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Dysuria in Children

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641. Prostatic Carcinoma

disease: Haematuria, dysuria, incontinence. Haematospermia. Perineal and suprapubic pain. Obstruction of ureters, causing loin pain, anuria, symptoms of acute kidney injury or chronic kidney disease. Impotence. Rectal symptoms - eg, tenesmus. Metastatic disease: Bone pain or sciatica. Paraplegia secondary to spinal cord compression. Lymph node enlargement. Loin pain or anuria due to ureteric obstruction by lymph nodes. Lethargy (anaemia, uraemia). Weight loss, cachexia. Signs Advanced disease: general (...) 2016 ; NICE Technology Appraisal Guidance, July 2014 ; NICE Interventional Procedure Guidance, March 2005 ; Androgen deprivation treatment in prostate cancer. BMJ. 2013 Jan 8346:e8555. doi: 10.1136/bmj.e8555. I am Mohammad Asaduzzaman, age: 45+ years from Bangladesh. I am married and I have two kids whose are 11 & 8 years old. I am patient of prostate cancer which was found in August 2016. Then my PSA (... Asadlipton Health Tools Feeling unwell? Assess your symptoms online with our free symptom

2008 Mentor

642. Sexually Transmitted Disease

, it is important to look at the various ways by which the diseases may be spread. Not all such diseases are always spread by sexual activity. Transmission of infection can occur, for example, by intravenous drug abuse. Some diseases can be vertically transmitted from mother to child. The pool of undiagnosed disease in a population is also an important problem. Such people can spread infection unwittingly. The number of people carrying undiagnosed infection varies according to the disease concerned. In many (...) over the age of 25 with no change of partner. Men Urethral discharge and/or dysuria usually indicate an STI. Ideally, a diagnosis of urethritis needs to be made for which microscopy of a Gram-stained slide is required. See separate article. Tests for gonorrhoea and chlamydia are recommended. Men with testicular swelling or discomfort should have STI excluded. The most common cause of these symptoms in men aged under 40 is C. trachomatis . A midstream specimen of urine (MSU) is also advisable

2008 Mentor

643. Sexual History Taking Full Text available with Trip Pro

employees should adhere to the Caldicott principles for confidentiality and the General Medical Council (GMC) has specific guidance. [ ] The duty of confidentiality can only be broken in exceptional circumstances when it is in the patient's or public's interest - for example, certain child protection cases. Duty of confidentiality should be explained to the patient verbally but also reflected in patient literature, posters, etc. In specialist clinics for treatment of STIs, legislation protects (...) : Change in vaginal discharge. Vulval skin problems. Lower abdominal pain. Dysuria. Changes in menstrual cycle or irregular bleeding. In men: Urethral discharge. Dysuria. Genital skin problems. Testicular swellings or discomfort. Peri-anal/anal symptoms. Partners Establish if the person is sexually active Sexual history should cover all partners within the preceding three months. If no partners are reported during this time then the last time the patient was sexually active should be noted

2008 Mentor

644. Schistosomiasis

circulation. Presentation [ ] Infection can be acute or chronic. Physical findings vary with the stage of illness, worm burden, worm location and the organs involved. Schistosomiasis is associated with anaemia, chronic pain, diarrhoea, exercise intolerance and malnutrition. [ ] Acute syndrome (Katayama syndrome) The acute reaction is due to the sudden release of highly antigenic eggs. The most common acute syndrome is Katayama fever. It usually occurs in children or young adults with no past exposure (...) of egg production in the mesentery or bladder wall, the extent of damage to liver or spleen, the degree of lung involvement, and possibly other sites including the central nervous system (CNS). Symptoms Bloody diarrhoea, abdominal pain, right upper quadrant pain, cramps, haematemesis, which can occur from oesophageal varices with portal hypertension. Haematuria, dysuria: The first feature may be frequency of micturition. Initially, haematuria is only terminal but, as it becomes more severe, the blood

