Loéva 12 th PROSTATE

 

Elderly can have enlarged prostate -which is benign-  or prostate cancer--which is a malignant tumour.

From the BBC:

King Charles 'doing well' after prostate treatment

Published 17 hours ago

By Sean Coughlan

Royal correspondent

"King Charles has had his treatment for an enlarged prostate, after being admitted to hospital on Friday morning.

The King is "doing well". He is expected to spend at least one night at the hospital.

The procedure was carried out at the London Clinic private hospital.

King Charles had made his health problem public as a way of sending a message to other men to get their prostates checked.

Following the disclosure, the NHS website saw a surge in searches about enlarged prostates, an interest welcomed by doctors and charities.

The prostate is a gland that is part of the male reproductive system. 

It is located below the bladder and in front of the rectum. The prostate is responsible for producing a fluid that mixes with sperm and other fluids during ejaculation. The gland is also involved in the process of urination and helps to control the flow of urine. The prostate can be affected by various conditions such as inflammation, enlargement and cancer.

It can also be infected by microbs, bacteria...Prostatitis is a condition that results from an inflammation or an infection. The symptoms may include painful urination and or frequent urination at night, urgency to urinate, blood in urine and urinary retention.

The diagnosis of prostatitis involves taking a medical history, and physical examination (including a digital rectal exam performed to examine the prostate), and urine tests to look for infection; and blood tests to look for sign of infections.

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Prostate hypertrophy, also known as benign prostatic hyperplasia (BPH), can have several consequences. Let’s explore them:

1. Urinary Symptoms:

   • Irritative Symptoms:
     • Increased frequency of daytime urination.
     • Nocturia (frequent urination at night).
     • Urgent need to urinate, sometimes accompanied by leakage.
   • Obstructive Symptoms:
     • Difficulty initiating urination.
     • Weakened urine stream.
     • Struggling to completely empty the bladder (resulting in dribbling).
     • These symptoms arise due to the gradual difficulty of the bladder muscle to contract effectively.

2. Complications:

   • Urinary Retention: In severe cases, BPH can lead to the inability to urinate, causing discomfort and potential damage to the bladder.
   • Frequent Urinary Tract Infections: Incomplete bladder emptying increases the risk of infections.
   • Bladder Stones: Stagnant urine can lead to the formation of bladder stones.
   • Damage to Bladder Muscles: The bladder muscles may weaken over time.
   • Acute Urinary Retention: Sudden inability to urinate.
   • Kidney Problems: Chronic obstruction can affect kidney function.

3. Diagnosis:

   • Rectal Examination: A gloved finger is inserted into the rectum to assess prostate size and exclude tumors.
   • Urine Analysis: To rule out infections.
   • Antigen Test: Checks for prostate-specific antigen (PSA) levels.
   • Biopsy: If cancer is suspected.
   • Urodynamic Tests: Measure urine flow and detect bladder blockage.
   • Ultrasound: Determines prostate size and condition.

4. Treatment Options:

   • Medications:
     • Alpha-blockers (e.g., Alfuzosin, Tamsulosin) relax bladder neck and prostate muscles.
     • 5-alpha reductase inhibitors (e.g., Finasteride, Dutasteride) shrink the prostate.
   • Procedures:
     • Transurethral Resection of the Prostate (TURP): Removes most of the prostate tissue.
     • Transurethral Incision of the Prostate (TUIP): Creates incisions in the prostate.
     • Laser Therapy: Uses laser equipment to remove blockages.
     • Embolization: Reduces blood supply to the prostate.
     • Open or Robotic Prostatectomy: Surgical removal of the prostate.

5. Lifestyle Considerations:

   • Diet: Consume foods rich in vitamin C (broccoli, sprouts, cauliflower, tomatoes) and zinc (oysters, crab, lamb).
   • Avoid: Processed foods, caffeine, dairy, and spicy foods.

Remember, if you experience any symptoms related to BPH, consult a doctor promptly. Early intervention can prevent complications and improve quality of life.

