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NEPHROLITIASHIS DEXTRA

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URETEROLITHIASIS SINISTRA
Rahmatul Ikbal.Sked
04084821517017

Lectured by
Dr.Marta Hendry, SpU
Department of Surgery
RSUP Dr. MOHAMMAD HOESIN
PALEMBANG
Faculty of Medicine
Sriwijaya University

Overview

Urolithiasis was a disease have known
since centuries ago. It was evidenced by
research in archeology. One of research
was found a stone in urinary tract on
mummy with 5000 years in Egypt at
1901 by England Archaelogist. Although
the urolithiasis have been known in a
long time ago but the etiology of the
disease still debated

Sekayu. Siti Khodijah Age : 54 years old Gender : woman Religion : Islam Education : junior high school Worked as : housewife Status : married Address : Serasan Jaya. Med Reg : RI 15029177 MRS : 09-11-2015 Pukul 19:30 Wib .Identify           Name : Mrs.

Chief Complain Sick of left waist since 6 months ago  Additional Complain  Nausea and Vomiting .

History of disease  ± 6 months ago patient have a complain with sick of left waist and felt like cholic. she confess that was the first pain. Patient also felt chest pain on left chest. . a long time ago she never felt sick like this. The pain made patient lay down and sweaty. the patient felt hot and spread into lower stomach. The pain getting worst and felt like stabbed. Patient cant localized the point of pain. The pain came unexpectedly.

Fever history rejected . Trauma history on stomach or back rejected. The vomiting was a food what she ate and drunk.defecate was normal. the colour of vomiting wasn’t green. Sick whenever urination or urination unclearly rejected by patient. In other way. ± 1 month ago the sick of left waist appeared and getting often.patient felt nausea and vomting until 5 times a day.

she rarely drunk water. Patient confessed she always drink coffee and coke. She worked as housewife and made she rarely activity in outdoor .

rejected by patient.rejected. History of hipertension. The patient didn’t consuming drugs with a long term.History of disease previously  Have a history of stone. History of diabetics.rejected. .

Otorhae (-/-) Nose : Septal Deviation (-). deformity (-) Eye : Konjungtiva anemis (-/-). sclera icteric (-/-). Ray reflect (+/+)      Ear : Sekret (-/-). pale (-) Neck : Enlargement lymph gland (-) .Physical Examination  General status          General State : look likes a mild sick Consciousness: Compos Mentis (GCS : 15) Vital Sign : BP = 120/80 mmHg PB = 80 x/menit RR = 21 x/menit T = 36. Rhinorae (-) Mouth : no dry. pupil isokor.5 oC Head : Normocephal.

metallic sound (-) Palpation : Tenderness right regio (+). defans muskular (-). Wh/Ro (-/-) CARDIONARY Inspection : Ictus cordis not visible Palpation : Ictus cordis palpable . Gallop (-/-)         Local Status Abdomen Inspection : Flat. balottement (-). nyeri ketok CVA sinistra (+). thrill (-) Percussion : cardio in normal limit Auscultation : cardio sound I/II regular. Murmur (-). rectraction (-) Palpation : stem fremitus normal Percussion : Sonor Auscultation : VBS (+/+). not palpable mass Percussion : Tymphani in all quadrant abdomen . nyeri ketok supra simphisis (+). invisible mass Auscultation : Bowel sound in normal limit.          THORAX PULMONARY Inspection : simetris. hepar/lien not palpable.

500/mm Elektrolit Elektrolit 37% Natrium Natrium 229.0 mg/dL : 4.6 gr/dL Ureum Ureum Eritrocyte Eritrocyte : : Leucocyte Leucocyte : : Hematocryte Hematocryte : : Trombocyte Trombocyte : : 4.190.0 mg/dL .Additional Examination Hematology Hemoglobin : Hemoglobin : Chemistry Clinic 11.000/L Kalium Kalium 0/5/55/34/8 Diff count Diff count    : 39 mg/dL : 39 mg/dL : 1.26 mg/dL : 1.26 mg/dL                 : 140 mg/dL : 140 mg/dL : 4.000/m creatinin creatinin 3 m     3 11.

L2-3 • Excretion function and secretion function left kidney was in normal • Looked a stone/ dam sign on left kidney • Emptying function of vesica urinaria was in normal .Foto polos abdomen Opacity on left paravertebrae. L1.L23 BNO .IVP • Non visualized right kidney • Nephrolitiasis right kidney on L1.

 Working diagnose   Nefrolitiashis dextra + Ureterolithiasis Sinistra Differential diagnose  Cholic abdomen ec Acute appendicitis .

 Treatment Non Pharmacology      Pharmacology       Bedrest Diet NB Education about the disease Observation of vital sign IVFD RL gtt xx/menit Antibiotica: Cefazoline 2x1gram Analgetica: Ketorolac 3x1amp (20mg) Anti histamine: Ranitidine 2x1amp (25mg) Rehidration >2L/day Operative procedure    Pro uretrolitotomy sinistra URS DJ Stent dextra .

Prognosis   Quo ad vitam : ad bonam Quo ad functionam : ad bonam .

history of disturbance urination (-). green of vomiting (-).cholic on left waist. sand on urine (+). Blood on urine (-).Case analysis  A woman 54 years old worked as housewife came with sick of left waist. stone in urinary tract (-). fever or night sweaty (-).vomiting (+) contents what she ate and drunk. The pain getting worst and felt like stabbed. The patient confessed that symptom appeared 2 months ago. urination unclearly (-) . In family history. .

Inspection. leucocyte was in normal. there was a bulging on regio lumbal dextra. creatinin was increase and ureum was in normal. crystal urine (-). In abdomen examination. . there was microhematuria because more eritrocyte in urine. pain of CVA dextra et sinistra (-). In laboratory examination. tenderness (-) on suprapubic (-). In urinalysis. vital sign was in normal.   In physical examination. patient looks have a mild sick.

the patient is a woman and 54 years old. L2-L3. In USG abdomen. In other way. hydronephrosis dextra with normal organs abdomen Based on etiology. prevalence of urolithiasis more happens in men than woman. and increase on age 40 – 60 years old. patient rarely consuming water so se felt dehydration . Patient worked as housewife wherever consuming coffee and coke. In this case. nephrolithiasis dextra on L1. non visualized in right kidney.   In radiography examination. excretion function dan secretion of left kidney was good. BNO & IVP (29 October 2015).

kidney.   From anamnesis. patient confess that she haven’t the disease in family and the disease was a first time she felt. Etiology of hydronephrosis is a chronic obstruction in urinary tract so it makes pressure of fluid accumulation in pelvic.L2-L3 so the therapy was open surgery likes pielitotomy and nephrolitotomy to take the stone in kidney and ureter .and ureter Cause the patient came with stone in kidney on L1.

THANKYOUVERYMUCH THANKYOUVERYMUCH .