2008 Mentor

645. Right Upper Quadrant Pain

features of Fitz-Hugh-Curtis Syndrome in the emergency department. Yonsei Med J. 2012 Jul 153(4):753-8. doi: 10.3349/ymj.2012.53.4.753. ; Abdominal pain and swelling as an initial presentation of spinal tuberculosis. BMJ Case Rep. 2014 Feb 192014. pii: bcr2013202550. doi: 10.1136/bcr-2013-202550. ; Acute Abdominal Pain in Children. Pediatr Gastroenterol Hepatol Nutr. 2013 Dec16(4):219-224. Epub 2013 Dec 31. ; Guideline for the diagnostic pathway in patients with acute abdominal pain. Dig Surg. 201532(1 (...) such as pyrexia, cough or dysuria. Discuss: Appetite. Any change in weight. Bowels. Urine. Smoking and drinking. Medication - prescribed and over the counter. Family and social history may be helpful. Signs Note the general condition of the patient - ie whether they are fairly well, shocked, pyrexial or dyspnoeic. Note whether there is jaundice. Note temperature, pulse rate and quality, and blood pressure. The patient should be adequately disrobed and both the patient and the examiner should

2008 Mentor

646. Postpartum Haemorrhage

is defined as abnormal bleeding from the genital tract, from 24 hours after delivery until six weeks postpartum. Shah Jehan built the Taj Mahal in memory of his third wife, Mumtaz Mahal, who died giving birth to her fourteenth child, apparently of a PPH, in 1631. Primary postpartum haemorrhage Aetiology The causes of PPH have been described as the "four T's": T one: uterine atony, distended bladder. T rauma: lacerations of the uterus, cervix, or vagina. T issue: or clots. T hrombin: pre-existing (...) and general anaesthetic. Retained products of conception (RPOC). Assessment History Symptoms vary but may include: Fever. Abdominal pain. Offensive smelling lochia. Abnormal vaginal bleeding - postpartum haemorrhage. Abnormal vaginal discharge. Dyspareunia. Dysuria. General malaise. Look for history of extended labour, difficult third stage, ragged placenta, PPH. Examination There may be: Fever. Rigors. Tachycardia. Tenderness of the suprapubic area and adnexae. Elevated fundus which feels boggy in RPOC

2008 Mentor

647. Lumps in the Groin and Scrotum

) ; The Royal Childrens Hospital Melbourne, January 2013 ; NICE CKS, February 2010 (UK access only) ; Isolated tuberculous epididymitis: a review of forty cases. J Postgrad Med. 2005 Apr-Jun51(2):109-11, discussion 111. ; Inguinal hernias. BMJ. 2008 Feb 2336(7638):269-72. ; Inguinal hernia in female infants: a cue to check the sex chromosomes? BJU Int. 2005 Aug96(3):401-3. ; Assessment and management of inguinal hernia in infants. Pediatrics. 2012 Oct130(4):768-73. doi: 10.1542/peds.2012-2008. Epub 2012 Sep (...) , , . Nontender nodes. Femoral hernia. . Vascular: . (varicosity of saphenous vein at the junction with the femoral vein). Scrotal lumps [ ] Painful lumps: . Torsion of a testicular or epididymal appendage. . . Haematocele/haematoma. Painless lumps: Inguinal hernia (may sometimes be painful). . . Spermatocele (feels similar to epididymal cyst but is filled with semen). . . Skin swellings (as for groin lumps). Less common causes of scrotal swelling include: Idiopathic scrotal oedema (mainly children

2008 Mentor

648. Lower Urinary Tract Symptoms (LUTS) in Women

on research evidence, UK and European Guidelines. You may find the article more useful, or one of our other . In this article In This Article Lower Urinary Tract Symptoms in Women In this article Lower urinary tract symptoms (LUTS) are the name given to a group of symptoms including dysuria and incontinence. The term was first coined in the 1990s to describe symptoms in men which had previously been known as prostatitis, to aid recognition that these symptoms were not always attributable to prostate (...) recommend making a specific diagnosis when possible and treating any underlying cause. [ ] However, some urologists also urge doctors not to over-investigate women and to offer appropriate reassurance if there is no reason to suspect serious underlying disease. [ ] In 2002, the International Continence Society divided LUTS into three categories: [ ] Storage symptoms: eg, frequency, urgency, dysuria, nocturia, stress incontinence, urge incontinence. Voiding symptoms: eg, poor stream, hesitancy, terminal

