Thursday, August 18, 2016

Urinary Incontinence or Leaking of Urine

Involuntary loss of urine, continuous dribbling, inability to properly hold urine all account in symptoms of Urinary incontinence. It leads to a personal misery, a health and a social nuisance and is a matter of loss of productivity for an otherwise healthy individual.
Before knowing about the Urinary Incontinence, we need to know a little about Anatomy i.e structure of Urinary System.
As per American Journal of Medicine, 2006, almost half to 4/5th elderly in long term facilities suffered from urinary incontinence. The problem was more often seen in females than in males along all ages. . The US Department of Health and Human Services data estimates that approximately 13 million Americans suffer from urinary incontinence.In the UK, an estimated least 3 million people - 5% of the total population - suffer from urinary incontinence.  In India, a questionnaire-based survey of 2,000 women aged 30-50 in Chennai found a prevalence of about 40 per cent. (Study by GAURI ). Therefore, urinary incontinence is overall a big health issue among women and elderly population. This incontinence is different from enuresis that occurs in children.
                                             
Types of urinary incontinence

Stress Incontinence: When there is an increase in abdominal pressure eg. Sneezing, coughing, laughing and bearing weight, there is leakage of urine.

Urge Incontinence: Incontinence occurring with sudden urge to pass urine.

Mixed: A combination of stress and urge incontinence.

Functional: Neuro-urologic and lower urinary tract dysfunction leading to leakage of urine. (Spinal injury, UTI. Post surgical etc)


Any of the symptoms should always be confirmed by consulting a doctor, so that a hidden pathology is not missed. 



Management
For a successfully managed case of UI, a management plan should be tailored as per pathology, age and cause of incontinence. Role of health professional in counseling and information dissemination is vital.
Some of the General management approaches are:
Pelvic floor physiotherapy, anti-incontinence devices and sometimes surgery are indicated for Stress Incontinence. Urge incontinence requires dietary and behavioral modification, pelvic-floor exercises, and/or medications and newer surgical intervention. Overflow incontinence is treated with bladder catheterization or urinary diversion. Functional incontinence needs the treatment of the underlying cause.

Absorbent products may be used temporarily until the patient undergoes a definite treatment. Adult Pant Style diapers.
Adult diapers are of great value in caring of patient with incontinence.

LIFREE adult diapers are specialized for the care of such problem.

Lifree absorbent Pants are-
1.       With Underwear like elastic. Easy to wear and remove for elderly as well.
2.       Light and comfortable with extra stretch ability
3.       A good adsorption system that can prevent leakage of urine as well.
4.       Soft leg passage with flexible opening for legs.
 The product is available for those who are capable of walking to toilet independently- Pant type
With time and experience, researches were carried out to improve the patient or consumer comfort and better design and materials are now used for Adult adsorbent pants. Now a days, the products have higher absorption, less discomfort, no soiling problems that occur accidentally and are available over the counter. A brand, Lifree has been making its mark sales in India.


For more details visit: Lifree ‘Japan’s number 1 brand*’: http://www.lifree.co.in/index.html

Thursday, August 4, 2016

How to check an Error in ABG ? ABG analysis



Sometimes, clinicians might find ABG result not matching with the patient condition. These results might arise from technical errors in machine and there are certain points which can be used to check the error.

How to Check whether ABG result is Right or has Error?






1. Check patient and ABG correlation

2. Check Lab values: If TCO2- HCO3 > 4meq/L , likely technical error.

3. For pH 7.3 to 7.5, actual bicarb should be

X= 24X PaCO2/HCO3

Y= 80- V

Y should be around last 2 digits after decimal of pH.

V= 30

4. PaO2 –pCo2 relationship: paO2 + PaCO2 should never exceed > 150 mmHg( if not under oxygen.)

5. PaO2-FiO2 relationship.
Also


And



If you have any comments, please leave it below.

Wednesday, July 20, 2016

Common mistakes in Per Abdominal examination

1. Forgetting to Expose abdomen adequately:
Before examination, patient should ideally be exposed from nipples to mid thigh. Failure to do so may lead to missing findings during examination eg. Hernia



2. Abdominal symmetry and movement: Should be examined tangentially and from leg end. Comment should be made on movement of all quadrants with respiration.

