Medical notes (hydrocoele)

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Urology

Hydrocoele

Collection of fluid in the tunica Vaginalis

Types
Congenital

Due to patent processes vaginalis

Sub types
Vaginal hydrocoele- only around the scrotum (sac)
Infantile hydrocoele- till the external ring
True congenital hydrocoele- connection with peritoneum
Encysted-Appears like a small cyst at the root.
Hydrocoele en bissac- has connection with an abdominal sac.

Acquired.
Primary vaginal hydrocoele
Young or middle age
1.Due to increased secretion
2.Due to defective lymphatic drainage

Clinical features
Localized to scrotum, Cystic, transillumination positive, get above the swelling present.

Fluid- serous - albumin fibrinogen.

Secondary vaginal hydrocoele
Epididymo orchitis
1.Tuberculosis
2.Filariasis - recurrent, liquid fat
Tumor
Pyocoele- infection on an pre existing hydrocoele.
Hematocoele

Feature -transillumination negative
Also negative in thick tunical vaginalis

Treatment
1.Plication (making folds)- "Lords plication" done for small hydrocoele, tunica vaginalis is cut and plicated to tunica albugenia fluid is drained by lymphatics.
2.Partial excision and eversion, it is sutured to the back of testis.
3.Aspiration

Complication
Hematocoele
Pyocoele
Calcification
Rupture
Hernia of the sac

MGNREGA

MGNREGA

It is a rural employment program started by the government of India.

It was started in 2005, covered 200 districts in 2006, and by 2008 it covered all villages.

It was initially named as National Rural Employment Guarantee Act, then it was changed to Mahatma Gandhi National Rural Employment Guarantee Act.

It is hailed as the largest social security and public works program in the world.

Its objective is to provide at least 100 days of paid employment to a rural adult in each household.

And it is completely implemented by gram panchayaths, no contractors are used.

Every applicant who volunteers for the program should be given a job within 5 km of his house.

The applicant will work on creating durable assets such as roads, canals, ponds...

If work is not provided within 15 days of applying then he/she is entitled to an unemployment allowance.

Maharashtra under former Chief Minister Vasantrao Naik was the first to start such a scheme in 1970.

It was later taken up by the planning commission and made a national wide program.

The present Act is an integration of several such programs like the Employment Assurance Scheme from the 1970s'.

But corruption and politics have have dimmed it's magnificence, in 2014-15, only 28% of the payments were made on time. 

But its largely a success story, that has raised minimal wages, started 12 crore jobs, and completed 14.6 million projects.

Apart from providing economic security and creating rural assets, it has helped in protecting the environment and empowering women.

World Bank called MGNREGA a "stellar example of rural development", and we agree wholeheartedly.

Medical notes (surgery)

Urology

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Varicocoele

Dilatation of testicular veins.

Right testicular vein drains in to Inferior vena cava
Left in to renal vein.
Left sided varicocoele is more common since its lower.

Etiology
Young, thin.
Old- Renal cell carcinoma

Clinical features
Dragging pain
On standing swelling enlarges.
Cough produces impulse in the veins
Valsalva's maneuver produces pulse - blow test- (blowing air via the ears)
Varices Reduces on lying down.

Types
1.Small (palpable on Valsalva's)
2.Medium (palpable without it)
3.Large (visible)

Complications
1. Oligospermia (temperature, hormones)
2. Hydrocele

Treatment-
Surgery
1. Inguinal approach - ligation of
Pampariform plexus
2. Retroperitoneal approach - ligation of one testicular vein.
3. Sub inguinal microscopic varicocelectomy.

Medical notes (surgery)

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Urology

Torsion testis

Predisposing factors

1. Long redundant spermatic chord
2. Invertion of testis
3. Sudden contraction of cremastric muscle
4. Epididymis separated from testis.

Types of testicular torsion

1. Extravaginal
2. Intravaginal

Clinical features
10- 25 (age)
Sudden agonizing Pain.
Empty scrotum on the affected side also edematous.

