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Medical institute methodological recommendations




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MYNISTRY OF EDUCATION AND SCIENCE OF UKRAINE

SUMY STATE UNIVERSITY

MEDICAL INSTITUTE


Methodological recommendations

for practical work

«Nonspecific diseases of kidneys and pararenal space»

by the discipline of «Urology»

(according to conditions of Bolonskiy process)

For the 4th - year students

Of specialty 7.110101 of full time training


Sumy

Production of Sumy State University

2009

Studying edition


Methodological recommendations for practical lesson «Nonspecific diseases of kidneys and pararenal space»

by the discipline «Urology» (according to conditions of Bolonskiy process) for the 5th - year students of specialty 7.110101 of daily form of studying


Editor N.B. Lisogub

Responsible for issue V.D. Shyschuk

Computer version of Sikora V.V.


Signed for printing at 20 .05. 2008,

Format 60х84/16. Paper ofc. Printing ofc.

Ум. друк. арк. Equipment. – Publish. ark.

№ of printed copies 50 pr. Prime cost of publish.

Зам. №

Production of Sumy State University

40007, Sumy, R.-Korsakova str, 2

Certificate about addition of subject of production case to State registration

DK № 3062 from 17.12.2008.

Printed in pressroom of Sumy State University

40007, Sumy, R.-Korsakova str, 2.


Methodological recommendations

for practical lesson

«Nonspecific diseases of kidneys and pararenal space»

by the discipline of «Urology»

(according to conditions of Bolonskiy process)

For the 5th - year students

Of specialty 7.110101 of daily form of studying


Sumy

Production of Sumy State University

2009

Methodological recommendations for practical lesson «Nonspecific diseases of kidneys and pararenal space» by the discipline «Urology» (according to conditions of Bolonskiy process)

/ Author V.V. Sikora. – Sumy: Production of SumSU, 2009. – 24 p.


Chair of orthopedics, traumatology and urgency


^ Place of carrying out: studying room, wards, operating room, dressing ward, cystoscopic and roentgenologic room.

Object – to be able to diagnose nonspecific inflammatory diseases of kidneys and to detect the principles of treatment of patients with these pathologic states. To be able to diagnose, to detect the principles of treatment the patients with pyonephrosis and paranephritis, to know the methods of operative treatment.

^ Professional orientation of students. Acute pyelonephritis is nonspecific infectious-inflammatory injury of kidneys tubular- interstitial tissue. This process has an acute course, it always involves the calyx- pelvis system of kidneys into the pathologic process. Chronic pyelonephritis is chronic nonspecific inflammatory injury of kidneys tubular- interstitial tissue with the obligatory involvement of calyx-pelvis system of kidneys. Pyelonephritis is the most frequent kidney disease. Acute pyelonephritis during pregnancy occurs at 1,5- 2,5% of all pregnant women. Among adults it occurs at 100 sick people of 10 000 of population.

Pyonephrosis is the terminal stage of nonspecific or specific purulent- destructive pyelonephritis. This disease is detected mainly in the age of 30-50 years, it causes lethal issue often.


Basic level of knowledge and skills

  1. Anatomic- physiological features of kidneys and pararenal space.

  2. To know the symptoms of acute pyelonephritis, and also its possible reasons.

  3. Roentgenologic, functional, instrumental, laboratory, endoscopic methods of examination in the diagnostics of kidney pathology.

  4. To know the principles of treatment of various types of acute pyelonephritis (primary, secondary, purulent, pyelonephritis of pregnant women).

  5. To know the symptoms of chronic pyelonephritis, and also its possible principles of preventing.

  6. Roentgenologic, functional, instrumental, endoscopic methods of examination in the diagnostics of pyonephrosis and paranephritis.

