<?xml version="1.0" encoding="UTF-8"?>
<opml version="2.0">
  <head>
    <title>051-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Urinary tract disease: foundations">
      <outline text="Orientation">
        <outline text="Collecting systems to ureters to low-pressure reservoir"/>
        <outline text="Bladder contraction with outlet relaxation empties"/>
        <outline text="Disease impairs drainage, storage, voiding, continence"/>
        <outline text="Immediate priorities">
          <outline text="Infected obstruction, acute retention, anuria"/>
          <outline text="Severe bleeding, testicular emergencies"/>
          <outline text="Rapidly deteriorating renal function"/>
        </outline>
      </outline>
      <outline text="History and localisation">
        <outline text="Ureteric colic">
          <outline text="Peristalsis works against obstruction"/>
          <outline text="Fluctuating flank pain radiating to groin"/>
          <outline text="Restless movement, unlike peritoneal stillness"/>
        </outline>
        <outline text="Constant flank pain with fever: upper-tract infection">
          <outline text="Older or immune-suppressed may lack features"/>
        </outline>
        <outline text="Lower urinary symptom domains">
          <outline text="Storage: frequency, urgency, nocturia"/>
          <outline text="Voiding: hesitancy, weak stream, straining"/>
          <outline text="Post-void: incomplete emptying, after-dribble"/>
          <outline text="Quantify intake and volumes, not assume prostate"/>
        </outline>
        <outline text="Haematuria history">
          <outline text="Anticoagulation reveals bleeding, not sole cause"/>
          <outline text="Painless visible blood: assess for malignancy"/>
        </outline>
        <outline text="Medicines and retention">
          <outline text="Anticholinergics, opioids, sympathomimetics"/>
          <outline text="Diuretics and sedatives worsen incontinence"/>
        </outline>
        <outline text="Baseline renal function and solitary kidney"/>
      </outline>
      <outline text="Examination">
        <outline text="Observations, hydration, perfusion, sepsis"/>
        <outline text="Abdomen: masses, hernias, enlarged bladder"/>
        <outline text="Costovertebral tenderness supportive, not specific"/>
        <outline text="Genitalia with consent, privacy, chaperone"/>
        <outline text="Testicular pain">
          <outline text="Lie, swelling, cremasteric response"/>
          <outline text="Never delay surgical review for torsion"/>
        </outline>
        <outline text="Digital rectal examination">
          <outline text="Size correlates poorly with obstruction"/>
          <outline text="Normal examination does not exclude cancer"/>
          <outline text="No vigorous massage in acute prostatitis"/>
        </outline>
        <outline text="Neurological examination for cord or cauda equina"/>
      </outline>
      <outline text="Urinalysis and microbiology">
        <outline text="Dipstick findings need context">
          <outline text="Haem: red cells, haemoglobin, or myoglobin"/>
          <outline text="Nitrite needs nitrate reduction and dwell time"/>
          <outline text="Pyuria means inflammation, many causes"/>
        </outline>
        <outline text="Midstream or catheter port, not bag"/>
        <outline text="Culture in pregnancy, recurrence, complicated cases"/>
        <outline text="Asymptomatic bacteriuria usually untreated">
          <outline text="Treating colonisation causes harm and resistance"/>
        </outline>
      </outline>
      <outline text="Urinary tract infection">
        <outline text="Cystitis: dysuria, frequency, no systemic illness">
          <outline text="Vaginal symptoms suggest alternatives"/>
        </outline>
        <outline text="Pyelonephritis: fever, flank pain, bacteraemia"/>
        <outline text="Antibiotics by syndrome, severity, cultures"/>
        <outline text="Failure: obstruction, abscess, resistance, adherence"/>
        <outline text="Catheters bypass defence and form biofilm">
          <outline text="Diagnose from symptoms, not cloudy urine"/>
          <outline text="Prevention: avoid, asepsis, closed system, remove"/>
        </outline>
      </outline>
      <outline text="Obstruction and retention">
        <outline text="Raised upstream pressure">
          <outline text="Lower filtration and impaired concentration"/>
          <outline text="Infection and eventual atrophy"/>
        </outline>
        <outline text="Bilateral or solitary kidney: painless anuria"/>
        <outline text="Retention may be painless if chronic">
          <outline text="Measure post-void residual by ultrasound"/>
        </outline>
        <outline text="Difficult catheterisation needs experienced help">
          <outline text="Blind attempts create false passages"/>
        </outline>
        <outline text="Post-obstructive diuresis">
          <outline text="Retained salt and water, or impaired concentration"/>
          <outline text="Replace a considered proportion"/>
        </outline>
      </outline>
      <outline text="Urinary stones">
        <outline text="Supersaturation modified by volume, pH, inhibitors"/>
        <outline text="Imaging">
          <outline text="Non-contrast computed tomography highly sensitive"/>
          <outline text="Ultrasound avoids radiation in pregnancy"/>
        </outline>
        <outline text="Analgesia, antiemetics, correct deficit">
          <outline text="Forced fluid does not push the stone"/>
        </outline>
        <outline text="Infection plus obstruction is an emergency">
          <outline text="Antibiotics and stent or nephrostomy"/>
          <outline text="Definitive treatment after stabilisation"/>
        </outline>
        <outline text="Prevention by urine volume and cause">
          <outline text="Keep dietary calcium to limit oxalate uptake"/>
        </outline>
      </outline>
      <outline text="Haematuria and urological cancer">
        <outline text="Confirm, then seek glomerular features"/>
        <outline text="Clots suggest non-glomerular bleeding">
          <outline text="Clots can obstruct outflow"/>
        </outline>
        <outline text="Imaging and often cystoscopy by age and risk"/>
        <outline text="Bladder cancer linked to smoking, occupation"/>
        <outline text="Prostate-specific antigen is organ-specific"/>
      </outline>
      <outline text="Incontinence and neurogenic bladder">
        <outline text="Mechanisms">
          <outline text="Stress: abdominal pressure beats urethral closure"/>
          <outline text="Urgency, overflow, functional, often mixed"/>
        </outline>
        <outline text="Diary, residual volume, selective urodynamics"/>
        <outline text="Treat reversible contributors first"/>
        <outline text="Pelvic-floor training first-line for stress"/>
        <outline text="Antimuscarinics: dry mouth, confusion, retention"/>
        <outline text="Neurogenic: low-pressure storage protects kidneys"/>
      </outline>
    </outline>
  </body>
</opml>