 

 QUIZZ

-1 It is necessary to operate on the prostate surgically to remove the obstacle of benign prostatic hyperplasia in order to facilitate flow and prevent complications upstream 

2  In the case of prostate cancer, doctors advise surgery to remove the entire prostate or to perform an irradiation of the prostate.

3 Prostate is not a necessary gland and men can have their prostate removed anytime, the sooner the better.

Loéva 11 Paediatrics

 

How many children are there in the family ?

Did you have any miscarriages ?

stillbirths ?

Is there a history of illness in the relatives? 

concerning your parents, yourselves, or the siblings?

PREGNANCY HISTORY. To know about this pregnancy history the doctor asks questions;

-Were you well during the pregnancy?

-Did you take any drugs during the pregnancy?

-Was he a premature baby? or  was he a full-term infant?

The kind of delivery...

Was the delivery

-a normal vaginal delivery?

-a caesarian section?

-a forceps delivery?

-a vacuum extraction. (ventouse in french..) 

 

NEONATAL HISTORY 

What was the birth weight?

Were there any complications in the newborn period?

Sometimes complications happen : jaundice, anaemia, difficulty in breathing, apnea, fits, convulsions, vomiting, etc

 

FEEDING HISTORY

-How was the child fed? and for how long ?

bottle or breast:   breast-fed; bottle-fed: Was the child breast-fed?

Were vitamine supplements given?

What formula feed did you use?    Formula is a ready-made, close-up milk for babies that contains all they need.

At some point, solids are introduced...

At what age were solids introduced?    six   nine monts...

Is the baby a good eater? or a poor eater?

Is he a very hungry baby?

Is he a windy baby?

Are his bowel motions normal?

Was there a satisfactory weight gain in infancy?

IMMUNIZATIONS

DEVELOPMENTAL MILESTONES

SOCIAL HISTORY

CHILDHOOD DESEASES                       to be seen later on...

QUIZ

1 During  pregnancy there is no need to pay attention to what you eat or drink because the placenta between the mother and the foetus is there as a prevention.

2 During pregnancy the mother must be careful to cook her meat well so as not to catch parasites such as toxoplasmosis, above all at the beginning but even until the end of it.

3 Immunizations of the mother must be complete before the beginning of the pregnancy 

Loéva 10 th: THE GENITAL TRACT PART TWO THE MALE GENITALIA

 Do you have any pain in the penis ? When?

during rest

or during micturition

or during intercourse ???

Is your testis normal or do you have any swelling or  lump, or any pain around your testis ?

Do you have any discharge from your urethra ?

Two testicles; the left one is usually lower than the right one. 'One can say testis as well'

 Lumps or tumors can be discovered by the patient or the doctor when examining.

Discharge from the urethra can be uncovered: the same as for the woman, it means there is some kind of infection.

Sexually transmitted deseases- Sexually transmitted infections (STIs), also known as sexually transmitted diseases (STDs), are caused by various bacteria, viruses, or parasites that are transmitted through sexual contact.

1. Prevalence: More than 1 million STIs are acquired every day worldwide, with the majority being asymptomatic.
2. Common Curable STIs:
   • Chlamydia
   • Gonorrhea
   • Syphilis
   • Trichomoniasis
3. Viral STIs:
   • HIV
   • Genital herpes simplex virus (HSV)
   • Viral hepatitis B and C
   • Human papillomavirus (HPV)
   • Human T-lymphotropic virus type 1 (HTLV-1)
4. Impact:
   • STIs can lead to stigmatization, infertility, cancers, pregnancy complications, and increased risk of HIV.
   • Hepatitis B is associated with chronic liver disease.
   • HPV is linked to cervical cancer and anal cancer.
   • Syphilis in pregnant women can result in adverse birth outcomes.
5. Drug Resistance: Resistance to drugs poses a significant threat in managing STIs globally.

Remember that practicing safe sex, regular testing, and seeking medical advice are essential for preventing and managing.

