Sx of kidney Flashcards
What is the arterial & venous supply of the kidney
renal a. & renal v.
What are the most common nephroliths
CaOx
What CS are associated w/ nephroliths
Absent or non specific
Depression, anorexia, hematuria, pain
How to dx nephroliths
survey radiographs
ultrasound
What parameters do you use to determine best mgmt for nephroliths
type of calculi
anatomical location
clinical effects
When is sx for nephroliths indicated
obstruction
infection associated w/ calculi
what are the tx opt for nephroliths & advantages/disadvantages of each
if asymptomatic:
monitor renal function/renal imaging
medical mgmt
no damage d/t sx of kidney
can eventually need sx
if symptomatic:
sx
removal of stones
sx damages kidney
lithotripsy
breaks up stones into passable pieces avoiding sx
pieces may get stuck in/ damage ureters
- how do you perform a nephrolithotomy
- what instuments can you use to occlude the renal vessels
- how long can you occulde the renal vessels for
- how do you close the sx site
- ventral midline celiotomy, retract mesocolon or mesoduodenum, dissect retroperitoneal fat to isolate vessels, mobilize kidney, make a sagittal incision, remove stone
- Rumel tourniquet
Bulldog vascular clamp
Satinsky clamp
what are the advantages of a pyelolithotomy over a nephrolithotomy & when would this be indicated
does not require occlusion of blood supply
does not damage nephrons
used to remove calculi when proximal ureter & renal pelvis are dilated
what is the post op mgmt of a nephrolithotomy
post op rediographs
monitor PCV
CVP (hydration)
monitor urine output
monitor renal enzymes/electrolytes
provide diuresis
how can you dx renal trauma & how to manage it
many cases have hematuria
contrast excretory urography
exploratory celiotomy
u/s
depending on extent of trauma:
conservative tx or sx
what are the indications for performing a nephroureterectomy
Severe infection
Severe trauma
Obstructive calculi with persistent hydronephrosis
Neoplasia
Transplant
why would you perform a partial nephrectomy & what are the disadvantages over a nephroureterectomy
Occlude blood supply
Incise and peel back capsule
Pass suture with straight needle
Divide in thirds
Tighten sutures
Loosen tourniquet
Close capsule
Higher incidence of post operative hemorrhage
Technically more difficult
CS, dx & mgmt of hydronephrosis
Unilateral:
Abdominal distension
Palpable mass
Bilateral:
Severe azotemia
Death
Abd rads
excretory urogram
u/s
Eliminate cause
Evaluate function
May need nephroureterectomy
CS, dx & mgmt of pyelonephritis
Polyuria-polydipsia, lethargy, depression, fever, and anorexia
ultrasonography and IV pyelography
if advanced consider nephroureterectomy
