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Batu Ginjal & Penanganannya

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Penanganan batu ginjal
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  Kidney Stones - Conditions KIDNEY STONES Go to that section Where do kidney stones become stuck ? Go   Will a stone in the ureter pass spontaneously ? Go   What are the interventions for a kidney or ureteric stone ? Go   What is a ureteric stent ? Go   What is laser treatment for kidney stones ? Go   What is ESWL ? Go   What is PCNL ? Go   Can my stone be dissolved ? Go   Stones during pregnancy Go   Can I prevent a stone from forming ? Go   When should I see a medical kidney specialist ? Go   What are the risks from surgery for a kidney or ureteric stone ? Go   What causes kidney stones ? Go   What follow-up do I need after my stone is treated ? Go   Where do kidney stones become stuck ? This x-ray shows the outline of the urinary tract where stones   can become stuck.     Three locations:  1. Just where the ureter enters the bladder  –  the vesico-ureteric junction (VUJ) 2. When the ureter crosses iliac vessels at the pelvic brim 3. Just where the ureter begins to leave the kidney  –  the pelvi-ureteric Junction (PUJ). Will a stone in the ureter pass spontaneously ? 1. Only if it is small < 5 mm in size 2. We use non contrast CT scan to measure stone size and determine stone location 3. If you have a small stone you will be prescribed 2 drugs to help the stone pass spontaneously: o    Anti-inflammatory tablet either ibuprofen, voltaren or indocid suppositories and o   Flomaxtra (tamsulosin) 4. The combination of these relaxes the muscle in the ureter and helps the stone to pass 5. It can take 2 to 4 weeks for the stone to pass 6. If the pain continues or you get fevers then we may have to abandon this approach and perform endoscopic surgery to remove the stone. What are the interventions for a kidney or ureteric stone ? There are several treatment options:  1. Use medications and watch and wait until it passes 2. For larger stones insert a ureteric stent to unblock the kidney and allow urine to drain 3. Endoscopic surgery using a telescope and laser to fragment the stone 4. Open surgery is rare 5. ESWL, extracorporeal shock wave lithotripsy 6. PCNL, percutaneous nephrolithotomy  7. Dissolve a uric acid stone. The watch and wait option:  1. For small (<5 mm ) stones 2. With no kidney blockage or infection 3. Only when pain can be controlled using oral pain tablets. What is a ureteric stent ? 1. When the stone is causing severe pain and/or blockage and/or infection 2. The stent allows urine to pass around the stone and unblock the kidney and drain infection 3. At a later stage usually within one week we telescopically look into the ureter or kidney and remove or laser the stone. Ureteric stent is a hollow plastic tube that unblocks the kidney. They are also used after laser stone treatment for a short period of time to allow stone fragments to pass through the system.   What is laser treatment for kidney stones ?  There are 3 steps involved in treating a stone with laser:  1. Step 1 is to place a ureteric stent to unblock the kidney, relieve pain or infection and return to perform laser within one week when the patient has settled (or in some situations the laser procedure is able to be done right away without having to have the ureteric stent for one week prior) 2. Step 2 is to return within one week and insert a fine flexible telescope that enables the stone to be fragmented using laser. A ureteric stent is more often than not replaced at the end of this procedure in order to allow the stone fragments to pass more easily 3. Step 3 is to have the ureteric stent removed within 48-72 hours of the laser procedure 4. With large stones multiple attempts at laser may be required to achieve complete stone clearance. Laser treatment of a ureteric or kidney stone can require multiple steps.   What is ESWL ?    Ultrasound shock waves are used to break up the kidney stone using a device called a lithotripter ad this is performed as a day procedure under a general anesthetic    The benefit is that it is non-invasive    The problems can be that if the stone is too hard or in a difficult location within the kidney it may fail    Other problems are that large stones may not fragment enough to pass    Some patients still need a ureteric stent to allow the stone fragments to pass
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