QUIZ

a)    There is no need to apply a condom to prevent sexually transmitted deseases if one uses the pill.

b)    If one has caught some sexual transmitted bug he always know it rapidly because of burning sensations when passing urines.

c)   Doctors suggest young people and even less young people having intercourses for the first time apply at the same time two means of contraception..for some time: condom use and pill altogether at the beginning of sexual intercourse.

and Copilot suggests (=Chat GPT:djipiti!)

1. Abstinence: The safest method to avoid STIs is to abstain from sexual activity altogether. This means refraining from vaginal, oral, or anal intercourse.

2. Condom Use: Properly using a condom during every sexual encounter can help reduce the risk of STIs. Condoms provide protection against most STIs. However, it’s essential to note that some STIs, such as herpes or HPV , can still be transmitted through skin-to-skin contact even when using a condom. Make sure to use high-quality condoms and put them on correctly.

3. Limiting the Number of Partners: Commit to having sexual relations with only one partner who also commits to monogamy. Ensure that both you and your partner get tested for STIs to verify that neither of you is infected.

4. Vaccination: The most common vaccine to prevent STIs is the HPV vaccine. It is safe, effective, and can help prevent HPV-related health issues such as genital warts and certain cancers. The HPV vaccine is recommended for boys and girls aged 11 to 12, but it can be administered as early as age 9. It is also recommended for everyone up to age 26 if not already vaccinated.

5. Open Communication with Your Partner: Discuss STI prevention and safety with your partner before engaging in sexual activity. While it may be uncomfortable, protecting your health is your responsibility.

6. Get Tested: Many STIs do not present symptoms, yet they can still cause health problems. Talk to your healthcare provider and seek the tests recommended by the CDC . The only way to know for sure if you have an STI is to get tested.

7. If You Test Positive…: Contracting an STI is not the end of the world! Many STIs are curable, and all are treatable. If you or your partner is infected with a curable STI, both of you should start treatment immediately to prevent reinfection.

Remember that prevention is crucial for maintaining your sexual health.

 

 

Loéva 9 th: Genital tact : Part One The female genitalia

 When did you get your first periods: how old were you ?

What is the date of your last menstrual period ?

Dit it last long ? 

How is your menstrual flow ?   heavy or scanty ?

Are you losing more blood than usual ?

Do you have pain at the periods?  (Dysmenorrhea) ?

Do you loose any blood between your periods ?

Do you get abdominal pain midway between the periods ?

Do you get hot flushes ?  (Menopause...)

Yes....In English doctors ask if there is a vaginal discharge ?

The patient with vaginitis answers yes she has a vaginal discharge and the doctor asks what it looks like ?

Answers ....Reddish or brown

or thick, creamy, sticky..

or is it scanty, clear, or green

is it a heavy discharge ?

Is there any itching ?  (Vaginal pruritus)

around the vulva

the vagina

the front passage  ?

INTERCOURSE

Is intercourse painful ? (Dyspareunia)

BREAST SYMPTOMS

Do you get any pain, any tenderness in your breasts before your periods ?

Do you have lumps in your breasts ? (growths, tumors)

Do you have any swelling in the breasts, when ?  

QUIZ/

a) The breasts remain the same before, between and after the periods.

b) A vaginal discharge  is a symptom of vaginitis caused by some bacteria or parasites or thrush.

c) The "day after" pill is used to prevent or stop the pains related to the menstrual flow.

Loéva 8 th: Urinary system ; From mild pain to excruciating pain

Kydneys: two ;One bladder ; To pass one's urine; burning sensation; back pain (pain in the loin)

pain in the groin (Lo has a lymph node or a growth in her left groin... She told me recently it was gone, good news!)

pain in the suprapubic area: the bladder is just there: cystitis is the name of the desease when you have infection of the bladder

pain in the side left or right; spreading to the groin or to the suprapubic area: people with "kydney stone" have terrible pain spreading from their side or their back to the groin or the bladder; this pain can be excruciating which means absolutely unbearable: the patient doesn't know and cannot tell where his pain is coming from or spreading to...