  7. Usage of preparations of etiologic, pathogenetic and symptomatic therapy: medicamental and operative.

Program of students self training

  1. To be able to detect the main symptoms syndromes of acute pyelonephritis.

  2. Classification of acute pyelonephritis.

  3. Diagnostics of acute pyelonephritis.

  4. Indications to conservative and operative treatment of acute pyelonephritis.

  5. To be able to diagnose the main symptoms of chronic pyelonephritis.

  6. Classification of chronic pyelonephritis.

  7. Diagnostics of chronic pyelonephritis.

  8. Main principles of treatment of chronic pyelonephritis.

  9. Main symptoms and syndromes of pyonephrosis and paranephritis.

  10. To justify and formulate the clinical diagnosis according to classification.

  11. To hold differential diagnostics with urolithiasis, tumor and polycystic kidney.

  12. Therapy tactics in case of paranephritis and pyonephrosis.


Illustrative material

1. Slides:

1.1 Retrograde ureteropyelography in case of pyelonephritis.

1.2 Schematic illustration of chronic pyelonephritis.

2. Roentgenograms:

2.1 Retrograde ureteropyelogram – pyonephrosis.

2.2 Intravenously urogram – pyonephrosis.

3. Stand image.

3.1 Cystoscopic image – pus excretion from the ureter orifice.

Methodology of practical work execution

Task 1. To justify and formulate the clinical diagnosis.

Student collects complains, anamnesis of disease and life of patient, makes an objective examination, detects the main clinical signs of acute and chronic pyelonephritis, makes the diagnostic program, he formulates the clinical diagnosis.

Questions that student should answer

  1. What symptoms of acute pyelonephritis do you know?

  2. What complications of acute pyelonephritis do you know?

  3. What symptoms of chronic pyelonephritis do you know?

  4. To point constants of the total blood analysis and urine analysis, biochemical blood analysis (blood urea, creatinine).

Task 2. Holding of differential diagnosis.

Student makes differential diagnosis of patient with pyelonephritis based on his complains, anamnesis of disease and life, data of objective examination, laboratory, roentgenelogic and US-examination.

Questions that student should answer

  1. What diseases will you make the differential diagnosis with?

  2. What tactics will you choose depending on type of acute pyelonephritis (primary or secondary) and its stages?

  3. What tactics will you choose in treatment of pyelonephritis of pregnant women?

  4. What tactics will you choose in treatment of chronic pyelonephritis?

Task 3. To formulate clinical diagnosis.

Student collects complains, anamnesis of disease and life of patient, makes an objective examination, detects the main clinical signs of pyonephrosis, makes diagnostic program, he formulates diagnosis.

Questions that student should answer

  1. What is the clinical symptoms of pyonephrosis?

  2. What additional methods of examination are necessary to hold for patient with pyonephrosis?

Task 4. Making a differential diagnosis.

Student makes differential diagnosis of pyonephrosis based on his complains, anamnesis of disease and life, data of objective examination, laboratory, roentgenelogic and US-examination.

Questions that student should answer

  1. What diseases will you make differential diagnosis with?

  2. What tactics will you choose in treatment of pyonephrosis?

Task 5. To justify and formulate clinical diagnosis.

Student collects complains, anamnesis of disease and life of patient, makes an objective examination, detects the main clinical signs of paranephritis, makes diagnostic program, he formulates diagnosis.

Questions that student should answer

  1. What are the clinical symptoms of paranephritis?

  2. Classification of paranephritis.

  3. What volume of diagnostics measures should be made for patient with paranephritis?

Task 6. To make differential diagnosis.

Student makes differential diagnosis of paranephritis based on his complains, anamnesis of disease and life, data of objective examination, laboratory, roentgenelogic and US-examination.

Questions that student should answer

  1. What diseases will you make differential diagnosis with?

  2. What tactics of treatment will you choose for patient with paranephritis?


Situational tasks with the standards of answers


1. Woman was directed to urologic department from the antenatal clinic with the clinical symptoms of acute right pyelonephritis (body temperature was 38,4 C, frequent urination, from the urine analysis: proteins- traces, leucocytes- ½ of field of view.

What measures should be done for diagnostics purpose?

What is possible therapy tactics?

Answer. Chromocystoscopy is necessary. In case of function absence- kidney catheterization must be accomplished.


2. Patient K., 42- years old, was hospitalized urgently with complains on ache in loin at the left, temperature erased up to 39,2 C, trembling, common weakness. During last 6 years he had coral-like nephrolith of the left kidney.

What complication of the basic disease appears at patient?

What extra method of examination should be executed?

Treatment tactics.

