Semantic module № 9. Urinary system in children.

Concrete aims:

• To conduct the subjective and objective examination of sick child and interpret the state of urinary system.

• To appoint the necessary complex of diagnostic measures in patient with pathology of the urinary system.

• To interpret the exposed changes as a result of examination of child

Theme 12. Anatomic and physiologic features of organs of urinary system, methods of examination, semiotics of defeats.

Theme of practical training: Method of examination and semiotics of the most widespread microscopic changes of urinary sediment (proteinuria, hematuria, leucocyturia, cilinderuria and other). Syndrome of acute and chronic kidney failure. Care of patients.

Place of training: Educational room in children's nephrological department.

Professional orientation of students: Growth of nephrological pathology of children's age is marked in recent years, especially defeats of kidneys. The urinary system of child has the row of morphological and functional features, without taking into account which examination results and put clinical diagnosis cannot be correctly appreciated. In work of doctor repeatedly there is a necessity in the inspection of child and raising of diagnosis on the basis of clear knowledge of symptoms of defeat of the urinary system. These actions are especially important for timely beginning of treatment.

Base level of knowledge and abilities:

№	Discipline	To know
1. 2. 3. 4.	Anatomy Normal physiology Histology Pathological physiology	Development of the urinary system in fetus and in different periods of childhood. Description of functions of the urinary system. Histological features of structure of kidneys and urinary system. Basic principles of formation of urine and its removing.

Plan of conducting of training.

№	Elements of practical training	Time (minutes)
1. 2. 3. 4. 5. 6. 7.	Verification of presents. Entrance control of knowledge and its analysis Demonstration and explanation of methods of clinical examination of patient with pathology of the urinary system. Distributing of patients for IWS. Independent clinical examination of patient and estimation of the state of the urinary system of child and substantiation of clinical syndrome. Team round of patients, its analysis and substantiation of clinical diagnosis. Results and general estimation of knowledge and abilities of students and task for independent preparation of students to a next training		5 min. 15 min. 30 min. 5 min. 50 min. 50 min. 5 min. Total 160 min.

List of theoretical questions:

1. Anatomic and physiologic features of the urinary system in children of a different age and their clinical value.

2. Method of clinical examination of patient with pathology of the urinary system:

а) inquire.

б) features of inspection: physical development, “kidney pallor”, edema, hemorrhages, ascites;

в) palpation: determination of liquid in an abdominal cavity, sensitiveness and pain in projection of kidneys, bladder palpation of shins, lumbar area, umbilical area with determination of edema; upper and middle points of urethers;

г) features of percussion: determination of free liquid in abdominal cavity, filling bladder, Pasternatsky’s symptom.

д) examination of urine: general analysis of urine, analysis of urine by Ntchiporenko’s, Zimnitsky’s methods, bacteriological analisis of urine for determination of sensitiveness of microorganisms to the antibiotics.

3. Semiotics of defeats of the urinary system in children.

а) description of syndrome of pain;

б) features of proteinuria;

в) features of hematuria;

г) syndrome of edema;

д) syndrome of dysuria;

е) syndrome of acute kidney failure;

ж) syndrome of chronic kidney failure.

4. Estimation of results of laboratory examinations.

Method of conducting of practical training:

1. After verification of presents and announcement of theme of training with the selection of its actuality a teacher conducts the writing entrance control of level of knowledge.

2. Analysis of results of testing and consideration of errors.

3. In a hospital ward a teacher demonstrates the method of clinical examination of patient with pathology of the urinary system.