PAIN IS THE MAIN SYMPTOM 

To diagnose the disease the doctor has to know the site of the pain: back, side, pubic area etc

Where does it hurt ?

When did it start ? At what date, at what time?

HOW: Did the pain begin little by little or suddenly ?

WHY: Do you know what causes it, is it the first time, did you suffer the same thing before ?

SEVERITY: Did you take pain killers ?

Does it force you to carry out your activities ?

Does it force you to go to bed ?

Does it force you to roll around seeking a comfortable position ?

KIND OF PAIN

Is it a burning sensation ?

Is it just a mild discomfort ?

Is it a nagging pain ?

Or is it a stabbing pain ( a sharp pain like a knife) ?

Do you have a bursting feeling ?, a distension ?

DURATION

How long have you had this pain ?

How long does it last when you get it ?

Does it fluctuate ?

RADIATION

Does the pain spread ?

Lower down ?  to the groin ? to the side ?

ASSOCIATED FACTORS

Nausea: Do feel like vomiting ? = do you have nausea ,

Fever: Do you feel cold ? Are you shivering ?

HISTORY personal history/family history

HAVE YOU EVER SUFFERED FROM RENAL COLIC ?

KYDNEY STONES ?

QUIZ

a) A kydney stone can "travel", move from the kydney to the bladder and be found in the urines.

b) If I feel like vomiting, and have a fever, and if I'm shaking, shivering this cannot be caused by a kydney stone

c) If there are signs of infection: difficulty passing urines (more often than usual, very little at a time, with a burning sensation) it can only be cystitis I'm suffering from.

 

LOEVA 7 Heart attack

CARDIO-VASCULAR  DESEASES 

Heart attack is the usual word to call that condition when the heart suffers from infarction -it is infarction of the muscle: myocardial infarction. The more severe  the attack is, the worse the condition is. Usually heart attacks happen because of a blocked artery inside the heart: what causes the blockade ?

A heart attack occurs when the blood flow to the heart is blocked, which can cause damage to the heart muscle. The most common cause of a heart attack is coronary artery disease  

. This is when the coronary arteries, (which supply oxygen-rich blood to the heart muscle), become narrow due to the buildup of fatty deposits, cholesterol, and other substances called plaque. 

Over time, this buildup hardens into cholesterol plaques, which can cause blood clots to form on the plaque’s surface. If the clot becomes large enough, it can block the blood flow to the heart, leading to a heart attack .

Other causes of heart attack include:

•  Often :A sudden and serious spasm (tightening) of your coronary artery.
• USUALLY: A coronary artery embolism, which occurs when a blood clot travels through your bloodstream and gets stuck in your coronary artery .
• Sometimes :Spontaneous coronary artery dissection (SCAD), which occurs when a tear forms inside your coronary artery .

The following factors are associated with an increased risk of a heart attack:

• Age
• High cholesterol levels
• Diabetes
• Diet with too much sugar, too much fat, too many calories
  
• Genetics
• Hypertension (high blood pressure: HBP)
  
• Obesity
• Smoking
• Stress at work.

To prevent  heart attack, it is recommended to:

• Quit smoking
• Have a balanced and healthy diet
• Stay active: do plenty of exercise
• Get sufficient and quality sleep
• Keep diabetes under control
• Reduce alcohol consumption
• Maintain optimal blood cholesterol levels
• Keep blood pressure under control
• Maintain a healthy body weight
• Avoid stress and learn to manage stress.

The patient comes to the surgery. He complains about his pain in his chest. He has got a chest pain. What kind of chest pain is it? Is it a constrictive pain? a tightness? or is it just achy, just a dull pain?

Sometimes the patient has to call 15,  straight away, to call for an ambulance and be brought to the emergency department of the hospital.  

QUIZZ

1  The heart is a muscle

2  Alcool is good for your health; it is "the french paradox".

3  Smoking is good to reduce stress and avoid heart attack.