Docstoc

ECTOPIC KIDNEY

Document Sample
ECTOPIC KIDNEY Powered By Docstoc
					          ECTOPIC KIDNEY
Ectopic kidney usually causes no symptoms unless
complications such as ureteral obstruction or
infection develop
Congenital disorders. Is a low kidney on the proper
side which failed to ascend normally. (Over the
pelvic brim. In the pelvis).
Prone to ureteral obstruction and infection, which
may lead to pain or fever.
 Palpable  examination may find such a kidney,
  leading to an erroneous presumptive diagnosis, eg,
  cancer of the bowel, appendiceal abscess.
 Excretory or retrograde urograms will reveal the
  true position. Hydronephrosis, if present, will be
  evident. There is no redundancy of the ureter, as is
  the cause with nephroptosis or acquired ectopy(eg,
  displacement by large suprarenal tumor.
 Obstruction  and infection may complicate ectopy
  and should be treated by appropriate means.
 Anatomic vision: normal pelvic at the position of
  No. 1 or 2 lumbar vertebral level, kidney mobility
  range is 1—4 cm with respiration . Kidney
  descending level is much than this range at the
  position of standing we call Ectopic Kidney.
                VARICOCELE
 Varicocele   is common in young men and consists
  of dilatation of the pampiniform plexus above the
  testis. The left side is most commonly affected.
 These veins drain into the internal spermatic vein
  in the region of the internal inguinal ring. This vein
  passes lateral to the vas deferens at the internal
  inguinal ring and, on the left side, drain into the
  renal vein. On the right it empties into vena cava.
 The  left internal spermatic vein is particularly
  liable to have incompetent valves. This fact, plus
  gravity, may lead to poor drainage of the
  pampiniform plexus, the veins of which gradually
  undergo dilatation and elongation. At times they
  are painful.
 Sudden development in an old men is sometimes
  as a late sign of renal tumor which invaded renal
  vein, thereby occluding the spermatic vein.
 Examination   upright reveals a mass of dilated,
  tortuous vein lying posterior to and above the testis.
 The degree of dilatation can be increased by the
  Valsalva maneuver. In the recumbent position,
  venous distention abates. Testicular atrophy from
  impaired circulation may be present.
 No treatment is required unless the varicocele is
  thought to contribute to infertility or is painful or
so large as to disturb the patient.
Treatment: scrotal support will relieve discomfort;
  ligation of internal spermatic vein (at the internal
  inguinal ring or HIGH ligation) is indicated. The
  results from this operation are excellent,
  particularly in the treatment of infertility. Vein
  atomosis also applied in clinic and micro injure
  operation by larparoscopy is more fasionable.
                HYDROCELE
A  hydrocele consists of a collection of fluid within
  tunica or processus vaginalis. It may occur within
  the spermatic cord.
 Hydrocele of tunica vaginalis is common in the
  newborn, as a result of late closure of the
  processus vaginalis, which is continuous with the
  peritoneum. Most of these fluid collection subside
  spontaneously during the first few weeks of life.
 Causes:  secondary to local injury; acute
  nonspecific or tuberculous epididymitis, or orchitis.
 Clinical findings:
 Young boys with hydrocele commonly have a
  history of a cystic mass which is small and soft in
  the morning but large and more tense at night. One
  can only conclude, in these instances, that a small
  communication exists in the processus vaginalis
between the peritoneal cavity and the tunica
vaginalis. Hernia or communicating hydrocele is
therefore the proper diagnosis.
Hydrocele is painless unless it is accompanied by
acute epididymal infection. Patient may complain
of its bulk or weight.
 Diagnosis   made by finding a rounded cystic
  intrascrotal mass which is not tender unless
  underlying inflammatory disease is present.
 Mass is transilluminate
 If hydrocele is enclosed within the spermatic cord,
  a cystic fusiform swelling is noted in the groin or
  in the upper scrotum.
 Differentiated  diagnosis: a tense hydrocele which
  dose not transilluminate must from tumor of the
  testis or tuberculosis.
