Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
Let's finish up the kidney. Cancer of the kidney is a common
cancer and is hard to diagnose. Blood in the urine or a mass
felt in the kidney region can help make this diagnosis, but
often it is only weight loss, and fatigue that is seen. The
disease does not respond well to radiation or chemotherapy,
so early detection is a must. Once it has escaped to the
local lymph nodes, survival rates plummet. Diagnosis is most
easily done by an abdominal CT.
The ureter connects the kidney to the bladder and, except for
stones, is relatively disease-free. A common problem with it
however, is that it can be cut during gynecological
operations, specifically hysterectomy. It heals poorly, so
many gynecologists ask a urologist before surgery to mark the
ureters so they are easily identifiable.
The bladder is a structure that lies in the pelvis and stores
urine. It can hold up to 1 liter without backing up, but most
people feel very uncomfortable at 500 cc -- a half a liter.
The most common malady is infection, usually common up from
below. It is far more common in women and, as such, women
must teach their daughters proper bathroom hygiene to avoid
this problem. Not eliminating when one has the urge can also
lead to this problem.
Infection can have any one of the following: fever, frequent
need to use the bathroom although only a small amount of
urine comes out, pain or burning on urination, blood in the
urine. Often in diabetics and the elderly many of these signs
may be absent, and in young children as well.
This disease can go up to the kidneys and even spread to the
blood stream if not treated. High fever, vomiting, pain in
the flank and rigor are signs of a worsening infection.
Treatment fortunately is very simple. Since the kidney
filters most chemicals that reach the body, antibiotics are
no exception and they reach the urine in high
concentrations.
However, the most common microorganism is resistant already
to Resprim (Cotrimazole in UK) and don't let the Kuppah
doctor save money by giving you this drug. Three day regimens
are fine for most uncomplicated regimens. A one day treatment
exists which is drunk as a liquid. Men with this disease and
children under 5 must have their urinary tract studied with
radiographic studies and an ultrasound to make sure the cause
of the problem isn't reflux of urine which may result in
kidney failure. People with one kidney are especially at
risk.
Fungal infections of the tract exist but are rare and usually
in very sick patients. Some parasites like the urinary tract
-- some of these are seen in nearby Egypt -- but again, rare
in this country. Write me in care of the Yated.
A message from Glaxo, sponsor of this column.
Serantide, Glaxo's combination of an inhaled steroid and a
long-acting airway dilator, is a standard in asthma
prevention. It is now available to people in the Clalit
Kuppah, It is worth it; there is no comparable drug in the
market
