Prostatomegaly differential diagnosis
A 71 years old male patient complaining, pain abdo, difficulty in urination, urgency to urinate, frequently at night, dysuria, fever,constipation, xerostomia, sometimes patient feels severe abdominal pain at UR and also supra pubic region, orthopnoea too. Edematous at lower limbs. O/E BP 160/100mmHg HB 68bpm Chest B/L clear AS/ tenderness CVS s1 & s2 clear DM° What will be the proper investigations and the management......? Cystourethroscopy prostetic biopsy CBC RFT & other important haematological investigations also have been advised ECG reports show LBBB suggest me soon respected doctors
The features Suggestive of Renal failure due to back pressure by gr 3 enlarged prostate with long standing hypertension. Protate is hugely enlarged by weight and residual urine is also high. Pt is having chronic retention causing back pressure changed and Renal failure First catheterise the patient and measure the urine output, continuous drainage may release the back pressure change. Gor for Renal function test if urea label high , do it after 15 days after continuous drainage Treat hypertension with diuretics, this will help in reduction of swelling of legs May go for Cystoscopy no biopsy now, go for PSA if label high more then 10 then biopsy may considered., before that CT is the must to see the capsule is intact or not Along Tha start Tab Tansulosine 0°4 mg daily at night.
BPH Gr III with Umbilical hernia. Advice : 1. Non selective Alpha-1 Blockers(Prazosin, Alfuzosin Terazosin etc) . It will take care of both hypertension and BPH. Start at bed time as initial doses may cause postural hypotension. If BP not controlled may combined with antihypertensive of your choice. Remember Alpha-1A (Tamsulosin and Silodosin) doesn't have any role on BP control and Alpha-1B reduces BP but doesn't have role on BHP treatment. 2. Advice PSA. If value more than 10 then highly suspicious for CA. In that case must advice Prostate Biopsy for HPE. For value less than 5 usually need no biopsy. For 5-10 better to have the biopsy. 3. Rule out Kidney failure advise atleast Creatinine. R/O associated UTI advice R/E & M/E of Urine. 4. Give stool softner and avoid raised intra abdominal pressure to take care of Umbilical hernia. Better to have a surgeon's opinion.
The features Suggestive of Renal failure due to back pressure by gr 3 enlarged prostate with long standing hypertension. Protate is hugely enlarged by weight and residual urine is also high. Pt is having chronic retention causing back pressure changed and Renal failure First catheterise the patient and measure the urine output, continuous drainage may release the back pressure change. Gor for Renal function test if urea label high , do it after 15 days after continuous drainage Treat hypertension with diuretics, this will help in reduction of swelling of legs May go for Cystoscopy no biopsy now, go for PSA if label high more then 10 then biopsy may considered., before that CT is the must to see the capsule is intact or not Along Tha start Tab Tansulosine 0°4 mg daily at night.
Respected "Dr.Maqusud Sir it's a Critical case. According to Complications More difficulties to treat the patient. I think "Prostate specific Antigen"/PSA 10/PSA 20 do urgently for Confirmation. Your management always b best I think Cap Urimax 0.4 also add. M also Agree to "Dr.Dinesh Gupta Sir".
Cap.Nupenta Cap. Geriflo Cap. Ramcor 5mg Tab. Levomac 500mg Tab. Flavomark 200mg These medicines are advised by me instantly....
