melakukan perasat, memperhatik an kenyamanan pasien



1. mengucapkan

2. salam, perkenalan

Melakukan kontak mata dengan pasien dan berempati

3.

4. menjelasakan dan meminta ijin untuk melakukan perasat, memperhatikan kenyamanan pasien


1

1



Learning task 2

Title

Objective

Competency

(bold letter)


: Anamnesis , physical examination and interpret data from abdominal

X-ray (BOF/BNO) in urinary system disorders.

: Student can do structured anamnesis, physical examination and make a right interpretation from BOF/BNO in urinary tract disorders


2. Physical examination skill

3. Skill in clinical procedure or interprate data from laboratory finding and/or imaging to make a diagnosis or

4.

5.

6.

7. diferensial diagnosis


Management


Profesional behaviour


A 30 years-old male patient has been suffering from tenderness, urgency and interruption during urination since 5 months.


Task:

1.

2.

Do the anamnesis and physical examination

Ask the facilitator if you need laboratory examination or

3. imaging!





Aspek yang dinilai

0


Pemeriksaa n fisik



Mahasiswa tidak mampu menginterpretasi

1



-

2 3


7 dan fundamental



1. Vital sign

2. Pemeriksa an palpasi ginjal dan bladder

-




1. Vital sign

2. Pemeriksa an palpasi ginjal dan bladder

Mahasiswa mampu menginterpretasi dengan benar foto

X-Ray abdomen

(BOF)

3

3

3

Bobot Skor

Menentuka n diagnosis


Total



1. mengucapk an salam,

2. perkenalan


3.

4. berempati menjelasak an dan meminta ijin untuk melakukan perasat, memperhati kan kenyamana n pasien



1. mengucap kan salam,

2. perkenala n


3. pasien dan berempati menjelasa kan dan meminta ijin untuk

4. melakukan perasat, memperha tikan kenyaman an pasien




2. perkenala n


3. pasien dan berempati menjelasa kan dan meminta ijin untuk

4. melakukan perasat, memperha tikan kenyaman an pasien




2. perkenalan


3.

4. berempati menjelasak an dan meminta ijin untuk melakukan perasat, memperhat ikan kenyaman an pasien


1

1



Collection and Interpretation of Culture and Susceptibility Test from Urine Specimen

Learning Task

Case 1

A 26-year-old woman had performed complete laboratory examination including examination of urine culture. Sometimes she complained dysuria. she is an employee of one of the famous Bank in Bali. Her job required her sitting behind a desk in long period of time. On microscopic examination of urine sediment was found 1-5 leukocytes / LPB, Gram negative rod bacteria. Culture examination found Escherichia coli 1000 CFU / ml.

Question:

1. Explain how the urine specimen collection techniques in patient above?

2. Explain how the techniques of storage and transportation of urine specimens?

3. Describe the stages of microbiological examination of urine specimens?

4. How the interpretation of the results obtained by microbiological examination?

5. Explain whether the patient requires antibiotic therapy?

Case 2

A 61 years old male patient, complained of pain in the lower abdomen. On physical examination found tenderness in the suprapubic and urethral catheter inserted. He also has been suffering from prostate enlargement and is currently on treatment. Urine specimen was collected in the emergency room for complete examination and urine culture. On microscopic examination of urine sediment found 10-15 leukocytes / LPB, Gram negative rod bacteria.

Culture examination found Pseudomonas aeruginosa 100.000 CFU / ml.

Questions:

1. Mention the bacteria that cause urinary tract infection based on clinical presentation?

2. Explain whether Pseudomonas aeruginosa in this case is the microorganisms that cause urinary tract infections?

3.

4.

Explain how the specimen collection techniques in the above case?

Explain whether the patient requires antibiotic therapy?

Circumcision

Introduksi a. Definisi

Tindakan pembuangan dari sebagian atau seluruh prepusium penis dengan tujuan tertentu. b. Ruang lingkup



Fimosis merupakan suatu keadaan dimana prepusium tidak dapat ditarik ke belakang

(proksimal) atau membuka, dan lubang pada ujung prepusium yang kecil sehingga urin sulit keluar. Maka dari itu fimosis perlu dilakukan tindakan sirkumsisi.



