1. Practical lesson №1 Subject: Dysuria
Practical lesson №1 Subject: Dysuria. Differential diagnosis of urine acid diathesis and cystitis. Tactics of GP. Indications for the direction to the narrow expert or hospitalization in profile office. The principles of treatment, supervision, control and rehabilitation in the conditions of SVP or the joint venture. Principles of prevention».

2. The purpose of the training session
: Getting GPs on timely diagnosis and differential diagnosis of urine acid diathesis and cystitis. The clinical course and the principles of management of patients in primary care, provided the requirements of the "Qualification characteristics of the general practitioner."

3. Pedagogical objectives:
Consider diagnosis of cystitis and urine acid diathesis
Demonstrate patients with uric acid diathesis and cystitis
Discuss the results of clinical, laboratory and instrumental studies at urate diathesis and cystitis.
Make a differential diagnosis of urine acid diathesis and cysts.
Discuss questions about tactics in the qualifying characteristics of GPs
Discuss the principles of treatment (non-drug and drug).
Discuss the principles of management, supervision and monitoring of patients in a rural health units or a family policlinics.
Discuss the principles of primary, secondary and tertiary prevention in these diseases..

4. The student should be aware of:
The mechanism of urine acid diathesis and cystitis
Clinical manifestations of disease:
urate diathesis and cystitis
Diagnosis of diseases: urate diathesis
and cystitis
Differential diagnosis of these diseases:
The principles of treatment (drug and
non-drug) for the diseases.
Principles of follow-up and monitoring of patients in a rural health units, or family policlinics.
The principles of primary, secondary and tertiary prevention in these diseases.

5. GPs should be able to:
Data analysis and history of complaints for the diagnosis of cystitis and urine acid diathesis
Diagnose, to differentiate on clinical, laboratory and instrumental data of the disease.
Choose products with proven efficacy
Advise on non-medicated treatments.
To monitor the RHU or in family
policlinics.

6. Urine acid diathesis, disease and occur when exchanging nucleoprotein, characterized by elevated levels of uric acid and its salts in the blood, followed by deposition of uric acid crystals and amorphous sodium urate.
The mechanism of formation of stones in the urinary tract is not fully understood, but it is known that the main role belongs to the body of a man who for some reason can not cope with the "purification", "removal", "solutionof rhenium."These reasons are not fully defined. However, we know that a lack of magnesium in the organizationzme promotes the formation of stones in the urinary tract, and colloidal polysaccharides found in abundance, do not allow to join salts (rocks). Most scholars tend to attribute the cause to the tubulo-and fermentopathy.

7. When initial treatment should know which of the "stones" have a place in this patient. This is a complex issue diagnostic, but decides on the analysis of urine and ultrasound. The most frequent oxalate (56%), then - urate (19%), at least - phosphate (8%), others - mixed (17%).
              Urine acid diathesis (neuro-arthritic).At the heart - a violation of the protein (purine metabolism) + drug in solution of carbohydrate + lipid. Inherited by type fermentopathy. Critical age - school. Syndrome: neurasthenic, skin (urticaria, angioedema, dry seborrheic dermatitis, atopic dermatitis). Syndrome exchange (or padagrichesky padagra: arthralgia, pain), spastic syndrome (constipation, sheep feces, vomiting, paroxysmal abdominal pain, dyskinesia, functional diseases of the stomach.

8. Diagnosis:
acetone in the urine, blood: elevated hemoglobin, hematocrit, chloropenia, hypoglycemia, the development of metabolicacidosis or alkolosa, uric acid is> 268 umol / l.
Treatment:
During the attacks - elimination diet (no protein, alkaline water and enemas, Luminal, bromine, cocarboxylase, vitamin C, Riboxin, Essentiale, splenin, enzymes), detoxification therapy, phytotherapy.

9. The Factors of the risk: 1. Undercooling;
Cistitis - infectious-inflammatory process urinary bubble with primary defeat of the mucous shell.
The Factors of the risk:
1. Undercooling;
2. The Chronic inflammatory diseases feminine sexual spheres;
3. The De-flower;
4. Instrumental interference (cаtеtеrisаcia of urinary bubble, introduction x-rays contrasting facilities);
5. Hyperplacia and cancer of the postate gland, stone and tumors of urinary bubble;
6. The Breach of the fraudulent processes (the углеводного, fatty, saline);
7. Beam therapy;

10. The Criteria of the diagnostics:
increased the frequency of and painful urination;
an imperative urges on urination;
an absence to warm-up reaction;
leukocyturia, bacteriuria, proteinuria, hematuria in general urinalysis;
bacteriuria more 100 thous. microbial tel in 1 ml in sowing of the urine;
a bulge of the wall urinary bubble, finding stone, tumors, anomaly of the development at ultrasonographyof urinary bubble.

11. Laboratory- instrumental methods of the study:
- a general urinalysis;
- a sowing of the urine on микрофлору and sensitivity to antibiotic.
Instrumental:
- ultrasonography of urinary bubble and urinary ways.
The Evidences for direction to urologist:
- inefficacy medical treatments for 7 days;
- complicated сistitis (pyelonephritis, stone on urinary bubble, tumors urinary bubble and prostates);
- hematuria;

12. The Criteria to efficiency of the treatment:
non-drug:
- an ample drink;
- an exception from diet of the sharp food, seasonings,
- a diuretic herbs;
- an abstention from sexual contact during 5-7 days.
medical:
- nitrоfurаntоin on 100мг 4 times in day - 7 days or
- norfloktatsin on 400 mg 2 times in day - 7 days or
- ciprоflоksаtsin on 250 mg 2 times in day - 7 days.
The Criteria to efficiency of the treatment:
the normalization of the act of the urination and urinalysis.
The most Further observation:
Is not required.