4. A teacher distributes students between patients and puts the concrete tasks.

№ п.п.	Task	Recommendations of teacher to the students	Notes
1.	To collect anamnesis at a patient with pathology of the urinary system	Algorithm of collection of anamnesis 1.Anamnesis of diseases: beginning of disease; first clinical symptoms; whether treatment was conducted, by what preparations; dynamics of disease; complaints of patient at the moment of examination 2.Anamnesis of life: current of pregnancy in mother; current of delivery; state of health of child in a neonatal and breast period diseases of child; presence of allergic reactions; inherited diseases in family.	It is necessary to put questions which are up to the urinary system. It is necessary to find the negative factors of development of the urinary system
2.	To conduct the objective examination of the urinary system	Algorithm of practical work of student 1. Inspection of patient: physical development of patient; stigmas of dysembryogenesis displays of allergic diathesis; presence of external signs (extrarenal) defeats of urinary system («kidney pallor», edema, hemorrhages). 2. Palpation of abdomen: determination of presence free liquids in abdominal cavity; pain and amplified sensitiveness in projections of kidneys; palpation of lower part of abdomen for determination of edema; 3.Palpation of kidneys in vertical and horizontal positions. 4. Palpation of urinary bladder. 5. Palpation of pain points of ureters.	To conduct the examination of patient taking into account age-old features.
3.	To make a conclusion about the state of the urinary system in a child. To define the syndrome of defeat of organs of the urinary system.	Algorithm of practical work of student 1. To define the pathological changes (symptoms) in the urinary system. 2. To make the report of pathological information (symptoms) 3. To make a conclusion about the syndrome of defeat of the urinary system.	To give estimation to the exposed changes taking into account age features

5. Students fill protocol of examination of patient with estimation of the state of the urinary system with substantiation of pathological syndrome.

6. A teacher conducts the analysis of patients with estimation of done by the students substantiation of pathological syndrome. Signing of protocols.

7. A teacher works out the resume of training, gives estimation of knowledge and abilities of students and task of independent preparation to a next training.

Hardwares and materials of providing of training.

1. Tables: “Capacity of urinary bladder in the children of a different age”, “Skeletotopia of kidneys in children“.

2. Set of analyses of urine with the changes at different diseases of kidneys (10 standards).

3. Set of test tasks of entrance control (10 copies).

4. Set of test tasks of entrance control (10 copies).

5. Set of situation clinical tasks (5 copies).

6. Methodical developments:

1. “Anatomic and physiologic features of urinary system in children”

2. “Indexes of arterial pressure in children of different age”.

3. “Method of examination of the urinary system”

Forms and methods of self-control:

1. Before what age in children structure of kidneys is lobular?

1. 1 year

2. 2 years

3. 3 years

4. 10 years

5. 14 years

2. Ratio of thickness of cortical and medullar layers of kidneys in new-born makes:

1. 1/2

2. 1/3

3. 1/4

4. 1/5

5. 1/10

3. The capacity of urinary bladder in new-born makes:

1. 30 ml.

2. 80 ml.

3. 100 ml.

4. 200 ml.

5. 1000 ml.

4. Mass of kidneys in new-born child in relation to mass of body makes:

1. 1:50

2. 1:80

3. 1:100

4. 1:150

5. 1:200

5. Specific gravity of urine of new-born child:

1. 1006-1012

2. 1002-1006

3. 1012-1020

4. 1020-1025

5. 1025-1030

Standards of answers:

1.B

2.C

3.A

4.C

5.A

Clinical situation tasks

Task 1.

A 1 month girl was admitted to the children's hospital with the complaints of mother about the expressed restless of child, especially during urination, increase of body temperature by 38°С, weakness, changes in urinanalyse. It was reveal proteinuria, leucocyturia 60-80 in r/v.

What syndrome can be depending in sick child?

Task 2.

6 years old patient has complaints on weakness, fatigue ability, headache, edema at the face. Skin is pale, АP is 160/90 mm Hg, daily amount of urine is 500 ml, color of urine "meat slops", specific gravity of urine is 1009-1015, proteinuria 1,2 g/l, erythrocytes cover all r/v.

What disease this child has?

Task 3.

10 years old boy has complaints on dull pain in a lumbar area, increase body temperature - 38°С, skin is pale. АP - 110/70, ESR - 22 mm. Daily amount of urine is 1300 ml, urine is troubled, specific gravity is 1009- 1020, protein - 0,099 g/l, Leuc.- 50-80 in r/v, Erythr. - 5-7 in r/v. What disease is most reliable in this child?

Standards of answers:

1. Pyelonephritis

2. Glomerulonephritis

3. Pyelonephritis