Answer. Aggravation of the chronic calculous pyelonephritis (may be, it is complicated by nephritis pertaining to apostema). It is necessary to hold US-examination, review and excretory urography. Operative treatment.


3. Patient K., 67-years old, was hospitalized urgently with complains on ache in loin at the right, temperature erased up to 39C, trembling. From the anamnesis: For 12 years she had coral- like nephrolith of the right kidney. During chromocystoscopy dense pus was exuded from the right orifice. IK on the left at the 4th minute, on the right it appears at the 12th minute.

Objectively: right kidney is enlarge, painful. Pasternackiy’s symptom is positive on the right.

What is the previous diagnosis? Medical treatment?

Answer. Coral – like nephrolith of the right kidney. Right pyonephrosis. Right- side nephrectomia is prescribed to this patient.

4. Patient S., 37-years old visited the urologist at policlinics with complains on ache in loin at the right, that erase while extend of the right leg, body temperature erase up to 39,2 C.

Objectively: Hyperemia, pastose skin, acute pain during palpation at the right lumbar area. At roentgenoscopy of the chest limited mobility of diaphragm.

What is the previous diagnosis? Treatment tactics?

Answer. Acute right- side paranephritis. Patient need to be hospitalized urgently to the urologic department. Operation – lumbotomia at the right, opening and draining pyogenic abscess.


^ Tests

1. For treatment of primary acute pyelonephritis next praparations are used:

A Antibiotics, sulfanilamide, uroseptics, phytodiuretics.

B Sulfanilamide, spasmolytics.

C Antibiotics, uroseptics, hemostatics.

D Antibiotics, spasmolytics, phytodiuretics.

E Sulfanilamide, vitamins therapy, spasmolytics.

^ 2. The reason of pyelonephritis of pregnant women is:

A Violations of feed of women.

B Mechanical pressure of gravid uterus on the ureter, asymptomatic bacteriuria.

C Neurohumoral violations, congenital anomalies.

D Mechanical pressure of gravid uterus on the ureter, neurohumoral violations, asymptomatic bacteriuria.

E Congenital anomalies, asymptomatic bacteriuria.

^ 3. In case of pyelonephritis of pregnant women for the determination of character of urine outflow from kidneys the next method is used:

A Cystoscopy

B Intravenously urograhpy

C Chromocystoscopy

D Radioisotope renography

E Infusion urography

^ 4. In case of disturbance of urine outflow at pyelonephritis of pregnant women next method should be used:

A Kidney catheterization on the side of injury.

B Pyeloscopy.

C Retrograde pyelography.

D Percutaneous pyelostomy.

E Uretrostomy.

^ 5. In case of pyelonephritis of pregnant women the most used preparations are:

A Biseptol, gentamycin, cefazolin, aspirin

B Cefazolin, ampyox, furadonin, monural

C Cefazolin, tetracycline, furadonin

D Gentamycin, tetracycline, nythroxolin

E Biseptol, aspirin, nythroxolin, palin.

^ 6. At acute pyelonephritis in the urine sediment the next substances are founded:

A Bacteria, active leucocytes, bacillus Kochii.

B Cylinders, cubical epithelium, bacteria.

C Mycobacteria and rickettsia of Pravochek.

D Active leucocytes, bacteria, Shterngaimer- Malbin’s cells.

E Shtelvag’s cells, cylindrical epithelium, bacteria.

^ 7. The reasons of secondary acute pyelonephritis are:

A Inadequate treatment of the primary acute pyelonephritis.

B Infectious diseases.

C Iatrogenic damages during diagnostic manipulations.

D Concrements of kidneys and ureters.

E Urinogenic path of infection entry.