Signs
Deming's sign - tender lump at external ring
Prehns' sign- rising the scrotum increases pain.
Angells' sign- opposite scrotum is horizontal.

Management

Preferred detortioned in first 4 hours
First hour- manual detorsion
If it doesn't work explore the scrotum and detorsion is dome and its fixed to scrotum.
If the testis is necrosed  then remove it.
The other testis should be fixed to scrotum as soon as possible to prevent damage as its at risk.

Medical notes (surgery)

Urology
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Fournier's gangrene

Gangrene of the scrotum.

Etiology-
Low social economic factors and poor hygiene.

Pathogenesis
A trauma usually a scratch- infection - rapid inflammation of scrotum - fever and toxic symptoms - gangrene of the scrotum- exposed testis- spread to abdomen thigh even penis.

Organisms
Hemolytic Streptococcus
Staphylococcus
E coli
Anaerobes

Clinical features
Inflammation,
Scrotal gangrene
Fever
Toxic features
Spread

Treatment
Broad spectrum antibiotics
Ampicillin- gram +
Gentamycin- gram -
Metronidazole - anaerobes
Surgical excision of gangrene.
Implation in to thigh in case of exposed testis till
Skin graft is done.

Medial notes (surgery)

Pic - http://www.drugs.com/health-guide/hematuria.html

Hematuria

Hematuria is defined as blood in urine.

The blood can be microscopic and macroscopic.

It can also be early (at the start of urination)(urethra),  terminal (at the end) (bladder neck, prostrate), diffuse (throughout) (kidney, upper UTI).
Pseudo hematuria is pigmentation of urine by food.

Causes
Infection -
1.acute glomurulonephritis
2. TB
Infarction
1.Emboli in sub acute endocarditis to renal infact
2.Mismatched Blood transfusion
Injury
1.Stab or burn
Tumors
1.Wilms' tumor
2.Transitional cell carcinoma
Stones
Polycyclic kidney
Bleeding disorders- stickle cell.
BPH

Most common problems

Stone (ureter, urethra,  bladder)
Tumor (carcinoma bladder, prostrate)

Investigation
History
Age, Occupation

Color of urine (bright red, altered), Amount (small.rcc, profuse.papilloma)

Painless or painful

Early, terminal or diffuse

General exam- pallor, BP
Abdominal exam- kidneys palpable, bladder,

Rectal exam- prostrate.
Plain X- ray KUB
Urine exam- microscopy, culture, biochemistry (albumin, creatinine, urea)
Ultrasounds
IVP, IVUgraphy
CT
Urethroscope, cystoscope

Management- treat anemia, maintain blood volume and electrolytes, antibiotics, treat the cause.

Tuberculosis

The white old man tuberculosis, a "myco" bacteria clearly a racist by the way he sticks to the tropics.

Occupies your lungs without an invitation.

He rides mucus the sputum,  from noses to noses or mouths to mouths for recreation.

He converts them tissues in to curdy white cheese, by a process called calcification.

And he is bound to take a very long if not an indefinite lease, irregularly or in continuation. (Chronic)

He puts at least 5 lakhs (India) to external sleep, still the biggest killer since his coronation.

The old white man will make you cough your eyes out, burn with high fever.

Make you spit blood from your mouth (hemoptysis), loose weight and quiver.

You can try crying a river, but once he is set, he will not stop until everything he gets.

He can reach your gut, your brain, your spine, even your liver, he casts a wide net.

HIV and Smoke are two of his special hope, each pulls him in with a tight rope.

The white old man is certainly dope, but even he has enemies that will melt him like pears soap.

Rifampisin, Streptomycin, to name a few, can eat him up without a clue.

DOTS is a regimen that makes sure Rifampisin and his buddies are taken without fail, so TB gets cut off in its tail.

Remember the old white man may be gruesome and deadly, but he can be warted off or thrown out abruptly.