Kuliah Pem.Dasar Uro 2011 print

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UROLOGY:

DMS 2011 1 UROLOGY Urologists have a unique and interesting position in medicine. Their patients encompass all age groups, including prenatal, pediatric, adolescent, adult, and geriatric. Urologist has the ability to make the initial evaluation and diagnosis and to provide medical and surgical therapy for all diseases of the genitourinary (GU) system.

UROLOGI:

DMS 2011 2 UROLOGI URO + LOGOS UROLOGI: TRAKTUS URINARIUS PRIA & WANITA DAN TRAKTUS REPRODUKSI PRIA (UROLOGI & ANDROLOGI) [email protected] www.urology.unair.ac.id

UROLOGY:

DMS 2011 3 UROLOGY General Urology Pediatric Urology Endourology Oncologic Urology Female Urology Neuro Urology Andrology, incl.: Male Health, Sexual Medicine Male Infertility Kidney Transplantation

DEPARTEMEN / SMF UROLOGI FK UNAIR - RSUD DR.SOETOMO:

DMS 2011 4 DEPARTEMEN / SMF UROLOGI FK UNAIR - RSUD DR.SOETOMO Tilp. 031 550 1318 /fax: 031 502 4971 [email protected] www.urology.unair.ac.id www.urologi.or.id Prof.DR.Dr.Doddy M.Soebadi, SpB, SpU(K) Prof.DR.Dr.Soenarjo Hardjowijoto, SpB, SpU(K) Dr.Adi Santoso, SpB, SpU(K) DR.Dr. Sabilal Alif, SpU(K) Prof.DR.Dr.Soetojo, SpU Dr.Tarmono, SpU Dr.Wahjoe Djatisoesanto, SpU

Pemeriksaan dasar Urologi:

DMS 2011 5 Pemeriksaan dasar Urologi Doddy M.Soebadi Departemen Urologi RSUD dr.Soetomo / F.K.Univ.Airlangga Surabaya [email protected]

Pemeriksaan dasar Urologi:

DMS 2011 6 Pemeriksaan dasar Urologi Kepustakaan: Smith ’ s General Urology, 16th Eds., Tanagho EA, McAninch JW (eds.), Lange Medical Books / McGraw-Hill, 2004. (Campbell ’ s Urology, 9th Ed., Walsh PC, Retik AB, Vaughan ED, Wein AJ I (eds.), WB Saunders Co.,2007.)

Pemeriksaan dasar Urologi:

DMS 2011 7 Pemeriksaan dasar Urologi Anamnesa / Keluhan (symptoms) Pemeriksaan fisik Laboratorik Radiologik

Pemeriksaan dasar Urologi:

DMS 2011 8 Pemeriksaan dasar Urologi Anamnesa / Keluhan (symptoms) keluhan utama riwayat penyakit dahulu (pernah operasi, rawat inap, di ” tembak ” , dll riwayat penyakit keluarga Tanyakan hal2 yg kita ingin tahu, berdasarkan Ax awal diatas Obat2, jamu, alternatif, dsb

PowerPoint Presentation:

DMS 2011 9 Listen to the patient he is telling the diagnosis!

Pemeriksaan dasar Urologi:

DMS 2011 10 Pemeriksaan dasar Urologi keluhan utama harap diingat oleh dokter durasi, beratnya, akut/kronik, periodik, derajat gangguan dan hal2 penting (demam, BB turun, lemah) apa yang mengganggu saat ini

Symptoms GU tracts:

DMS 2011 11 Symptoms GU tracts Systemic manifestations Fever & weight loss Unexplained attacks of fever General malaise

Pemeriksaan dasar Urologi KELUHAN (Symptoms):

DMS 2011 12 Pemeriksaan dasar Urologi KELUHAN (Symptoms) Nyeri Hematuria LUTS (lower urinary tract symptoms) Disfungsi seksual Hematospermia Pneumaturia Discharge urethra Demam & menggigil

PAIN:

DMS 2011 13 PAIN Pain arising from the GU tract may be quite severe and is usually associated with either urinary tract obstruction or inflammation Inflammation of the GU tract is most severe when it involves the parenchyma of a GU organ Tumors in the GU tract usually do not cause pain unless they produce obstruction or extend beyond the primary organ to involve adjacent nerves

RENAL PAIN:

DMS 2011 14 RENAL PAIN dull pain colicky pain pseudorenal pain (referred pain) Pain is usually caused by acute distention of the renal capsule, generally from inflammation or obstruction. The pain may radiate across the flank anteriorly toward the upper abdomen and umbilicus and may be referred to the testis or labium Renal pain may also be confused with pain resulting from irritation of the costal nerves, most commonly T10-T12

URETERAL PAIN:

DMS 2011 15 URETERAL PAIN Ureteral pain is usually acute and secondary to obstruction. The pain results from acute distention of the ureter and by hyperperistalsis and spasm of the smooth muscle of the ureter as it attempts to relieve the obstruction

PowerPoint Presentation:

DMS 2011 16 Copyright © 2003, Elsevier Science (USA). All rights reserved.

PowerPoint Presentation:

DMS 2011 17 I.Ureter 1/3 proximal II.Ureter 1/3 tengah III.Ureter 1/3 distal

VESICAL PAIN:

DMS 2011 18 VESICAL PAIN Constant suprapubic pain that is unrelated to urinary retention is seldom of urologic originInflammatory conditions of the bladder usually produce intermittent suprapubic discomfort Pain in conditions such as bacterial cystitis or interstitial cystitis is usually most severe when the bladder is full and is relieved at least partially by voiding

PROSTATIC PAIN:

DMS 2011 19 PROSTATIC PAIN poorly localized may complain of lower abdominal, inguinal, perineal, lumbosacral, and/or rectal pain frequently associated with irritative urinary symptoms such as frequency and dysuria in severe cases: acute urinary retention.

PENILE PAIN:

DMS 2011 20 PENILE PAIN Pain in the flaccid penis  inflammation in the bladder or urethra  referred to urethral meatus Paraphimosis  engorgement of the glans penis Pain in the erect penis is usually due to : Peyronie's disease priapism

Pemeriksaan dasar Urologi:

DMS 2011 21 Pemeriksaan dasar Urologi Hematuria Painless Painful (loin or ureteral) Total (throughout voiding) Initial (only at the start) Terminal (only at the end) INTERMITTENT PAINLESS TOTAL GROSS HEMATURIA

Pemeriksaan dasar Urologi:

DMS 2011 22 Pemeriksaan dasar Urologi Anamnesa / Keluhan (symptoms) LUTS (lower urinary tract symptoms) keluhan iritatif: keluhan obstruktif inkontinensia enuresis

Pemeriksaan dasar Urologi:

DMS 2011 23 Pemeriksaan dasar Urologi Anamnesa / Keluhan (symptoms) LUTS (lower urinary tract symptoms) keluhan iritatif (STORAGE): keluhan obstruktif (VOIDING):

Pemeriksaan dasar Urologi:

DMS 2011 24 Pemeriksaan dasar Urologi LUTS (lower urinary tract symptoms) (1) Storage (filling): Daytime frequency (try to ascertain the #) Nocturia (an average # is helpful) Urgency + incontinence Strangury (urethral pain at the end, etc) Suprapubic pain

Pemeriksaan dasar Urologi:

DMS 2011 25 Pemeriksaan dasar Urologi LUTS (lower urinary tract symptoms) (1) Voiding (obstructive): Hesitancy Reduced flow pressure (compared to the past) Post micturition dribble Intermittent flow Feeling of incomplete emptying Pneumaturia Faecaluria Dysuria (urethral pain during voiding)

Pemeriksaan dasar Urologi:

DMS 2011 26 Pemeriksaan dasar Urologi Anamnesa / Keluhan (symptoms) LUTS (lower urinary tract symptoms) Inkontinensia continue (true) stress overflow urge Enuresis diurnal nocturnal

Pemeriksaan dasar Urologi:

DMS 2011 27 Pemeriksaan dasar Urologi Anamnesa / Keluhan (symptoms) Disfungsi seksual libido menurun impotensi gagal ejakulasi anorgasmus ejakulasi prematur

Pemeriksaan dasar Urologi:

DMS 2011 28 Pemeriksaan dasar Urologi Anamnesa / Keluhan (symptoms) Hematospermia sering sembuh sendiri jarang ada patologi o.k.inflamasi non spesifik uretra prostat, ves.seminalis

Pemeriksaan dasar Urologi:

DMS 2011 29 Pemeriksaan dasar Urologi Pemeriksaan fisik ginjal dewasa: sulit teraba (bimanual) palpasi bimanual Bila teraba : permukaan, konsistensi, nyeri tekan K.p. : perkusi, transilluminasi