^ 8. Dangerous complication of the treatment of acute pyelonephritis is:

A Alkalosis and hyperkalemia

B Hepatorenal insufficiency

C Endotoxic shock

D Hypovolemic shock

E Vegetative- vascular dystonia

9. In case of acute secondary pyelonephritis next measure should be done firstly:

A To increase of antibiotics dose

B To change antibacterial preparations

C To prescribe analgesics, spasmolytics, dry warm and hot bath

D To restore the urine passage

E To prescribe the treatment according to antibioticogram

^ 10. Often differential diagnostics of acute pyelonephritis is done comparing with:

A Leptospirosis and influenza

B Syndrome of Reiter and disease of Ormond

C Acute appendicitis and cholecystitis

D Acute pancreatitis and enterocolitis

E Gastritis and gastric ulcer

^ 11. The most important reason of transition of acute pyelonephritis into chronic one is:

A Pregnancy

B Infection diseases

C Old age of patients

D Diseases of the blood circulation system

E Absence of systematic dispensary care of patients, that had acute pyelonephritis

^ 12. The most informative method for detection of leukocyturia at the chronic pyelonephritis is:

A Probe of Reberg

B Probe of Tareev

C Method of Kakovskiy- Adis

D Probe of Zemnickiy

E Biological probe

13. Detection of latent leukocyturia at chronic pyelonephritis can be executed with help of:

A Test of Govard

B Prednizolon test

C Probe of Folgard

D Test of Rapoport

E Reaction of Ashgaim – Zondek

^ 14. The roentgenologic sign of chronic pyelonephritis is:

A Symptom of Shevasyu

B Symptom of “lion mouth”

C Symptom of “wilted flower”

D Symptom of Hodson

E Elevation of the cupula of diaphragm

15. During arteriography at chronic pyelonephritis the next symptom is detected:

A Symptom of “curtain”

B Symptom of “burnt tree”

C Symptom of “fishing hook”

D Symptom of “snake tongue”

E Symptom of Shtaufer

^ 16. Differential diagnostics of chronic pyelonephritis should be executed in comparison with:

A Nephroptosis and hydronephrosis

B Chronic cholecystitis and pancreatitis

C Disease of Peirony and Ormand

D Disease of Furnie and Marion

E Glomerulonephritis and hypoplasia of kidneys

^ 17. Sanatorium-and-spa treatment of chronic pyelonephritis is more appropriate to hold at:

A Svalyava

B Morshuno

C Truscavec

D Carlovy Vary

E Hmelnyk

18. For stimulation of non-specific immunologic reactivity the next preparations are used:

A Cycloferon

B Methyluracil

C Gonorrheal vaccine

D Para-aminosalicylic acid

E Cyclopenthanperhydrofenantren

^ 19. The treatment of chronic pyelonephritis has to be systematic and it must last for:

A 12 month

B 10 month

C 8 month

D 4 month

E 2 month

20. Chronic pyelonephritis is the reason of:

A Polycystic kidneys and pancreatic diabetes

B Nephroptosis and acute pyelonephritis

C Psoriasis and obesity

D Chronic kidney insufficiency and nephrogenic hypertension

E Glomerulonephritis and priapism

^ 21. The sign of paranephritis at roentgenoscopy of the chest is:

A Elevation of the cupola of diaphragm

B Limited excursion of diaphragm on the side of injury

C Petrifications at lungs

D Pleuritis on the side of injury

E Shift of mediastinum

^ 22. The most often the next type of paranephritis occurs:

A Back

B Frontal

C Upper

D Lower

E Total

23. In case of paranephritis excretory urography is done:

A In the vertical position

B In the horizontal position

C At the inspiration and expiration

D In the horizontal and vertical position

E At inspiration

^ 24. In case of purulent paranephritis the next manipulation is prescribed:

A Massive antibacterial therapy

B Catheterization of kidney and antibacterial therapy

C Nephrostomy antibacterial therapy

D Lumbotomy, opening of the paranephral abscess and its drainage

E Decapsulation of kidney and nephrostomy

^ 25. In case of pyonephrosis the following changes can be detected:

A Decrease of kidney size

B Convexity of the kidney contour and unsharp lumbar muscle

C Erase of kidney size

D Absence of the contour of lumbar muscle

E Erase of kidney size, absence of the contour of lumbar muscle

^ 26. Treatment of apostema pyelonephritis is based on:

A Prescription of the massive antibacterial therapy

B Catheterization of kidney

C Decapsulation and nephrostomy

D Percutaneous pyelostomy

E Place of stent

27. In case of carbuncle of kidney the following changes can be observed at review roentgenogram:

A Convexity of the kidney contour and unsharp lumbar muscle

B Decrease of kidney size

C Lime of kidney

D Convexity of the kidney contour

E Erase of kidney size

^ 28. During diagnostics of kidney carbuncle the following measures are necessary:

