2. Deyo RA. Evaluating and Managing Acute Low Back Pain in the Primary Care Setting.J Gen Intern
Med. 2001 : 16 :120-131.
3. Chou R, Qaseem A, Snow V, Casey D, Cross TJ ,Shekelle P, Owens DK. Diagnosis and
Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Ann Intern Med.2007 ; 47: 478-491
4. Chou R and Huffman LH. Nonpharmacologic Therapies for Acute and Chronic Low Back Pain: A
Review of the Evidence for an American Pain SocietyAmerican College of Physicians Clinical Practice Guideline. Ann Intern Med.2007 ; 47: 492-504
5. Mogil J. Pain 2010 an Updated Review. IASP Press, seattle, 2010. NEUROGENIC BLADDER
dr. Kumara Tini, Sp.S, FINS
Aim : Describe the the structure of urinary bladder and understand the normal micturation mechanism and
neurogenic bladder dysfunction. Explain clinical characteristic, risk factors , diagnostic work-up including history, clinical examination and treatment of neurogenic bladder.
Learning outcome :
1. Know the the structure of urinary bladder and understand how they normally operate to control
of micturition
urination 2. Understand and be able explain
that impairs bladder and bladder outlet afferent and efferent signaling can cause neurogenic bladder.
3. Understand and be able explain pathophysiology of neurogenic bladder. 4. Be able to obstain a comprenhensive history, physical examination and assessment of patients
with neurogenic bladder. 5. Understand management of neurogenic bladder.
Abstract
Neurogenic bladder dysfunction, sometimes simply referred to as neurogenic bladder, is a dysfunction
of the urinary bladder
due to disease of the central nervous system
or peripheral nerves involved in the control of
micturition urination.
Symptoms of neurogenic bladder range from detrusor underactivity to overactivity, depending on the site of neurologic insult. The urinary sphincter also may be affected, resulting in sphincter underactivity or
overactivity and loss of coordination with bladder function. Urinary incontinence, characterized by either
the involuntary release of large volumes of urine or continuous dribbling of small amounts, bed-wetting may occur, frequent urination, Persistent urge to urinate despite recent voiding; constant feeling that the
bladder is not completely empty, pain or burning on urination and dribbling urine stream
The appropriate therapy and a successful outcome are predicated upon accurate diagnosis through a careful medical and voiding history together with a variety of clinical examinations, including urodynamics
and selective radiographic imaging studies.
Self assesment.
1. What is the classification of neurogenic bladder ?
2. What is causes of neurogenic bladder ?
3. Explain the mechanism neurogenic bladder?
4. Explain the diagnostic work-up neurogenic bladder?
5. Explain the treatment of neurogenic bladder
Scenario :
Faculty of Medicine Udayana University, DME 45
A 55 years old man, fisherman complaint urinary retention,
accompanied by a dribbling urinary stream
and sexual dysfunction since 3 months ago. He has been suffering diabetes for 15 years with poorly control of blood sugar.
Learning task :
1. What is the differential diagnosis of this patient ? 2. what is diagnostic work-up for this patients ?
3. What is the management of this patient ?
Learning Resources :
1.
Wein AJ, Rackley RR. Overactive bladder: a better understanding of pathophysiology, diagnosis and management. J Urol. Mar 2006;1753 Pt 2:S5-10.
[Medline]
2.
Rackley, RR, Kim, ED. Neurogenic bladder. Avaiable at http:emedicine.medscape.comarticle453539-overview accessed 11 April 2014
3. Wein AJ, Dmochowski RR. Neuromuscular dysfunction of the lower urinary tract. In: Wein AJ,
Kavoussi LR, Novick AC, et al, eds. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 65.
ACUTE AND REFERED PAIN Dr.dr.Pt. Pramana, Sp.AN., KMN.,M.Kes.
Aims Describe mechanism and function of pain
Learning Outcomes Apply its concepts and principles in acute pain patient setting
Curriculum Contents Describe basic mechanism of pain
Describe neuronal circuit processing of pain Describe role of neurotransmitter in central and peripheral nervous system
Abstracts Of Lectures Pain is a personal, subjective experience that involves sensory, emotional and behavioural factors
associated with actual or potential tissue injury. What patients tell us about their pain can be very revealing, and an understanding of how the nervous system responds and adapts to pain in the short and
long term is essential if we are to make sense of patients’ experiences. Although acute pain and associated responsescan be unpleasant and often debilitating, they serve importantadaptive purposes.
They identify and localize noxious stimuli,initiate withdrawal responses that limit tissue injury, inhibitmobility thereby enhancing wound healing, and initiate motivationaland affective responses that
modify future behavior. Nevertheless,intense and prolonged pain transmission, as well asanalgesic undermedication, can increase postsurgicaltraumaticmorbidity, delay recovery, and lead to development
of chronicpain. The wide area of discomfort surrounding a wound, or even a wound that has healed long ago, such as an amputation stump, is a natural consequence of the plasticity of the nervous system.
An understanding of the physiological basis of pain is helpful to the sufferer, and the professional who have to provide appropriate treatment.
Understanding the anatomical pathways and neurochemicalmediators involved in noxious transmission and pain perception
is key to optimizing the management of acute and chronicpain.
Faculty of Medicine Udayana University, DME 46
According to the International Association for the Study of Pain IASP, pain is defined as “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in term
of such damage. “IASP 1979. With regard to a more recent classification, pain states maybe characterized as physiologic, inflammatory nociceptive, orneuropathic. Physiologic pain defines rapidly
perceived nontraumaticdiscomfort of very short duration. Physiologic pain alertsthe individual to the presence of a potentially injurious environmentalstimulus, such as a hot object, and initiates
withdrawalreflexes that prevent or minimize tissue injury.Nociceptive pain is defined as noxious perception resultingfrom cellular damage following surgical, traumatic, ordisease-related injuries. Nociceptive pain
has also been termedinflammatory 6 because peripheral inflammation and inflammatorymediators play major roles inits initiation and development.In general, the intensity of nociceptive pain is proportional
tothe magnitude of tissue damage and release of inflammatorymediators.Neuropathic pain is defined by the International Associationfor the Study of Pain as “pain initiated or caused by apathologic lesion or
dysfunction” in peripheral nerves and CNS.Some authorities have suggested that any chronic pain stateassociated with structural remodeling or “plasticity” changesshould be characterized as
neuropathic.Neuropathic painis usually constant and described as burning, electrical, lancinating,and shooting.
Case A 45 years old woman was admitted to emergency unit with broken left lower arm and bruishing in her left
foot due to motorcycle accident. She was fully conscious. She was crying for those pain. It was so painful, she told the physician at the emergency unit. She brought to the OR for close reduction and wound toilette
under general anesthesia. The anesthesiologist gave some opioid analgesic and non steroid anti- inflamation drug post anesthesia. She looks comfortable in post anesthesia care unit and discharge at the
same day.
Learning Task
Describe mechanismpathophysiology of pain in this patient? How should we manage the pain in this patient?
What is the risk of under-treatment in the acute pain patients?
Self Assesment
What is meant by analgesia? What is the difference between analgesia anesthesia?
What is hyperalgesia? What is a dysesthesia?
What is neuroplasticity in pain and explain the mechanism?
DAY 6
th
April 16
th
2015 DEMENTIA ALZHEIMER
dr. I Putu Eka Widyadharma, M.Sc, SpSK
Aims : Provide initial assessment and management, established tentative diagnosis and refer patient with
Alzheimer Dementia AD and vascular dementia VaD
Learning outcome : 1. Describe different types of dementia
2. Describe signs and symptoms of dementia 3. Explain risk factors and prevention of dementia
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