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Management session on bladder cancer

By:- mesfin semunigus Lidiya chanyalew

Identification

Name Yaya Ahmed Age 60 Sex M Religion muslim Ethnicity Oromo Occupation Farmer Address combolcha,oromia Admission date 15/05/04

Chief compliant

reddish urine discoloration of 04 months

History of present illness

The patient was relatively health 4 month back at which time he fall to ground on his abdomen while he was walking. Following the accident he has no history of loss of consciousness, abdominal pain, distention & no loss of desire to urinate. After a day, he started to notice reddish discoloration of the urine which was intermittent at onset. it is painless & he passes through out the stream. But at the end it become frank red.

Cont

He has hesitence, nocturia of 2x and sense of incomplete urination The patient has no difficulty on micturation, dysuria, incontinency, frequency or urgency. He has veggie type of supra pubic & bilateral flunk pain which is non radiating. He has no extremity or face swelling.

He has no chest pain , cough, hemoptosis. No bone pain. No history of vomiting, diarrhea, constipation, yellowish eye discoloration & skin pruritis. He has associated symptoms dizziness, vertigo, easily fatigability, loss of appetite & lost unspecified amount of weight.

He has smoking history 3 pack year He has no personal & family history of DM, hypertension, cardiac disease, asthma 8 years back abdominal surgery was done for a compliant of chronic vomiting (??GOO)

Physical exam

General appearance chronic sick looking, not in cardiopulmonary distress. V/S stable

HEENT pink conjunctiva and non icterous sclera. poor dental hygiene and dental care. LNs ; no LAP RS; no flaring of analzy, cyanosis, use of accececary muscles. central trachea, no mass or tenderness resonant percussion note vesicular breath sound. no added sound.

CVS; all superficial accessible arteries palpable JVP ;not raised. pericardium quite, apical impulse not visible PMI is at 5th ics MCL.S1 & S2 heard no murmur, no gallop.

Abdominal exam

are free. There is vertical midline surgical scar. Auscultation; normoactive bowel sound, no brow heard Palpation; no tenderness no mass, organomegaly is palpated Percussion:-tympanic percussion note PR

Inspection; shaphoid ,move with respiration, hernial sites

Intact anal sphincter tone. no blood, ulcer Normal sized prostate, rubbery inconsistence, Rectal mucosa move over it, Medial sulcus is palpable & upper border is reachable.

GUS: no CVA & supra pubic tenderness MSS: no joint deformity, Integmontery: no rash, edema CNS: conscious, oriented to time, place & person

Investigation

Hct 38, Blood group B+ Cr 0.96 BUN nornal SGPT & SGOT normal u/a

Albumin; +1 Bld; +4 Microscopy ; too much RBCs/HFM

CXR IVP Cyctography Cyctoscopy Urine cytology Flow metery CT of pelvic

u/s : irregular soft tissue mass in the bladder.