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  <head>
    <title>051-02 Urinary drainage physiology, infected obstruction, haematuria, and bladder function</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
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    <outline text="Drainage, infected obstruction, haematuria, bladder function">
      <outline text="Low-pressure drainage protects kidneys">
        <outline text="Obstruction anywhere from pelvis to urethra">
          <outline text="Fixed or intermittent, unilateral or bilateral"/>
          <outline text="Anatomical or functional"/>
        </outline>
        <outline text="Symptoms do not measure severity">
          <outline text="Slow bilateral obstruction may be painless"/>
          <outline text="Small moving stone causes extreme colic"/>
        </outline>
        <outline text="Urgent questions">
          <outline text="Infection trapped behind obstruction"/>
          <outline text="Both kidneys or solitary kidney threatened"/>
          <outline text="Bladder pressure damaging upper tract"/>
        </outline>
      </outline>
      <outline text="Ureteric colic and infected obstruction">
        <outline text="Peristalsis and pressure above mobile obstruction">
          <outline text="Flank pain migrating toward groin"/>
          <outline text="Microscopic haematuria supports, not required"/>
        </outline>
        <outline text="Red flags: fever, hypotension, anuria">
          <outline text="Infection, infarction, rupture, renal threat"/>
        </outline>
        <outline text="Infected obstruction is a source-control emergency">
          <outline text="Pressure cuts antibiotic delivery and clearance"/>
          <outline text="Rapid bacteraemia and septic shock"/>
          <outline text="Bladder urine may be deceptively sterile"/>
        </outline>
        <outline text="Resuscitate, antibiotics, stent or nephrostomy">
          <outline text="Stone removal waits for infection control"/>
        </outline>
        <outline text="Forced fluid worsens pain or overload"/>
      </outline>
      <outline text="Stone formation and imaging">
        <outline text="Low urine volume concentrates every solute"/>
        <outline text="Sodium intake raises urinary calcium"/>
        <outline text="Low dietary calcium leaves oxalate unbound"/>
        <outline text="Citrate complexes calcium, inhibits crystals"/>
        <outline text="Stone types">
          <outline text="Uric acid precipitates in acidic urine"/>
          <outline text="Cystine reflects inherited transport"/>
          <outline text="Urease infection forms branching struvite"/>
        </outline>
        <outline text="Non-contrast computed tomography finds stones, alternatives"/>
        <outline text="Ultrasound first in pregnancy">
          <outline text="May miss early obstruction or small stones"/>
        </outline>
        <outline text="Intervene for persistent obstruction or infection"/>
      </outline>
      <outline text="Bladder control and retention">
        <outline text="Emptying: detrusor contracts, outlet relaxes"/>
        <outline text="Storage: sympathetic and somatic closure">
          <outline text="Parasympathetic activity restrained"/>
        </outline>
        <outline text="Pontine and cortical coordination"/>
        <outline text="Many causes of residual urine">
          <outline text="Prostate size alone cannot define mechanism"/>
        </outline>
        <outline text="Chronic high-pressure retention can be silent">
          <outline text="Until kidney failure or overflow leakage"/>
        </outline>
        <outline text="Bedside ultrasound avoids needless catheters"/>
        <outline text="Blind attempts cause false passages, stricture"/>
      </outline>
      <outline text="Anuria and post-obstructive diuresis">
        <outline text="Production failure versus drainage failure">
          <outline text="Check catheter kinking, blockage, bag height"/>
        </outline>
        <outline text="Empty bladder with bilateral hydronephrosis">
          <outline text="Suggests upper-tract obstruction"/>
        </outline>
        <outline text="Empty bladder without hydronephrosis">
          <outline text="Circulatory failure or parenchymal injury"/>
          <outline text="Early obstruction may show slight dilatation"/>
        </outline>
        <outline text="Post-obstructive diuresis">
          <outline text="Retained sodium and water, failed concentration"/>
          <outline text="Matching every millilitre perpetuates diuresis"/>
          <outline text="Under-replacement causes hypovolaemia, shock"/>
        </outline>
      </outline>
      <outline text="Symptoms and urinalysis">
        <outline text="Storage, voiding, post-void: treatment differs"/>
        <outline text="Frequency from small capacity or high output"/>
        <outline text="Nocturia without bladder disease">
          <outline text="Sleep apnoea, heart failure, oedema mobilisation"/>
        </outline>
        <outline text="Frequency-volume chart reveals mechanism"/>
        <outline text="Dipstick blood detects haem pigment">
          <outline text="Microscopy confirms red cells"/>
        </outline>
        <outline text="Leukocyte esterase is not proof of bacteria"/>
        <outline text="Nitrite false negatives with frequent voiding"/>
      </outline>
      <outline text="Infection and catheters">
        <outline text="Syndrome plus testing, not culture alone"/>
        <outline text="Fever, flank pain: tissue-penetrating therapy"/>
        <outline text="Mimics: prostatitis, urethritis, stones, malignancy"/>
        <outline text="Empirical antibiotics without culture select resistance"/>
        <outline text="Catheter biofilm makes bacteriuria expected">
          <outline text="Cloudiness and odour do not prove infection"/>
          <outline text="Culture from port, never from bag"/>
        </outline>
      </outline>
      <outline text="Haematuria and tumours">
        <outline text="Glomerular: protein, dysmorphic cells, casts"/>
        <outline text="Urological: clots, stone pain, visible lesions"/>
        <outline text="Anticoagulation amplifies, does not end workup"/>
        <outline text="Painless visible blood warns even if transient"/>
        <outline text="Imaging misses flat or small bladder lesions">
          <outline text="So combine with cystoscopy"/>
        </outline>
        <outline text="Clot retention needs irrigation or endoscopy"/>
        <outline text="Kidney tumours: mass, anaemia or erythrocytosis"/>
      </outline>
      <outline text="Incontinence and neurogenic dysfunction">
        <outline text="Stress, urgency, overflow, functional, fistula">
          <outline text="Stereotype-based treatment often fails"/>
        </outline>
        <outline text="Pelvic-floor training needs dose and months"/>
        <outline text="Antimuscarinics worsen cognition and retention"/>
        <outline text="Neurogenic care protects kidneys">
          <outline text="Symptoms may underestimate pressure"/>
          <outline text="Intermittent catheterisation, low-pressure storage"/>
        </outline>
      </outline>
      <outline text="Discharge safety">
        <outline text="Explain urgent return signs"/>
        <outline text="Catheter indication, removal date, owner"/>
        <outline text="Symptom resolution does not prove clearance"/>
        <outline text="Confirm kidney function and cause resolved"/>
      </outline>
    </outline>
  </body>
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