1 / 21

SURGERY SEMINAR

akasma
Download Presentation

SURGERY SEMINAR

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. SURGERY SEMINAR PRESENTED BY, ASWATHY K SASI www.similima.com 1

    2. hydronephrosis www.similima.com 2

    3. definition An aseptic dilatation of the kidney due to a partial or complete obstruction to the outflow of urine Two types www.similima.com 3

    4. www.similima.com 4

    5. Unilateral hydronephrosis By some form of ureteric obstruction, with the ureter above the obstruction being dilated Causes 1) Intraluminal 2) Intramural ( in the walls) 3) Extramural obstruction www.similima.com 5

    6. INTRALUMINAL - stones & papillary necrosis in DM, analgesic nephropathy INTRAMURAL 1) Congenital - PUJ dyskinesia/ Achalasia of PUJ - due to failure of trasmission of neuromuscular impulses through the narrow PUJ - male:female= 2:1 - common in males on left side www.similima.com 6

    7. 2) Ureterocoele - congenital narrow ureteric orifice 3) Physioslogical narrowing of the PUJ leading to PUJ obstruction 4) Inflammatory stricture following removal of a calculus, repair of a damaged ureteric segment or tuberculous infection 5) Neoplasm of the ureter or bladder cancer involving ureteric orifice www.similima.com 7

    8. EXTRAMURAL OBSTRUCTION Tumor from adjacent structures Eg: CA cervix, prostate, rectum, colon, caecum Idiopathic retroperitoneal fibrosis Retrocaval ureter Obstruction by aberrant vessels Retrocaval ureter Horse shoe kidney www.similima.com 8

    9. www.similima.com 9

    10. Clinical features Insidious onset of mild pain or dull aching in the loin Attacks of renal colic Intermittent hydronephrosis - after an attack of acute renal pain, a swelling in the loin is found. Some hours later, following the passage of a large volume of urine, the pain is relieved & the swelling disappear “DIETL’S CRISIS”; common in hydronephrosis www.similima.com 10

    11. Bilateral hydronephrosis/ ormond’s disease Result of urethral obstruction; but may also be caused by one of the lesions described above occuring on both sides Causes In children - phimosis - meatal stenosis - posterial urethral valve - bilateral vesico ureteric reflex www.similima.com 11

    12. In young adults - stricture urethra- due to gonococcal urethritis - bilateral aberrant vessels- a branch of renal artery & veins which cross the ureters Middle ages & above - BHP (common cause) - Contracture of the bladder neck - Idiopathic retroperitoneal fibrosis Physislogical - pregnancy due to growing foetus & partly due to progesterone www.similima.com 12

    13. Pathogenesis In a kidney with an extra renal pelvis - the dilatation first affects the pelvis alone( pelvic hydronephrosis) if the obstruction is not relieved the calyces become increasingly dilated & the renal parenchyma is progressively destroyed by atrophy In a kidney with an intra renal pelvis - destruction of parenchyma occurs more rapidly If the disease progresses, leads to a non functional kidney If the disease is bilateral- uraemia www.similima.com 13

    14. www.similima.com 14

    15. Clinical features From lower UT obstruction - dull loin ache - symptoms of bladder outflow obstruction predominate From upper UT obstruction - although both systems are obstructed, symptoms may be referred to one side only From pregnancy - dialatation of ureter & renal pelvis occurs early in pregnancy & becomes more marked until 20 th week - results from high levels of circulating progesterone on ureteric smooth muscles - ureters returns to their normal size within 12 weeks of delivery www.similima.com 15

    16. www.similima.com 16

    17. investigations Plain X ray KUB USG CT scan Intra venous pyelography Isotope renography Retrograde pyelography(RGP) Blood urea Creatinine www.similima.com 17

    18. treatment Indications for operation : 1) bouts of renal pain 2) increasing hydronephrosis 3) evidence of parenchymal damage 4) obstruction www.similima.com 18

    19. Principles of surgery Non inflammatory kidney with thinned out cortex with hydronephrosis (pyonephrosis- nephrectomy) If the cortical thickness is adequate by US, even though it is non inflammatory kidney, a preliminary nephrostomy to decompress the system has to be done www.similima.com 19

    20. Grades of renal pelvic diameter & management Grade 1 mild 11-20 mm - Conservative / non operative management Grade 2 moderate 21-35 mm - Conservative management Grade 3 severe >35 mm - Operated early - Anderson-Hyner Pyeloplasty to prevent permanent damage to kidney www.similima.com 20

    21. www.similima.com 21

    22. www.similima.com 22

More Related