A To prescribe massive antibacterial therapy

B To execute planned operation

C To execute urgent operation

D To prescribe disintoxication therapy

E To make catheterization of kidney

^ 29. In case of kidney abscess the operative treatment is based on:

A Decapsulation, incision of abscess, drainage of abscess and paranephrium

B Incision of abscess, drainage of paranephrium

C Decapsulation, drainage of kidney and paranephrium

D Nephrostomy and drainage of paranephrium

E Opening and drainage of abscess

^ 30. The most informative method for confirmation of the diagnosis of kidney carbuncle is:

A Review urography, retrograde pneumopyelogram

B Review, excretory urogram, retrograde pyelogram

C Radioisotopic renography, retrograde pyelography

D Chromocystoscopy, cystography

E Review urogram, radioisotopic renography


31. Boy is 7-years old, he grew up and developed normally till 1 year. At the age of 1 year and 2 month he had dysentery. At the age of 1,5 years leucocytes 40- 50 in the field of view and traces of protein were detected in urine for the first time. After treatment the analysis came to normal and he didn’t complain in the future. Analysis were not repeated. At the age of 4 years he had ARVI with hyperthermia. In the total urine analysis: proteins- 0,66 g/l, leucocytes – in all the field of view. Edema on feet, under eyes appeared, he mentioned headache, weakness, nausea. Skin was pale, muffled heart sounds, systolic sound at the apex of heart. Arterial pressure – 130/80 mm of mercury column. Blood: hemoglobin- 87 g/l, erythrocytes – 2,9 x 1012, leucocytes- 12 x 109, e- o, stab neutrophils – 3, s – 49, l – 37, m – 10, ESR – 50 mm/ hour. Urea – 21,7 mmol/l, creatinine – 240 mmol/l. What is the diagnosis?

A Chronic pyelonephritis, period of exacerbation, AKI (acute kidney insufficiency)

B Acute cystitis

C Malignant tumor of kidneys

D Chronic kidney insufficiency

E Acute pyelonephritis.

32. 4 – year old girl was refered to hospital with complains on periodical temperature erase up to 37,8- 38,7 C during last month. 6 month ago she received treatment for infection of urinary tracts by amoxyl (for 10 days). The same time US- examination of kidneys was executed, it did not show any anomaly of kidney’s development. One month ago on the background of acute bronchitis leucocyturia was detected again. After liquidation of bronchitis clinical symptoms erase of temperature occurs periodically during 2-3 days. What examination is the most informative for detection of leucocyturia genesis?

A Cystoscopy

B Excretory urography

C Mixed cystography

D Dynamic nephroscinigraphy

E Review roentgenography of the organs of abdominal cavity.

^ 33. Point the optimal treatment tactics of the patient with acute right- side obstructive serous pyelonephritis, his ureter is catheterized.

A Conservative treatment with further planned liquidation of obstruction

B Transcutaneus paracentetic nephrostomy with further planned liquidation of obstruction

C Opened operation

D Transuretral vessel dilatation of ureter

E Ureterolythoextraction.

34. 42-years old woman has acute pyelonephritis, that was complicated with bacteriemic shock and acute kidney insufficiency. 2 days ago phase of renewal of diuresis started. What organism’s changes should be prevented firstly during this phase?

A Hyperazotemia

B Hypokaliemia

C Hypoalbuminemia

D Edema syndrome

E Anemia.

35. During 5 days 36-years old patient N. had moderate ache in the left lumbar area and mild pyrexia in the evening, but suddenly body temperature erased up to 39C, unendurable ache in the left lumbar area appeared. During examination the general condition of patient is difficult, consciousness is obscured. Tongue is clear, dry. Stomach is soft, moderately painful during palpation in the left hypogastral area. Symptom of Schetkin – Blumberg is negative. Symptom of Pasternazkiy is sharp positive at the left side, and moderately positive at the right side. At the line of excretory urograms you can see calculus of the bowl- ureter segment. The following diagnosis is formulated: acute pyelonephritis, blocking nephrolith at the left side. What should be the doctor’s tactics?