2008 Mentor

649. Interstitial Cystitis

reluctant to seek treatment [ ] . More recently, the prevalence of the condition has increased to at least 2% among females, due to broader and more inclusive diagnostic criteria [ ] . The average age at diagnosis is 40 years [ ] . However, around 35% of patients actually have symptoms that started in childhood [ ] . This condition can occur in children. Aetiology This condition has a multi-factorial aetiology including epithelial dysfunction, subclinical infection, mast cell and vascular abnormalities (...) sensitivity as well as affective and sensory aspects of interstitial cystitis [ ] . Presentation Symptoms vary widely in severity and nature but the onset of symptoms is often acute and may be sudden. Recurrent symptoms similar to urinary tract infections (urgency, frequency, dysuria), lower abdominal pain, pressure in the bladder and/or pelvis, and dyspareunia. Characteristics of the pain include: Pain, pressure or discomfort perceived to be related to the bladder, increasing with increasing bladder

2008 Mentor

650. Lichen Sclerosus

and to monitor response. Is essential if lesions do not respond to adequate treatment. Swabs are not required routinely but may be necessary in cases where there is erosive disease to exclude infection such as or . Blood tests: Consider autoimmunity screen and if symptoms are present. There is no evidence to support testing for autoantibodies without a clinical indication. Differential diagnosis In children, signs may mimic those of child sexual abuse. Note that a diagnosis of LS does not automatically (...) . ; Lichen sclerosus: epidemiological distribution in an equal access health care system. J Urol. 2011 Feb185(2):522-5. doi: 10.1016/j.juro.2010.09.107. Epub 2010 Dec 18. ; British Association of Dermatologists' guidelines for the management of lichen sclerosus 2010. Br J Dermatol. 2010 Oct163(4):672-82. doi: 10.1111/j.1365-2133.2010.09997.x. ; Balanitis xerotica obliterans in children and adolescents: a literature review and clinical series. J Pediatr Urol. 2014 Feb10(1):34-9. doi: 10.1016/j.jpurol

2008 Mentor

651. Stevens-Johnson Syndrome

and Israel. J Am Acad Dermatol. 2008 Jan58(1):25-32. Epub 2007 Oct 24. ; Medications as risk factors of Stevens-Johnson syndrome and toxic epidermal necrolysis in children: a pooled analysis. Pediatrics. 2009 Feb123(2):e297-304. doi: 10.1542/peds.2008-1923. Epub 2009 Jan 19. ; Stevens-Johnson syndrome and toxic epidermal necrolysis. Chem Immunol Allergy. 201297:149-66. Epub 2012 May 3. ; Acute skin failure. BMJ. 2012 Aug 6345:e5028. doi: 10.1136/bmj.e5028. ; ALDEN, an algorithm for assessment of drug (...) are aged 10-30 but cases have been reported in children as young as 3 months. Risk factors The rarity of the disease has made it difficult to clearly ascertain specific risk factors among heterogeneous populations; however, the presence of particular HLA alleles has been found to be associated with SJS/TEN among particular groups - for example: HLA B1502 and HLA B1508 among the Han Chinese have been found to be associated with SJS/TEN in reaction to carbamazepine and allopurinol respectively. HLAb 5701

2008 Mentor

652. Chlamydial Genital Infection Full Text available with Trip Pro

of exploitation. Where this is the case, seek expert paediatric advice and follow local child protection procedures. Referral [ ] Consider seeking expert advice by referral to a GUM clinic in the following situations: All cases where chlamydia is confirmed where aspects of management cannot be managed according to national standards within primary care (eg, screening for other STIs, partner notification). Pregnancy (urgent if pelvic pain). PID (urgent referral in acute PID). Intolerance of treatment (...) iners ) was associated with an increased risk for chlamydia infection. Presentation Symptoms In most cases the infection is asymptomatic and is often only detected during screening or investigation of other genitourinary illness. Female If women are symptomatic they may describe: Vaginal discharge. Dysuria (always consider chlamydia as a cause of sterile pyuria). Vague lower abdominal pain. Fever. Intermenstrual or postcoital bleeding. Deep dyspareunia. Male Men tend to have either classical