 Complications include compression of the blood
  supply of the testicle, which lead to atrophy;
  hemorrhage into the hydrocele sac following
  trauma or aspiration(hematocele); or, rarely,
  infection complicating aspiration.
 Treatment    unless complication are present, active
  therapy is not required. The indications for
  treatment are a very tense hydrocele which might
  embarrass circulation to the testicle or a large, bulk
  mass which is cosmetically unsightly and perhaps
  uncomfortable for the patient.
 One aspiration of a dydrocele that is present during
  the first few months of life is often curative
the parietal tunica vaginalis should be resected for
chronic hydrocele which refill slowly, after
repeated aspiration. Secondary infection may
required incision and drainage. Hematocele should
be treated by resection of the hydrocele sac.
            RENOVASCULAR
            HYPERTENSION
 Renal  ischemia could produce hypertension.
 Etiology and Pathogenesis why the ischemic
  kidney causes elevation of blood pressure, the
  theory has been the following: decreased blood
  flow through the afferent glomerular arteries leads
  to an increased number of secretory granules in the
  juxtaglomerular bodies, which are thought to
  elaborate renin. This enzyme reacts with an alpha
globulin to produce angiotensin l, which acted
   upon by a converting enzyme, it is changed to
   angiotensin ll, a potent vasoconstrictor which
   also acts to increase aldosterone secretion by the
   adrenal cortex. Thus, hypertension is
   established.
Sever Hypertension caused by stenosis of the renal
   artery. Renin has been found increased
   amounts from the renal vein of ischemic organ.
 The common causes of renal artery are
 arteriosclerotic plques, fibromuscular hyperplasia
 of the media(which usually affects relatively
 young females and children),
 neurofibromatosis(most often seen in children),
 and embolism or thrombosis, etc. chronic
 pyelonephritis, aneurysm of the renal artery,
 hydronephrosis, renal tumors, and renal
 tuberculosis.
 Clinicalfindings:
 A. Symptoms: 1.family history of hypertension,
 particularly young patients. 2.Sever flank pain or
 abdominal pain or trauma with or without
 hematuria(suggesting emblism or thrombosis of
 renal artery or an organized perirenal hematoma).
 3.If there is abrupt acceleration of preexisting
 hypertension,esp. in an older person.
 Clinical findings:
   A. Symptoms: 4. In the presence of sever
  hypertension in any age.
   B. Signs: sustained diastolic hypertension; retinas
  changes; renal mass may found eg, renal tumor;
  the presence of an aortic aneurysm or vascular
  insufficiency of the extremities is suggestive.
 Clinical findings:
 C. Lab. Findings:
    Bacteria and pus cells in urine may indicate
 chronic pyelonephritis. In the malignant phase of
 hypertension, proteinuria, casts, and red cell will
 be seen. Total renal function is usually normal
 unless malignant hypertension, polycystic disease,
 bilateral atrophic pyelonephritis, or bilateral renal
 artery stenosisis present.
 Clinicalfindings:
 D. X-ray findings: excretory urography is
 screening test: Delay in appearance of the
 radiopaque medium is a importance sign. The
 following findings are suggestive of renal ischemic:
 1. A kidney at least 1 cm shorter than its mate; 2.
 Lack of function of one kidney; 3. Delayed
 appearance of visualization on the early films; 4.
 Hyperconcentration of the radiopaque medium due
 to overabsorption of water.
 the urographic changes of chronic pyelonephritis,
hydronephrosis, and polycystic disease should be
obvious.
E. renal isotope study: renogram and scan show
slow excret of isotope.
F. Estimation of renal vein renin level: its great
value in establishing the diagnosis of renovascular
hypertension.
G. Renal angiography: showing significantly
stenotic lesion of renal artery.
H. A positive saralasin test is strong evidence.
 Treatment
 surgery should be done in order to protect renal
 function from effects of high blood perssure.
  Nephrectomy. ( poor renal function)
  Endarterectomy, homograft, sleeve resection of
 involved arterial segment. ( good renal function)
  Vaso-Catheter dilatation.( micro-invade)
  Renal arterial reconstruction operation. (riskness)
 Treatment
 preoperation preparation:
 Control blood pressure by a-block and b-block
 drugs.