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Hydronephrosis
Pathophysiology of acute pyelonephritis essay
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Between February 2012 and June 2015, three patients (2 females and one male) underwent laparoscopic repair for RCU in our department. Mean age was 36 years (range 18 - 48). All patients were symptomatic with in all cases a history of intermittent moderate right- side flank. One female patient had repeated episodes of acute pyelonephritis on the same side.
Abdominal ultrasound demonstrated right renal hydronephrosis in all patients. Urography showed medial displacement of the right JJ catheter. A computed tomography scan (CT) suspected the presence of a retrocaval ureter. Diuretic renography with 99mTc-DTPA showed significant obstruction in one patient. After informed consent, the patients had laparoscopic Pyelo-pyelostomy as described bellow.
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The patient was first placed in the lithotomy position and underwent right ascending pyelography to confirm the diagnosis (typical image in the form of a hook or S-shaped (Figure 1). A right JJ catheter was then placed. After that, the patient was placed in right- side-up flank position and a transperitoneal approach was used.
The colon was reflected medially exposing the retroperitoneum. The renal pelvis and proximal ureter were identified helped by the presence of the jj catheter. The ureter was dissected and followed until the right side of the vena cava. In the interaortocaval area the ureter was identified and dissected caudally (Figure 2, 3). Using sharp and blunt dissection the retrocaval segment was then entirely mobilized and separated from the inferior vena cava (IVC). The renal pelvis was sectioned. The stent was partially withdrawn and the ureter was drawn medially from behind the vena cava. After checking the retrocaval portion was not atretic, the renal pelvis and the ureter were reanastomosed with running 4-0 polyglactin sutures in a normal anatomic
Liver percusses to 8 cm at midclavicular line, one fingerbreadth below right costal margin: This indicates that the patient does not have signs or symptoms of liver disease or ascites.
Many people never find out that they have had stones in their kidneys. Some stones are small enough to flow through the kidney without ever causing any pain. These are called "silent stones"(Ford-Martin & Odle, 2005) Kidney stones cause problems when they get in the way of the normal flow of urine. They can block the flow through the ureter that carries urine from the kidney to the bladder. “The kidney is not accustomed to experiencing any pressure. When pressure builds from backed-up urine, it causes hydronephrosis” (Ford-Martin & Odle, 2005). If the kidney is subjected to this pressure for a while, there may be damage to the fragile kidney structures. When the kidney stone is lodged further down the ureter, the backed-up urine may also cause the ureter to swell. Because the ureter is a musc...
In one of the meetings with the mentor regarding altered and/or impaired homeostatic function, a case study of a patient admitted with sepsis was discussed. Assessment, care and evolving treatment provided was looked into. Following the discussion, the management of sepsis has been examined further by the learner as she was not familiar with the bundle of six sepsis mentioned by the mentor. The learner looked on the situation and reflected back on the occurrence that took place realizing if appropriate measures were implemented and how things can be different in future practice (Schon, 1987). This
7) Spettel, Sara, and Mark Donald White. "The portrayal of J. Marion Sims' controversial surgical legacy." The Journal of urology 185.6 (2011): 2424-2427.
Hurtado R, Bub G, Herzlinger D: The pelvis–kidney junction contains HCN3, a hyperpolarization-activated cation channel that triggers ureter peristalsis. Kidney International 2010;77:500–508.
26-Noble S, Asgar A, Cartier R, Virmani R, Bonan R. Anatomopathological analysis after CoreValve ReValving system implantation.EuroIntervention 2009;5:78–85.
2013). Inappropriate use of urinary catheter in patients as stated by the CDC includes patients with incontinence, obtaining urine for culture, or other diagnostic tests when the patient can voluntarily void, and prolonged use after surgery without proper indications. Strategies used focused on initiating restrictions on catheter placement. Development of protocols that restrict catheter placement can serve as a constant reminder for providers about the correct use of catheters and provide alternatives to indwelling catheter use (Meddings et al. 2013). Alternatives to indwelling catheter includes condom catheter, or intermittent straight catheterization. One of the protocols used in this study are urinary retention protocols. This protocol integrates the use of a portable bladder ultrasound to verify urinary retention prior to catheterization. In addition, it recommends using intermittent catheterization to solve temporary issues rather than using indwelling catheters. Indwelling catheters are usually in for a longer period. As a result of that, patients are more at risk of developing infections. Use of portable bladder ultrasound will help to prevent unnecessary use of indwelling catheters; therefore, preventing
Walker, H. (1990). Chapter 93Inspection, Auscultation, Palpation, and Percussion of the Abdomen. In Clinical methods: The history, physical, and laboratory examinations (3rd ed.). Boston:
Shouldice Hospital focus on hernia repair surgery which is mostly performed on males. Shouldice operation strategy involves early ambulation following hernia repair surgery that was superior to others. Only external kind of abdominal hernias were repaired at Shouldice Hospital. Internal types, such as hiatus (or diaphragmatic) hernias were not treated. First time repairs (primaries) of hernias involved straightforward operating procedures that required about 45 minutes. Such cases represent 82% of all operations and remaining were patients suffering recurrences of hernias previously repaired elsewhere. The market was targeted by providing following services
Kaiser, L. R., A. C. O. Surgeons, and W. H. Pearce. Acs surgery, principles & practice. 6th. Webmd Prof Pub, 2007. eBook.
After further multidisciplinary team meetings with the involvement of John the treatment option of automated peritoneal dialysis was implemented (NSF 2004). Once the Tenchkoff catheter had been inserted, education and training completed John was ready for discharge home.
About 82% of all surgeries at the Hospital are primaries. The remaining 18% involve recurrence of hernias repaired elsewhere. These are more complex,
United States Renal Data System (USRDS). (2008). Annual data report: Incidence and prevalence. Retrieved July 8, 2009, from http://www.usrds.org/2008/pdf/V2-02-2008.pdf
From the results of the numerous tests carried out according to the patient history of frothy urine with a significant oedema over a maximum period of 5 days, the patient was diagnosed with Nephrotic Syndrome. This is condition that occurs due to leakage in the kidney filtration part leading to a large amount of protein leaking from the blood into the urine. This is mainly due to fluid retention known as oedema which is as a result of low protein level in the blood. It occurs due to abnormal functioning or a part of the kidney is affected (glomeruli). This syndrome can be caused by numerous diseases coming together to cause or form one particular disease; these causes range from minimal change disease, membranous nephropathy, focal segmental glomerulosclerosis (FSGS) and other conditions, disorders of the glomeruli. The membranous nephropathy also known as the membranous nephritis or membranous glomerulonephritis, only causes diseases in adults and very uncommon in children. Leakage occurs from this due to the thickening of the membranous in the glomeruli which is the filter of the glomeruli. Focal segmental glomerulosclerosis is a causative due to the formation of small scars (sclerosis) on some of the kidney glomeruli. Another form of cause of nephrotic is minimal change which is due to lack of virtual change detected in the glomeruli when examined under the microscope. This causes the syndrome in 9 out of a total of 10 children under the age of 5 years.
It occurs due to the overproduction of Escherichia coli and/or after kidney transplantation. The transplantation can lead to two different types diseases, chronic (long-lasting) or acute (sudden and limited). The kidney’s function are water/fluid balance, removing waste products from blood, and regulation of blood pressure via enzyme Renin. The infection is treatable via prescribed antibiotics. Lastly, pyelonephritis can be prevented by maintaining a positive healthy body. I would like to conclude that learning about pyelonephritis has made me have a different view on the importance of a fit