2008 Mentor

653. Drug Eruptions

be found in the Medscape link under 'Further reading & references', below. Potentially fatal drug eruptions Most drug eruptions are unpleasant rather than potentially life-threatening. There are two that are worthy of special mention. Stevens-Johnson syndrome See related separate article . [ ] This is a much more serious drug eruption. It may be the result of malignancy in adults or viral infection in children but drugs should be considered as the potential culprit. It may be associated (...) of hands and extensor surfaces. The rash may be confined to any one area of the body, most often the trunk. There is no pruritus. Mouth involvement may be severe enough that patients may not be able to eat or drink. Genitourinary involvement result in dysuria or an inability to pass urine. The rash can begin as macules that develop into papules, vesicles, bullae, urticarial plaques, or confluent erythema. The typical lesion has the appearance of a target, which is considered pathognomonic. As stated

2008 Mentor

654. Balanitis

); a benign, idiopathic condition presenting as a solitary, smooth, shiny, red-orange plaque of the glans and prepuce of a middle-aged to older man. Queyrat's erythroplasia (penile Bowen's disease - carcinoma in situ). [ ] Psoriasis. Lichen planus. Leukoplakia. Seborrhoeic dermatitis. Pemphigus. Pemphigoid. Miscellaneous Irritation or contact dermatitis: wet nappies, poor hygiene, smegma, soap, condoms. Trauma: zippers, accidental or inappropriate foreskin retraction by a child/parent. Stevens-Johnson (...) syndrome. Severe oedema due to right heart failure. Morbid obesity. Presentation Sore, inflamed and swollen glans/foreskin. Non-retractile foreskin/phimosis. Penile ulceration. Penile plaques. Satellite lesions. May be purulent and/or foul-smelling discharge (most common with streptococcal/anaerobic infection). Dysuria. Interference with urinary flow in severe cases. Obscuration of glans/external urethral meatus. Impotence or pain during coitus. Regional lymphadenopathy. Investigations Blood/urine

2008 Mentor

655. Acute Nephritis and Nephrosis

. This disease generally involves the tubules and/or the interstitium of the kidney and spares the glomeruli. When inflammation affects the area of the kidney between the nephrons (the renal interstitium) it is known as interstitial nephritis, or sometimes tubulo-interstitial nephritis. Renal disease can present in a number of different ways, including as: Nephritic syndrome (nephritis). Nephrotic syndrome (nephrosis). Acute kidney injury. Chronic kidney disease. Hypertension. Renal pain and dysuria (...) ). Hypertension. Uraemic symptoms (including anorexia, pruritus, lethargy, nausea). Deteriorating renal function. Aetiology Post-infection with nephritogenic strains of Group A beta-haemolytic streptococcus (typically occurs in children). Any of the other causes of glomerulonephritis: Other bacterial infections - eg, typhoid, secondary syphilis, meticillin-resistant Staphylococcus aureus (MRSA) infection, pneumococcal pneumonia, infective endocarditis. Viral infections - eg, hepatitis B, mumps, measles

2008 Mentor

656. Antenatal Infections and their Consequences

or bleeding. Severe disease - eg, dense rash. Significant immunosuppression, including systemic corticosteroids in the previous three months. Cytomegalovirus [ ] is a common viral infection, which is usually mild or asymptomatic in healthy individuals. It may cause a febrile illness or have complications. Congenital CMV is the most common congenitally acquired infection in infants. It is the leading infectious cause of congenital malformation and non-genetic sensorineural hearing loss in children. CMV can (...) . These include: Thorough hand washing after nappy changing, feeding a child or wiping their face or handling children's toys. Not sharing food or utensils with a young child. Avoiding kissing a child on or near the mouth. Parvovirus B19 [ ] is a common virus with an estimated 50-60% of adults having been infected. Infection with parvovirus B19 has a number of manifestations including: Minor febrile illness. Erythema infectiosum (slapped cheek disease, fifth disease). Generalised rash similar to rubella