SUGGESTIVE. I. OF CHRONIC RENAL. FAILURE... WITH H T N.... ADVISABLE R / O.... SEPTICEMIA
Per rectal examination to know consistency of prostate Investigation- Cbc,RFT, urine routine and culture, PSA,bsl fasting, pp. Start alpha blocker (tamsulosine/alfuzosine) Antibiotics if culture positive- If PSA high with positive urine culture it may be secondary to urinary infection - then need to repeat PSA after antibiotics Also large gland 110 gm can have relatively high psa >4 Pain can be due to umbilical hernia Needs diabetes care if sugars high and antihypertensives
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Symptoms of Hernia ------------------------------- The main symptom of Hernia is swelling or formation of a lump. In Inguinal Hernia,the swelling appears in the groin.In Femoral Hernia, the swelling appears in the upper inner thigh region and in Umbilical Hernia, the swelling is apparent around the navel. Swelling is often accompanied by discomfort or a dragging type of pain around the swelling. In case of obstructed or strangulated Hernia, abdominal colic, vomiting, distended abdomen and constipation are the main symptoms. Types of Hernia ------------------------- Inguinal Hernia: This is the commonest type of Hernia. It can occur in infants or adults and since the swelling is in the groin, the panic button is pressed quite early. In InguinalHernia, a part of abdominal contents, mainly intestines, protrudes through the inguinal region of the abdominal wall. The inguinal region is present in the groin. Umbilical Hernia: This Hernia is more common in females than males and also in infants. In Umbilical Hernia, the abdominal contents bulge out from the umbilicus or navel of abdomen. Femoral Hernia: This Hernia is also more common in females and very uncommon in children. In Femoral Hernia, the abdominal contents protrude through the femoral canal present in the upper inner thigh region. Obstructed/Incarcerated Hernia: In this type of Hernia, the lumen of intestine (colon) gets obstructed, leading to intestinal obstruction. Strangulated Hernia: In this type of Hernia, the arterial supply of the contents of Hernia stops along with intestinal obstruction. Femoral Hernia is most liable to get strangulated. Top Homeopathic Remedies for Hernia ----------------------------------------------------------- Nux Vomica: Best Homeopathic cure for all types of Hernia Nux Vomica is a natural Homeopathic medicine which is of great help in treating all types of Hernias — be it femoral, inguinal or umbilical. It can be given to patients of Hernia in whom the abdominal muscles have been weakened due to long-standing constipation. The patient complains of a constant urge to pass stool or poop but scanty unsatisfactory stool is passed. Such a patient also usually feels very cold. There’s also an excessive craving for stimulants like alcohol or coffee. Weakness and soreness in the abdominal muscles are always experienced. For treatment of Umbilical Hernia in infants,Homeopathic remedy Nux Vomica is very beneficial. Calcarea Carbonica: Homeopathic treatment for Hernia in obese people Calcarea Carbonica is a top Homeopathic medicine for treating Hernia. It is mainly prescribed for obese people with weak abdominal muscles due to excessive fat in the abdomen. Such patients cannot bear tight clothes around the waist. Homeopathic medicine Calcarea Carbonicaalso gives excellent results in treatment of Hernia in children who sweat excessively on the head. The patients requiring this medicine are sensitive to cold air. There is alsoan unusual craving for boiled eggs or chalk or lime. Lycopodium Clavatum: Homeopathic medicine for Hernia with weak digestion, excessive flatulence Homeopathic medicine Lycopodium Clavatum is of great help to patients of Hernia who suffer from weak digestion and excessive flatulence in the abdomen. The patients requiring this medicine loveto eat sweets and have a craving for hot food and drinks. Rhus Toxicodendron: Homeopathic medicine for Hernia due to excessive weight lifing This Homeopathic medicine is very beneficial fortreatment of all such cases of Hernia where the abdominal muscles become weak due to excessive strainby lifting heavy weights. Homeopathic remedy Rhus Toxicodendron helps the patients by strengthening the abdominal muscles. Silicea: Homeopathic treatment for Hernia with excessive perspiration on feet Silicea is aHomeopathic medicine of great help for patients of Hernia who experience excessive and offensive perspiration on the feet. The patient always feels very chilly and desires warm clothing. Silicea is also a very helpful Homeopathic remedy for treatment ofHerniain children who are weak, very obstinate and headstrong. Best Homeopathic Treatment for Hernia Best Homeopathic medicines for Inguinal Hernia Homeopathic medicine Lycopodium Clavatum is an excellent Inguinal hernia remedy, specially benefcial for treating Inguinal Hernia of right side. 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