Parafimosis merupakan suatu keadaan di mana preputium tidak dapat ditarik ke depan (distal) atau menutup. Glands penis terjepit oleh preputium yang membengkak. Sebelum tindakan sirkumsisi terlebih dahulu dilakukan reduksi, bila gagal dilakukan sirkumsisi.



Kebudayaan yang melakukan sirkumsisi untuk alasan kesehatan, tanda peralihan menuju kedewasaan, sebagai tanda identitas budaya.


Study Guide The Urinary System and Disorder Block c. Indikasi operasi



Agama & kebudayaan



Medik

– Phimosis

– Paraphimosis

– Perlekatan preputium dan gland d. Kontra indikasi operasi:



Hipospadia



Chordae tanpa hipospadia



Striktur urethra

Teknik operasi



Teknik guillotine



Teknik konvensional

Persiapan



Persiapan operator : o Operator memakai pakaian kamar bedah o Mengenakan topi dan masker o Mencuci tangan dengan antiseptik, seperti savlon, hibiscrub, dan sebagainya o Mengenakan sarung tangan steril.



Persiapan pasien : o Rambut di sekitar penis (pubis) dicukur dan dibersihkan dengan air sabun o Pada pasien anak dilakukan pendekatan agar anak tidak cemas dan gelisah o Periksa apakah pasien mempunyai riwayat alergi terhadap obat, penyakit terdahulu atau hal-hal lain yang dianggap perlu.



Persiapan peralatan : o Sirkumsisi set o Spuit 10 cc & needle 21G o Jarum jahit jaringan & Catgut plain o Duk steril o Obat anestesi local (lidokain, prokain, bupivakain) o Povidon Iodine o Kasa steril o Plester o Handscoen

Teknik guillotine :



Persiapan operator, pasien, dan alat.



Tindakan asepsis & drapping duk steril berlubang



Tindakan Anestesi



Bersihkan daerah dalam gland penis dan melepaskan perlekatan prepusium



Prepusium dijepit pada arah jam 6 dan 12. Pada cara ini sebaiknya perlekatan preputium telah dilepaskan agar didapatkan hasil yang baik



Klem melintang dipasang pada prepusium secara melintang dari sumbu panjang penis. Arah klem miring dengan melebihkan bagian yang sejajar frenulum. Yakinkan bahwa glans penis tidak terjepit



Prepusium di bagian proksimal atau distal dari klem melintang di insisi. Insisi dapat dilakukan di sebelah luar klem (distal klem, cara ini yang banyak dipakai, mudah), atau disebelah dalam klem



Perdarahan yang terjadi dirawat dengan klem dan ligasi



Penjahitan frenulum-kulit. Digunakan arah jahitan benbentuk angka 8



Penjahitan mukosa-kulit di sekeliling penis. Jumlah jahitan disesuaikan dengan kondisi.



Teknik Konvensional :



Persiapan operator, pasien, dan alat.



Tindakan asepsis & drapping duk steril berlubang



Tindakan Anestesi



Membuka preputium perlahan-lahan dan bersihkan penis dari smegma menggunakan kasa betadin sampai corona glandis terlihat



Kembalikan preputium pada posisi semula



Klem preputium pada jam 11, 1 dan jam 6



Gunting preputium pada jam 12 sampai corona gland



Lakukan jahit kendali mukosa

– kulit pada jam 12



Gunting preputium secara melingkar kanan dan kiri dengan menyisakan frenulum pada klem jam 6



Observasi perdarahan (bila ada perdarahan, klem arteri/vena, ligasi dengan jahitan melingkar)



Jahit angka 8 pada frenulum.