A Holding the massive antibacterial therapy

B Antibacterial therapy with accounting of sensitivity

C Distant lithotripsy

D Nephrectomy

E Urgent operative intervention: pyelolythotomy, nephrostomy, decapsulation.


Student should know:

  1. Pyelonephritis (etiology, pathogenesis).

  2. Classification of pyelonephritis.

  3. Primary acute pyelonephritis (clinics, diagnostics).

  4. Treatment of primary acute pyelonephritis.

  5. Differential diagnostics of acute pyelonephritis with urolithiasis, tuberculosis of urinary system, acute diseases of abdominal cavity organs.

  6. Secondary acute pyelonephritis.

  7. Treatment of secondary acute pyelonephritis.

  8. Pyelonephritis of pregnant women.

  9. Treatment of pyelonephritis of pregnant women.

  10. Forms of purulent acute pyelonephritis (clinics, diagnostics, therapy).

  11. Nephritis pertaining to apostema.

  12. Abscess and carbuncle of kidney (clinics, diagnostics, therapy).

  13. Etiology and pathogenesis of chronic pyelonephritis.

  14. Clinics of chronic pyelonephritis.

  15. Diagnostics and differential diagnostics of chronic pyelonephritis.

  16. Treatment of chronic pyelonephritis.

  17. Paranephritis, classification.

  18. Symptoms and clinical course of paranephritis.

  19. Diagnostics of paranephritis.

  20. Differential diagnostics of paranephritis.

  21. Roentgenologic signs of paranephritis.

  22. Treatment of paranephritis.

  23. Complications that can be the result of paranephritis.

  24. Etiology and pathogenesis of pyonephrosis.

  25. Clinics of pyonephrosis.

  26. Diagnostics and differential diagnostics of pyonephrosis.

  27. Treatment of pyonephrosis.


Student should be able to:

  1. To suspect acute pyelonephritis based on complains and anamnesis.

  2. To make the plan of examination.

  3. To execute differential diagnostics.

  4. To make plan of treatment for patient with acute pyelonephritis.

  5. To be able to assess total blood and urine analysis, biochemical blood analysis (levels of urea and creatinine), roentgen, radioisotopic and endovesical examination.

  6. To make plan of treatment for patient with chronic pyelonephritis.

  7. To choose from the anamnesis data signs that are typical for pyonephrosis and paranephritis.

  8. To make plan of examination of patient with pyonephrosis and paranephritis.

  9. To determine the most characteristic signs of pyonephrosis and paranephritis.

  10. To make plan of treatment for patient with pyonephrosis and paranephritis.

  11. To execute kidney palpation. To be able to assess review and excretory urography, data of US- examination, retrograde pyelography, results of chromocystoscopy.



The list of basic|main| literature

1. J. Kellogg. The Brady Urology Manual. – USA 2006– 309 p.

2. Robert F.Reilly. Nephrology in 30 days.– USA 2005.– 410 p.

3. Emil A. Tanagho, Jack W. McAninch. Smith’s General Urology. – USA 2008. – 756 p.

4. E.M. Shimkus, S.E. Shimkus. Urology. – Simferipol IADCSMU 2005. – 255 p.


The list of additional literature

  1. Operative Urology/ editor N.A. Lopatkina, I.G.Shevcova.- M.- Medicine.- P. 68-78.

  2. Manual of clinical urology/ editor A.Y. Pytel.- М., 1969.

  3. Dyadik O.K., Kolesnik M.O. Infections of kidneys and urinary tracts. -|Donezk: КP| «Region», 2003. - 400 p.

  4. Dyadik A.M. Infections of urinary tracts at pregnancy // Method. Recommendations. – 2000. – 27 p.

  5. Cuznecova O.P., Vorobyov P.A., Yakovlev S.V. Infections of urinary tracts // Russian medical magazine. - 1999. - №4. - P. 21-29.

  6. Kolesnik M.O., Dudar I.I., Stepanova N.M. Report of medical care given to patients with pyelonephritis // Ukrainian magazine of nephrology and dialysis. - 2005 - № 2. - P. 19-26.

