Laporan pagi

Laporan pagiNama : Tn. DUmur : 49 tahunAlamat: Blimbingan, SlemanNo. RM : 0171xxxTanggal periksa : 25 Februari 2015Identitas PasienSuspek batu ureter proximal dextra, batu ginjal bilateralKeterangan Klinis

Foto abdomen, kondisi cukup, hasil :Tak tampak distensi cavum abdomen.Tampak pre peritoneal fat line dextra et sinistra tegas.Distribusi udara usus merata, fecal material prominent.Tampak psoas line dextra et sinistra tegas.Tampak renal outline dextra et sinistra samar.Tampak lesi opak soliter pada proyeksi renal outline dextra, bentuk bulat, batas tegas.Tampak lesi opak multipel pada proyeksi renal outline sinistra, bentuk bulat, kecil-kecil.Sacroiliaca dan hip joint normal.Sistema tulang yang tervisualisasi intak.

Kesan :Multiple nephrolithiasis bilateralTak tampak batu opak di proyeksi ureter dextraHasil pemeriksaanNephrolithiasisUp to 10% in industrialized nations (up to 20% in males)Onset typically in 3rd or 4th decade; peak in 5th decadeMale: Female 3-4:1Whites >> BlacksApprox 10% need hospitalization; 5% surgeryEpidemiology I. Calcium stones 70% of all stones26% calcium oxalate37% combination calcium oxalate with calcium phosphate5-10% uric acid core7% pure calcium phospateAll are radiopaqueEtiologyII. Uric Acid Stones5-10% of all stones (radiolucent)Uric acid can be increased in pt with high dietary intake and with certain d/os: gout, myeloproliferative, tumor lysis, RxsSuspect in pt with h/o of hyperuricemia and stones seen on IVP or U/S and not KUBMore important than uric acid level is low urine vol and low urine pH.EtiologyIII. Magnesium Ammonium Phosphate Stones (Struvite)10-15% of all stones; most common cause of staghorn caliculistones develop when increased ammonium concentration coincides with alkaline urine and urinary trivalent phosphate (conditions can only be met when bacterial urease present)EtiologyIV. Cystine Stones1-2% of all stonesCystinuria: autosomal recessive trait that generates excessive excretion of cystine (solubility of cystine 250mg/liter)Heterozygote 400-600 mg/dayHomozygote > 600/dayEtiologyRenal colic begins suddenlySevere flank painradiating to groinFrequently with nausea, vomiting, gross hematuria and dysuriaStones < 5 mm generally pass spontaneouslyStones > 7 mm usually require surgical interventionClinical / BackgroundThank you