Lakukan pemotongan frenulum di distal jahitan



Kontrol luka dan jahitan, oleskan salep antibiotik di sekeliling luka jahitan



Balut luka dengan kasa steril



Buka duk dan handscoen, cek alat dan rapikan kembali semua peralatan



Pemberian obat dan edukasi pasien



Smstr

10

9

8

7

6

5

4

3

2

1

~ CURRICULUM MAP ~

Program or curriculum blocks

Senior Clerkship

Senior Clerkship

Senior clerkship

Medical

Emergency

(3 weeks)

BCS (1 weeks)

The Respiratory

System and

Disorders

(4 weeks)

BCS (1 weeks)

Elective Study II

(1 weeks)

Special Topic:

-Travel medicine

(2 weeks)

The Cardiovascular

System and

Disorders

(4 weeks)

BCS (1 weeks)

Alimentary

& hepato- biliary systems

& disorders

(4 Weeks)

BCS (1 weeks)

Elective Study III

(6 weeks)

The Urinary System and Disorders

(3 weeks)

BCS (1 weeks)

The Endocrine

System, Metabolism and Disorders

(4 weeks)

BCS (1 weeks)

Clinic Orientation

(Clerkship)

(6 weeks)

Musculoskeletal Neuroscience system & connective and neurological tissue disorders

(4 weeks)

BCS (1 weeks) disorders

(4 weeks)

BCS (1 weeks)

Hematologic system & disorders & clinical oncology

(4 weeks)

BCS (1 weeks)

Immune system & disorders

(2 weeks)

BCS(1 weeks)

Medical

Professionalism

(2 weeks)

BCS (1 weeks)

Studium

Generale and

Humaniora

(3 weeks)

Evidence-based

Medical Practice

(2 weeks)

Medical communication

(3 weeks)

BCS (1 weeks)

Behavior Change and disorders

(4 weeks)

BCS(1 weeks)

Infection

& infectious diseases

(5 weeks)

BCS (1 weeks)

Health System-based

Practice

(3 weeks)

BCS (1 weeks)

The cell as bioche- mical machinery

(3 weeks)

BCS(1 weeks)

Growth

& development

(4 weeks)

BCS: (1 weeks)

Pendidikan Pancasila & Kewarganegaraan (3 weeks)

The Reproductive

System and Disorders

(3 weeks)

BCS (1 weeks)

Clinical Nutrition and

Disorders

(2 weeks)

BCS (1 weeks)

Special Topic :

- Palliative medicine

-Compleme ntary &

Alternative

Medicine

- Forensic

(3 weeks)

The Visual system & disorders

(2 weeks)

BCS

(1 weeks)

The skin & hearing system

& disorders

(3 weeks)

BCS(1 weeks)

Community-based practice

(4 weeks)

Special Topic

- - Ergonomi

- - Geriatri

(2 weeks)

Elective

Study II

(1 weeks)

Elective

Study I

(2 weeks)





REFERENCES

1.

2.

3.

4.

5.

Moore KL, Agur AMR: Essential Clinical Anatomy , 2 nd ed. Philadelphia, Lippincott

Williams & Wilkins, 2002.

Gartner LP, Hiatt JL. Color Textbook of Histology, International edition. Elsevier. 2007

Fawcett DW, Jenish RP : Bloom and Fawcett’s Concise Histology , 2nd ed. London,

Arnold, 2002.

Guyton A. C and Jhon E. Hall: Textbook of Medical Physiology , 10 th ed. Philadelpia,

WB Saunders Company, 2000

Silverthorn DU. Human Physiology an integrated approach, 2 nd edition, Prentice Hall.

2001

6.

7.

8.

Mitchell RN, Kumar V, Abbas K, Fausto N. Robbins & Cotran, Pathologic Basis of

Disease, 8 th edition. New York. , W.B. Sounders Company, 2010

Fischbach FT, Dunning MB: A Manual of Laboratory and Diagnostic Tests, 7 th ed.

Philadelphia, Lippincott Williams & Wilkins, 2004.

Behrman RE, Kliegman RM, Jenson HB: Nelson Textbook of Pediatrics , 17 th ed. New

York, W.B. Sounders Company, 2004

Macfarlane MT, et al. : Urology , 4 th ed. Lippincott Williams & Wilkins, 2006 9.

10. Friedman AL. Nephrology: Fluids and electrolytes. In: Behrman RE, Kliegman RM, editors. Nelson Essentials of pediatrics. 4th edition. Philadelphia: WB Saunders Co,

2001.