  7. Nikuda T.D., Moyseenko V.O., Palgenko I.A. Nonmedical methods of treatment in nephrology // Skill of treatment. - 2004. - №2. - 26 p.

  8. Pyrig L.A. Taran E.I. Therapy food at kidneys diseases // Magazine of practical doctor.- 2003.- №2,- P. 46-48.

  9. Semgdozka J.D. Pyelonephritis / Nephrology, editor L.A. Pirog.- K.: Health, 1995. – P. 81 – 96.

  10. Sosyn I.N. Clinical physiotherapy. – K.: Health, 1996. – 624 p.



Short methodological directions for practical lesson

At the beginning of|in the beginning of| the lesson the|occupation| test|tst| control of the initial|output| level|Y-level| of knowledge should be carried out. Then|after| there should be an independent|self-maintained| work|wrk| of students with patients. Under the direction of the teacher clinical analysis of the case record should be conducted. At the end of |at close of|the lesson|occupation| there should be the final|total| test|tst| control or resolution of situational tasks|tsk|.


^ Technologic chart of the lesson holding




Stage

Time,

min

Studying manual

Place of

holding

Methods of study

Equipment

1

Determination of

starting level

40

Tests




Studying room

2

Patients curation under

the teacher’s control

30

Patients




Wards

3

Clinical consideration of patients

under the teacher’s control

40

Disease cases, algorithms




Studying room

4

Substantiation of previous diagnosis

30

Tables, schemes, algorithms




Studying room

5

Substantiation of therapy tactics

30

Tables, schemes, algorithms




Studying room

6

Resultant control

30

Tests, situational tasks




Studying room

7

Summarizing the lesson

40







Studying room


^ Addendum A (obligatory)

Total urine analysis


Index

Norm

Amount, ml

Daily: 800-1500 ml, for examination> 100ml

Color

Pale yellow

Transparence

Transparent

Specific density

>1,020

Reaction

Subacid (pH 5,5 – 6,0)

Protein, g/l

Absent, traces

Glucose, mmol/l

No

Ketone bodies

No

Reaction to blood

Negative

Bilirubin

No

Urobilinoids

No

Bile acids

No

Indycan

No

Pavement epithelium

0-2 in the field of view

Leucocytes

0-3 (men’s), 0-6 (women’s) in the field of view

Erythrocytes: not changed,

changed

No

0-1 in the field of view

Hyaline cylinders

0-1 in the field of view

Mucus

No

Salts

Acid pH – urea, urates, oxalates

Alkaline pH – phosphates, urate ammonium.

Bacteria

No


^ Quantitative examinations at microscopy of sediments

(it is prescribed for diagnostics of latent leucocyturia and hematuria)

Method of Nechiporenko: 1 ml of urine includes:

- leucocytes up to 2000 (up to 4000 in case of chronic pyelonephritis)

- erythrocytes up to 1000

- cylinders from 0 to 20 (max 100, after physical load, dehydration)

Method of Kakovskiy – Addis the following substances discharge per day with urine:

- leucocytes up to 2.000.000 (2 x 106/day)

- erythrocytes up to 1.000.000 (1 x 106/day)

- cylinders up to 20.000 (2 x 104/day)

Method of Amburge the following substances discharge with urine per 1 minute:

- leucocytes up to 2000

- erythrocytes up to 1000

- cylinders up to 20


Addendum B (obligatory)

Medicinal plants that are used in case of pyelonephritis

^ Name of plant

Action

urinary

antiinflam-

matory

antibacterial

astringent

hemostatic

Marsh-mallow

-

-

++

-

-

Watermelon

++

-

-

-

-

Cowberry (leaf)

++

+

++

-

-

Elder black

++

-

+

+

-

Cornflower field

++

+

+

-

-

Дивосил

++

-

+

-

+

Oak

-

+

-

+

-

St. John's wort

+

-

+++

++

+

Strawberry (leaf)