Pemeriksaan dasar Urologi:

DMS 2011 30 Pemeriksaan dasar Urologi Pemeriksaan fisik buli-buli teraba bila terisi 150 ml palpasi (bimanual) perkusi mobilitas

Pemeriksaan dasar Urologi:

DMS 2011 31 Pemeriksaan dasar Urologi Pemeriksaan fisik penis bila tdk circ., tarik preputium kulit meatus urethrae palpasi indurasi, batu

Pemeriksaan dasar Urologi:

DMS 2011 32 Pemeriksaan dasar Urologi Pemeriksaan fisik ----- abnormal: penis fimosis Peyronie ’ s disease priapismus Hipospadia (+ chordee) karsinoma

Pemeriksaan dasar Urologi:

DMS 2011 33 Pemeriksaan dasar Urologi Pemeriksaan fisik skrotum & isi kulit testis (ganas) epididimis, vas (jinak) transiluminasi kanalis inguinalis (HIL)

PowerPoint Presentation:

DMS 2011 34 Figure 3–4. Examination of the inguinal canal. (From Swartz MH: Textbook of Physical Diagnosis. Philadelphia, WB Saunders, 1989, p 376.) Copyright © 2003, Elsevier Science (USA). All rights reserved.

Pemeriksaan dasar Urologi:

DMS 2011 35 Pemeriksaan dasar Urologi Pemeriksaan fisik pem. rektal & prostat pd. pria (CD/RT/DRE) semua pria dg . keluhan urologik semua pria diatas 40 th

Pemeriksaan dasar Urologi:

DMS 2011 36 Pemeriksaan dasar Urologi Pemeriksaan fisik pem. pelvis pd. perempuan pemeriksa pria didampingi dr./prw. perempuan inspeksi teliti dlm posisi litotomi VT atau RT (+ palpasi bimanual)

Pemeriksaan dasar Urologi:

DMS 2011 37 Pemeriksaan dasar Urologi Pemeriksaan fisik ----- abnormal: skrotum dan isi tumor testis (hampir selalu ganas) tumor para testikular (hampir selalu jinak) hidrokel, spermatokel, kista epididimis, varikokel torsio testis epididimitis orkitis / orko-epididimitis

Pemeriksaan dasar Urologi:

DMS 2011 38 Pemeriksaan dasar Urologi Pemeriksaan fisik ----- abnormal: prostat prostatitis akuta benign prostate hyperplasia (BPH) karsinoma prostat

Pemeriksaan dasar Urologi:

DMS 2011 39 Pemeriksaan dasar Urologi Laboratorik urinalisis pd semua pend urologi UL: kimiawi & mikroskopik cara koleksi: pria: arus tengah (midstream) perempuan: bersihkan & arus tengah atau urin dg kateter neonatus dan bayi: spp (supra pubic puncture / aspiration)

Pemeriksaan dasar Urologi:

DMS 2011 40 Pemeriksaan dasar Urologi Laboratorik urinalisis pem. fisik urin: warna, kekeruhan, BJ, pH pem. kimiawi: urine dipsticks : darah, protein, glukosa, keton, urobilinogen & bilirubin, leukosit hematuria & DD proteinuria glukosa & keton bilirubin & urobilinogen test nitrit

Pemeriksaan dasar Urologi:

DMS 2011 41 Pemeriksaan dasar Urologi Laboratorik urinalisis pem. mikroskopik: sel, silinder (cast) , kristal, bakteria, ragi, parasit biakan dan test kepekaan AB sekresi prostat (expressed prostatic secretion = EPS)

Pemeriksaan dasar Urologi:

DMS 2011 42 Pemeriksaan dasar Urologi Laboratorik darah: DL: Hb, leuko, diff, PCV, LED faal ginjal: BUN, kreatinin serum, as.urat k/p: elektrolit

Pemeriksaan dasar Urologi:

DMS 2011 43 Pemeriksaan dasar Urologi Radiologik USG foto polos abdomen (BOF, BNO,KUB) IVP / IVU (intravenous pyelo/uro-graphy)

DIAGNOSIS:

DMS 2011 44 DIAGNOSIS Diagnosis Primer Sekunder Komplikasi DD (differential diagnosis=diagnosis banding) Diagnosis kerja Diagnosis klinik Diagnosis patologik

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