Medical English 專欄 (六)

THE URINARY SYSTEM

(I)                           Case

Celeste loved cheese, ice cream, and cappuccino with lots of whipped cream. While driving home after an long working day during which she was too busy even to drink water, she developed sudden severe pain in the left mid-back. Tests revealed a stone in the upper part of her ureter, but with only partially blocked urine flow. She elected to try conservative treatment and spent the following days drinking copious amounts of barley water and eating watermelon. The stone passed few days later. She then close to avoid caffeine and dairy products, and always carry a bottle of spring water in her purse.

(II)                       Q & A

Q: Is there anything that you worry about?

A: 1. I have slight chronic back pain in my right kidney area.

   2. I have poor urinary flow.

   3. I have an urge to urinate frequently.

   4. I have a burning sensation when urination.

   5. I have pain at the start of urination.

   6. I have continuous pain in the lower right side pelvic area, sometimes radiating to the back.

   7. I have cloudy urine.

Q: Does any of your family members have hypertension or other chronic disease

A: 1. My brother has hypertension. His blood pressure reached 210/140.

   2. My father died of kidney cancer when I was 20 years old.

   3. My father and grandfather were both suffered from diabetes and hypertension..

   4. My father had hypertension, and he had a heart attack last year.

 (III)  Kidney stone

About 80 percent of all kidney stones simply pass on their own, usually with your urine within 48 hours. Typically, “renal colic” is a severe pain that has a sudden onset, as the stone blocks the kidney outlet or moves into your very sensitive ureter.

The pain begins in your flank, and radiates down around the lower abdomen into your groin area. You can’t get comfortable. The discomfort may first come in waves, intensifying over a fifteen-to thirty- minute period, to then become steady and excruciating. Finally, the pain may suddenly vanish, as the stone stops moving or passes into your bladder. An attack may be accompanied by nausea and vomiting. You may notice blood in your urine, burning and frequency with urination, or urinary retention. If you also have an accompanying infection, you may develop fever and chill.

(IV)         UTI: Urinary Tract Infection

Burning, frequent urination, painful spasms, and occasional blood urine – these are the all-too-familiar symptoms of urinary tract infections.

UTIs are caused by bacteria from vagina or intestinal tract that migrate up the urethra (urine tube) into the urinary tract, where they multiply within 24 to 48 hours and cause infection.

Urinary tract infections include bladder infections (cystitis) and kidney infections (pyelonephritis).

(V)           What Doctors Say?

1.      Once you’ve had one stone, you are at a somewhat higher risk of getting another. Once you’ve had a second stone, your risk is markedly increased.

2.      By far the single most important preventive measure is to increase water consumption, enough to pass 2 quarts of urine a day.

3.      Of all the stones we see, 92 percent are made of calcium or calcium products. And almost all of the calcium in your diet comes from dairy products. About 60 percent of all stones are known as calcium oxalate stone.

        4. People who are inactive tend to accumulate a lot of calcium in the bloodstream. Activity helps to

              pull calcium back into the bones, where it belongs.

        5. There is a direct correlation between the incidence of kidney stone disease and the amount of protein eaten.

(VI)        Change Your Diet

Most kidney stones are preventable. A diet high in meat, eggs and diary products is the root cause of this prevalent problem. Animal protein in the diet causes the body to excrete more calcium in the urine, to buffer the presence of the excess amino acids in your bloodstream.

Meat also contains purine, which is changed to uric acid in the urine, favoring stone formation. Vegetarians have a lower risk for kidney stones. Changing to a low-fat, vegetarian diet, free of dairy, may be all you need to do to prevent new stones from forming. Adequate fiber in your diet is important too. It acts to bind calcium in your digestive tract, and thus prevent increased amounts from reaching your bloodstream.

(VII)    Vocabularies

                   Cystitis

                   Nephritis

                   Renal Failure / Renal shutdown

                   Kidney Cancer

                   Hematuria / Red Urine

                   Bladder Stone

                   Proteinuria

                   Pyuria

                   Uremia

                   Cloudy Urine / Milky Urine

                   Urinary Incontinence  

                   Oliguria

(VIII)   Dialogues

P: Doctor, what is the cause of his kidney disease?

D: His kidney has been infected by bacteria. We will use antibiotic therapy to control the infection.

P: Would the disease lead to uremia if the treatment is not successful?

D: His disease is not severe. I’m confident we can cure it very soon. Two years ago, I successfully removed his kidney stones.

P: If his disease leads to uremia, what should we do, doctor? Will you use radiotherapy or nephrectomy to save his life?

D: The probability of uremia is very low. If that unfortunately happens, I’ll suggest kidney dialysis or a kidney transplant. Our hospital has sophisticated machines to filtrate his blood. We have competent surgeons to perform kidney transplants too, if his brother would donate a kidney for him.

P: Why do so many people have kidney problems?

N: It’s hard to say. Excessive intake of salt, alcoholism, arteriosclerosis, lead poisoning…… many things can all cause kidney problems.