+

+

+

-

++

Centaury

+

-

-

-

-

Конюшина рiлля

-

-

-

+

-

Журавлина

+

++

++

-

-

Nettle

-

++

++

+

+++

Root of cultivated angelica

++

-

-

-

-

Кубушка жовта

-

+

+

-

-

Corn

++

++

++

+

+

Leafs of birch

++

+

+

-

-

Яливец звичайний

+

+

+

-

-

Parsley curly

++

-

-

-

-

Пирiй

++

-

-

-

-

Kidney tea (leafs)

+++

-

-

-

-

Horsetail field

+++

+

+

+

++

Camomile

-

++

++

-

-

Ashberry

++

+

+

+

++

Спориш (горець пташиний)

+

+

+

-

+

Толокнянка

+++

++

++

+

-

Poplar black

-

+

+

-

-

Деревiй

+

-

-

+

+

Violet three-colored

++

-

-

-

-

Brier

++

-

-

+

+

Addendum C (obligatory)

Combination of antibiotics with other medical preparations

Antibiotics

(A)

^ Other preparations

(B)

Effect

Amoxycyline

Amynoglycozides

Idirect anticoagulants

Loop diuretic

(ethacrynic acid, furosemid).

Nonsteroid preparations.

Enhancement of effect of B

Enhancement of ototoxicity of A and B


Enhancement of nephrotoxic effects of A

Tetracycline

(Doxycycline)

Antiinflammatory preparations

Phenobarbital


Magnesium, aluminum, bismuth, iron salt

Calcium and zinc salt

Digoxin

Insuline

Decay of effect of A


Decrease of absorption of A

Decrease of absorption of A


Increase of toxicity of B

Enhancement of effect B

Cotrimoxazole

Indirect anticoagulants

Hypoglycemic preparations

Enhancement of effect B

Enhancement of effect B

Macrolides

Teopfyline


Carbamazepine

Increase of concentration of B, convulsions

Increase of concentration of B, nystagmus, ataxia

Nitrofuranes

Antacydes

Decay of absorption of A

Sulfanilamides

Inhibitors of MAO

Indirect anticoagulants

Hypoglycemic preparations

Enhancement of toxic effects of A

Hemorrhagic diathesis

Hypoglycemia

Fluoroquinolones

Antacydes, sucralfat

Teophylline

Decrease of absorption of A

Increase of concentration of B

Chloramfenicole

Iron salt, vitamins B12

Hypoglycemic preparations- derivative of sulfanile-urea

Decrease of efficiency of B

Increase of effect of B, hypoglycemia



Addendum D (obligatory)

Clinical classification of pyelonephritis,

I By the prevalence

1.1 One- side

1.2 Two- side

II By the process character

    1. Acute pyelonephritis (N 10)

      1. Serous (N.10)

      2. Purulent (N 15.1)

        1. Abscess (N.15.1)

          1. Carbuncle of kidney (N 15.1)

          2. Nephritis pertaining to apostema (N 15.1)

          3. Necrotic papillitis (N 15.1)

        1. Pyonephrosis (N13.6)

    1. Chronic pyelonephritis (N11)

      1. Phase of remission

      2. Phase of latent course

      3. Phase of exacerbation

      4. Terminal phase ( wrinkled kidney) (N.26)

III By the violations of urodynamics

    1. Chronic non-obstructive pyelonephritis

      1. Related to reflux (N.11.0)

      2. At infectious and parasitic diseases (N16.0)

      3. At neoplasms (N16.1)

      4. At blood diseases and diseases that involve immune mechanism (N16.2(

      5. At violations of metabolism (N16.3)

      6. At systematic diseases of connecting tissue (N16.4)

      7. At graft-versus-host reaction (N16.5)

    2. Chronic obstructive pyelonephritis

      1. Congenital (various anomalies of development, with anomalies of form and position of kidneys, cysts and urine tracts that causes violations of the normal urine passage Q 62.0 – Q 62.3)

      2. Acquired

        1. Urolithiasis (calculous pyelonephritis N.20.9)

        2. Tumors of kidneys and urinary tracts (C 60- C 68)

        3. Traumas of kidneys and urinary tracts and its consequences (S 37.0 – S37.2)

        4. Inflammatory diseases of urinary tracts (especially cystitis- N 30, uretritis- N 34, and other), that cause violations of urine normal passage

3.2.3 Hydronephrosis (as result of obstruction N.13.0 – N .13.5)

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