11. Davis ID, Avner ED. Nephrology. In: Behrman RE, Kliegman RM, Jenson HB, editors.

Nelson textbook of pediatrics. 17th edition Philadelphia: WB Saunders Co, 2004.

12. Smiths general Urology, 17th ed, 2008



INTRODUCTION

The curriculum block on Urinary System and Disorder is developed collectively by the academic staff from various departments: Anatomy, Histology, Physiology, Pharmacology,

Pathology, Clinical Pathology, Nephrology, Urology, and Pediatric.

The number of Urinary System credits is three. This book consists of general information on the learning schedule, block members, facilitatorsilitators, and the core curriculum, such as learning outcomes, learning situation, learning task and self-evaluation.

Lecture is only given to emphasize crucial things or objectives of material and to guide the students before discussion. During discussion, students also have to evaluate their learning progress independently (self evaluation). For difficult concepts in discussion and self evaluation, the students are also being asked to discuss several example of scenario. More than half of the learning material should be learned independently and in small group discussion.

Curriculum content, study load and teaching-learning are specified in curriculum and study guide, student assessment is carried out mainly by objective test at the end of theme course, and the minimum passing level is set at 70 (70%). A remedial is provided for those who failed, and later they have to re-sit a second summative test.

Since the integrated curriculum at Facilitatorsulty of Medicine Udayana University is still in progress, this guide book will also still have some changes in the future. Regarding that, we invite readers to give any positive comments for its development.

Planners i



CONTENTS

Introduction ……………………………………………………………………………………………………………..………………. i

Table of contents …………………………………………………………………………………………………….. ………………. ii

Curriculum Block Urinary System and Disorders…………………………….................................…………… 1

Planners Team …………………………………………………………………………………………………………..……………... 2

Lecturers ………………………………………………………………………….……………............................................. 2

Facilitators …………………………………………………………………………………………………………………... ………….. 3

Time Table Regular Class …………………………………………………………………………………………….………..…… 4

Time Table English Class …………………………………………………………………………………………….………..……. 8

Student Project ……………………………………………………………………………………………………………………….. 12

Assessment Method …………………………………………………………………………………………………………………. 13

Learning Program ……………………………………………………………………………………………………..…………..….. 14

1.

Abstract and Learning task of Lectures ………………………………………………………………………… 14

2.

Self assessment …………………………………………………………………………………………………...………. 32

Basic Clinical Skills ………………………………………………………………………………………………………………….. . 36

Curriculum Mapping ………………………………………………………………………………………………………..……….. 50

Block Mapping ………………………………………………………………………………………………………………………….. 51

Reference …………………………………………………………………………………………………………………………..…….. 52 ii


student project

~ CURRICULUM ~

~ PLANNERS TEAM ~

~ FACILITATORS ~

~ TIME TABLE ~

~ STUDENT PROJECT ~

~ ASSESSMENT METHOD ~

~ LEARNING PROGRAMS ~

Lecture 1 - 2:

Macroscopic and Microscopic Structure the

Urinary System

Lecture 3-4:

The Function of Urinary System

Lecture 5:

Pathogenesis of Glomerular and

Tubulo-Interstitial Injury

Lecture 6:

Common Kidney Diseases in Children

(Acute Poststreptococcal Glomerulonephritis and Nephrotic Syndrome), UTI in Children

Lecture 7:

Urinary Tract Infection:

Uncomplicated and Complicated

Lecture 8:

Urinary Calculi (Urolithiasis) and Urethral

Stricture

Lecture 9:

Common Neoplasm in Urinary System:

Renal tumors, bladder tumors.

Lecture 10:

Urinary tract trauma

(Rupture of the kidney and urinary tract)

Lecture 11 & 12:

Acute Kidney Injury & Chronic Kidney

Diseases

Lecture 13:

Renal Hypertension

Lecture 14:

Drug use in renal disorders

Diuretics

Urinary antiseptics

Lecture 15&16

Prostate & Male Penile Disorders

Anamnesis and Physical Examination in Urinary System and Male Genital

System Disorders

Check List

Urethral Catheterization

Lembar Check List

Smstr

~ CURRICULUM MAP ~

Program or curriculum blocks

REFERENCES

INTRODUCTION

CONTENTS

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