3. Forgetting to relax abdomen before palpation:
Flex the legs at knees and arms should be by side of body. Head should be rested on a pillow. Only after abdomen is in relaxed position palpation should be proceeded.

4. Missing points on palpation:
a. Remember to ask for pain in any site before palpating. The part with pain should be skipped and palpated at the end.
b. Look for rigidity and guarding besides tenderness.
c. Tenderness should be assessed by looking at facial expression +/- guarding
d. Remember to palpate urinary bladder
e. Hernial orifices should be palpated and is commonly missed point.
f. Make the patient sit and check for renal angle fullness and tenderness.


Rarely grading can be asked.


5. Remember- Shifting dullness is done in percussion and fluid thrill is done in palpation, in a patient with abdominal distension.

6. Auscultation- Look for Renal bruit, Hepatic bruit etc in indicated cases. Bowel sound  should be listened to. When bowel sounds are not present, one should listen for a full 3 minutes before determining that bowel sounds are, in fact, absent.



Recommended reading
https://meded.ucsd.edu/clinicalmed/abdomen.htm
http://www.ncbi.nlm.nih.gov/books/NBK420/

Friday, July 15, 2016

Birth Asphyxia and its manifestations

Definition: Birth asphyxia Birth asphyxia is defined as a reduction of oxygen delivery and an accumulation of carbon dioxide owing to cessation of blood supply to the fetus around the time of birth.

Although , APGAR score is retrospective scoring , it has been used to assess the severity of Asphyxia.
Apgar score 8~10: no asphyxia
Apgar score 4~8: mild
Apgar score 0~3: severe



Clinic manifestations
Complications:
CNS: HIE, ICH
Respiratory system: MAS, RDS, pulmonary hemorrhage
CVS: heart failure, cardiogenic shock
Gastrointestinal system: NEC, stress gastric ulcer
Others: hypoglycemia, hypocalcemia, hyponatremia

Diagnosis
American Academy of Pediatrics (AAP) and the American College of Obstetrics and Gynecology (ACOG) suggest that all of the following must be present for the designation of perinatal asphyxia severe enough to result in HIE:
  1. Profound metabolic or mixed acidemia (pH < 7) in an umbilical artery blood sample, if obtained
  2. Persistence of an Apgar score of 0-3 for longer than 5 minutes
  3. Neonatal neurologic sequelae (eg, seizures, coma, hypotonia)
  4. Multiple organ involvement (eg, kidney, lungs, liver, heart, intestines)
Suggested reading: Thompson Scoring for HIE

Here is the details for MBBS students on HIE- A CNS manifestation of Asphyxia




Any confusions can be cleared from author through comments. Feedback are welcomed.

Sunday, May 29, 2016

BIND Score in severe hyperbilirubinemia


Bilirubin-induced neurologic dysfunction (BIND) Score is used to assess bilirubin induced encephalopathy in neonates with severe hyperbilirubinemia. Johnson et al developed the BIND score to help identify an infant who requires more aggressive monitoring and management.
Parameters:  3 Parameters are assessed and scoring is done based on the parameters.
(1) cry pattern
(2) behavior and mental status
(3) muscle tone

Click to enlarge

BIND score = total score (points for all 3 parameters scored separately and added)
Tick all that apply, but total score is based on the highest in each category or 9.
Interpretation:  minimum score: 0  , maximum score: 9
BIND Score
Stage
1 to 3
Stage 1A
4 to 6
Stage 1B
7 to 9
Stage II

Stage of BIND
Features
IA
minimal signs; totally reversible with therapy
IB
progressive signs but reversible with therapy
II
irreversible signs but severity decreased with prompt and aggressive therapy

References: 
Johnson L, Brown AK, Bhutani VK. BIND - A clinical score for bilirubin induced neurologic dysfunction in newborns. Pediatrics. 1999; 104 (Supplement): 746-747.
http://www.meducator3.net/algorithms/content/clinical-severity-acute-bilirubin-induced-neurologic-dysfunction-bind-score
Resource for reading
http://pediatrics.aappublications.org/content/134/5/e1330