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 wasn’t 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 didn’t 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 Chemistry Clinic  

Hemoglobin

Eritrocyte

Leucocyte

Hematocryte

Trombocyte

Diff count

:

:

:

:

:

11,6 gr/dL

4.190.000/

mm3

11.500/mm3

37%

229.000/L

0/5/55/34/8

Ureum

creatinin

 

Elektrolit

Natrium

Kalium

:

:

 

 

:

:

39 mg/dL

1,26 mg/dL

 

 

140 mg/dL

4,0 mg/dL

Opacity on left paravertebrae, L1,L2-3

• 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

Foto polos abdomen BNO - IVP

Working diagnose Nefrolitiashis dextra + Ureterolithiasis Sinistra

Differential diagnose Cholic abdomen ec Acute appendicitis

Treatment Non Pharmacology

Bedrest Diet NB Education about the disease Observation of vital sign

Pharmacology 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 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,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

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