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NEPHROLITIASHIS DEXTRA +

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

Identify

Name : Mrs. Siti Khodijah


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

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.
The pain getting worst and felt like
stabbed, the patient felt hot and spread
into lower stomach. The pain came
unexpectedly. The pain made patient lay
down and sweaty. Patient cant localized
the point of pain. Patient also felt chest
pain on left chest, she confess that was
the first pain, a long time ago she never
felt sick like this.

1 month ago the sick of left waist


appeared and getting often. In other
way,patient felt nausea and vomting until
5 times a day. The vomiting was a food
what she ate and drunk, the colour of
vomiting wasnt green. Sick whenever
urination or urination unclearly rejected
by patient.defecate was normal. Trauma
history on stomach or back rejected.
Fever history rejected

Patient confessed she always drink coffee


and coke, she rarely drunk water. She
worked as housewife and made she
rarely activity in outdoor

History of disease
previously

Have a history of stone,rejected by


patient. History of hipertension,rejected.
The patient didnt consuming drugs with
a long term. History of diabetics,rejected.

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
= 36,5 oC
Head : Normocephal, deformity (-)
Eye : Konjungtiva anemis (-/-), sclera icteric (-/-),

pupil isokor, Ray reflect (+/+)

Ear : Sekret (-/-), Otorhae (-/-)


Nose : Septal Deviation (-), Rhinorae (-)
Mouth : no dry, pale (-)
Neck : Enlargement lymph gland (-)

THORAX
PULMONARY
Inspection
: simetris, rectraction (-)
Palpation
: stem fremitus normal
Percussion
: Sonor
Auscultation
: VBS (+/+), Wh/Ro (-/-)
CARDIONARY
Inspection
: Ictus cordis not visible
Palpation
: Ictus cordis palpable , thrill (-)
Percussion
: cardio in normal limit
Auscultation
: cardio sound I/II regular, Murmur (-), Gallop (-/-)

Local Status
Abdomen
Inspection
: Flat, invisible mass
Auscultation
: Bowel sound in normal limit, metallic sound (-)
Palpation
: Tenderness right regio (+), nyeri ketok CVA sinistra (+), nyeri
ketok supra simphisis (+), defans muskular (-), balottement (-), hepar/lien not
palpable, not palpable mass
Percussion
: Tymphani in all quadrant abdomen

Additional Examination
Hematology
Hemoglobin
:
Hemoglobin
:

Chemistry Clinic
11,6 gr/dL
Ureum
Ureum

Eritrocyte
Eritrocyte

:
:

Leucocyte
Leucocyte

:
:

Hematocryte
Hematocryte

:
:

Trombocyte
Trombocyte

:
:

4.190.000/m creatinin
creatinin
3
m

3
11.500/mm
Elektrolit
Elektrolit
37%
Natrium
Natrium
229.000/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
: 4,0 mg/dL
: 4,0 mg/dL

Foto polos abdomen

Opacity on left paravertebrae, L1,L23

BNO - IVP

Non visualized right kidney


Nephrolitiasis right kidney on
L1,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

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

Case analysis

A woman 54 years old worked as


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

In physical examination, vital sign was in


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

In radiography examination, BNO & IVP (29


October 2015), non visualized in right kidney,
nephrolithiasis dextra on L1, L2-L3, excretion
function dan secretion of left kidney was
good.
In USG abdomen, 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. In this
case, the patient is a woman and 54 years
old. Patient worked as housewife wherever
consuming coffee and coke. In other way,
patient rarely consuming water so se felt
dehydration

From anamnesis, patient confess that she


havent 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,kidney,and ureter
Cause the patient came with stone in
kidney on L1,L2-L3 so the therapy was
open surgery likes pielitotomy and
nephrolitotomy to take the stone in
kidney and ureter

THANKYOUVERYMUCH
THANKYOUVERYMUCH