2008 Mentor

657. Vaginal Discharge

or clear, non-offensive discharge that varies with the menstrual cycle. [ ] Causes of vaginal discharge Non-infective Physiological: Newborn infants may have a small amount of vaginal discharge, sometimes mixed in with a little blood, due to high levels of circulating maternal oestrogen. This should disappear by 2 weeks of age. During the reproductive years the fluctuating levels of oestrogen and progesterone throughout the menstrual cycle affect the quality and quantity of cervical mucus which (...) about 75% of women at some point during their reproductive life. 40-50% have two or more episodes and 10-20% may harbour Candida spp. asymptomatically at any one time. [ ] Assessment A full clinical and sexual history should be sought (see also the separate article ). Take particular note of the nature of the discharge (what has changed, odour, onset, duration, colour, consistency) and associated symptoms (these may include itch, superficial dyspareunia or dysuria, abdominal pain, deep dyspareunia

2008 Mentor

658. Urinary Tract Infection in Adults Full Text available with Trip Pro

asymptomatic and diagnosed only on routine dip testing. The presenting symptoms will vary with the age and sex of the patient and also with the severity and site of the infection but may include: Urinary frequency. Painful frequent passing of only small amounts of urine. Dysuria. Haematuria. Foul-smelling ± cloudy urine. Urgency. Urinary incontinence. Suprapubic or loin pain. Rigors. Pyrexia. Nausea ± vomiting. Acute confusional state - particularly elderly patients. Differential diagnosis The differential (...) has unexplained non‑visible haematuria and either dysuria or a raised white cell count on a blood test. Consider non-urgent referral to exclude bladder cancer in those aged 60 or over with recurrent or persistent unexplained UTI. Management Clinical Editor's notes (August 2017) Dr Hayley Willacy would like to draw your attention to the useful patient information produced this year by Public Health England [ ] . This includes information for your patient on recognising when they have an infection

2008 Mentor Controlled trial quality: predicted high

659. Vulval Lumps and Ulcers

include a GUM clinic or gynaecology or dermatology, based on appearance and suspicions of the examining GP. Sexual abuse See the separate articles and for detailed information. Sexual abuse can occur at any age (including in the elderly) but the problem is particularly well documented in children. If a child presents with a condition that is usually sexually transmitted (such as genital warts or HSV), sexual activity needs to be considered, but it is not the only cause. Evidence of trauma, especially (...) of their anatomy. Is there anything to see? Some women will have made close inspection with a hand mirror whilst others would not contemplate looking down there. Is there dysuria? If so, is there urinary frequency too? There may be no urinary tract infection but it is painful to pass urine through an inflamed area. If she is sexually active, does her partner have any problems? Are there any other current problems such as psoriasis, chickenpox or recent use of antibiotics? Signs Signs are as variable

2008 Mentor

660. Vulval Abnormalities and their Management

include a GUM clinic or gynaecology or dermatology, based on appearance and suspicions of the examining GP. Sexual abuse See the separate articles and for detailed information. Sexual abuse can occur at any age (including in the elderly) but the problem is particularly well documented in children. If a child presents with a condition that is usually sexually transmitted (such as genital warts or HSV), sexual activity needs to be considered, but it is not the only cause. Evidence of trauma, especially (...) of their anatomy. Is there anything to see? Some women will have made close inspection with a hand mirror whilst others would not contemplate looking down there. Is there dysuria? If so, is there urinary frequency too? There may be no urinary tract infection but it is painful to pass urine through an inflamed area. If she is sexually active, does her partner have any problems? Are there any other current problems such as psoriasis, chickenpox or recent use of antibiotics? Signs Signs are as variable

2008 Mentor

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