Morning report

Vesikolithiasis

RINA OVIE DENADA

1508438043
Identity
 Name : Mr. MB
 Age : 23 y.o
 Sex : Male
 Religion : Islam
 Address : Kampar
 MR Number : 714843
HISTORY

Chief Complain:
Bloody urine since 6 days before admited hospital
Present Illness History

6 Days before admitted to hospital, the patient complained of

bloody urine . The whole red urine , pain when urinating ( + )
since 2 weeks , which is felt mainly at the end of the urination .
Patients say when urination , urine initially flowed smoothly , but
suddenly stopped and then become smooth again after the
patient to change positions.
Present Illness History

 2 months ago , the patient had been urine with sand.

Already 2 this year , patients pee ddisjointed and
increasingly become heavy in the past two months . In
addition , patients also complain of bowel straining, since
three years ago and usually takes about 3-5 minutes to
peed. The patient feels no lampias when urinating .
urination powerful jets . Frequency urination 7 times / day
.
Present Illness History

 Since 1 year ago , the patient complained of pain in her

stomach and was advancing since the first month . Pain is felt
in the middle of the lower abdomen , intermittent, were sharp ,
and spread to the testicles and feet. Urination difficult since 5
years ago and the patient is regularly taking laxatives (
Dulcolax ) to help smooth bowel movements. No complaints
of fever , nausea and vomiting .
Past Illness History

 A history of trauma ± 5 years ago , falling from a tree height of

± 4 meters with the sitting position . Patients treated at Awal
Bros Panam Hospital and is said to have a pinched nerve , it is
advisable for surgery , but the patient refused . Patients
experiencing paralysis of the lower limbs until now . Urination
history ***

Family History
No family members with the same complaint ..
Physical examination
Status generalis
 General appearance: moderate illness
 consicousness : Compos mentis
 Vital sign
 BP : 110/70 mmHg
 HR : 80 x/minutes
 RR : 20 x/ minutes
 Temp : 37oC
 Head and neck : Normal
 Thorax : Normal
 Abdomen : normal
 Extremity : Localized status
 Limph : Normal
genitourinarius : localized status
 Urologi
Flank area
Right Left

Trauma _ _

Inflamatory _ _

Mass _ _

Ballotement _ _

CVA: tenderness _ _

CVA: Nyeri Ketok _ _

urology
Supra pubic
Inspection : former cystostomi scar , inflammatory signs
(-)
Palpation : tenderness (+), palpable masses
urology
external genitalia
Penis : size ( normal ) position ( straight ) , the prepuce (
circumcised ) , there are no signs of trauma , inflammation ,
mass
Scrotum : there are no signs of trauma , inflammation , mass
Testis : the presence ( + / + ) , size ( normal ) , consistency
( soft ) , tenderness ( - ) , transillumination (not done )
RECTAL TOUCHER
Sphincter tone Ani ( TSA ) : hipotoni
Mucosal rectum : slick
Bulbo cavernous reflex : ( - )
Prostate : interlobar sulcus ( + ) , consistency ( chewy ) ,
symmetrical , upper pole ( affordable ) , pain ( - ) , nodules ( - ) ,
the estimated weight of 20 grams
Handscoen : stool ( - ) , mucus ( - ) , blood ( - )
extremity
 Sensoric
 Motoric
 otonom
Work Diagnose
Susp.Vesikolithiasis
Paraplegia ec. Spinal Cord Injury

Differential diagnose
Ca Buli-buli
Suggestion examination
Routine blood tests
Examination of renal function
urinalysis
BNO - IVP
PEMERIKSAAN PENUNJANG
Routine blood exam (09 April 2016)
 WBC : 18.680/uL
 PLT : 695.000/uL
 HGB : 11 g/dL
 HCT : 32,9 %
PEMERIKSAAN PENUNJANG

Urinalisis (not )
Urin function exam (09 April 2016)
 Ureum : 9 mg/dl
 Kreatinin : 0,5 mg/dl
BNO-IVP

radio opaque stones in pelvic cavity

DIAGNOSIS
Vesicolithiasis
Paraplegia ec. Spinal Cord Injury
Suggestion Treatment
 Inj. Ceftriaxon 2x1 gram
 Inj. Ketorolac 3x30 mg
 Vesicolitotomy plan (Urology)
VESIKOLITHIASIS

 Stones in the bladder that can be formed in place or

comes from the kidneys into the bladder . 5 % of all
occurrences of urinary tract stones is a stone jar .
ANATOMI
 Terletak tepat di belakang pubis di dalam cavitas pelvis.
 VU yang kosong pada orang dewasa, seluruhnya terletak
di dalam pelvis. Bila VU terisi, dinding atasnya terangkat
sampai masuk regio hypogastricum.
ANATOMI
 Bentuk seperti piramid, memiliki apex, basis, dan sebuah
facies superior serta dua buah facies inferolateralis.
ANATOMY
 There is a smooth muscle in the bladder called the
musculus detrussor . In collum vesica , this muscle layer
thickens to form musculus bladder sphincter .
DEFINITION
→ crystalline material formed on minerals and protein in
the urine .
ETIOLOGI
 Because of the organic and inorganic components that
could potentially be a rocky core . Rock core formation
theory : core theory matrix theory The theory of
crystallization inhibitors
FAKTOR RESIKO

• Family history
endogen • sex
• Metabolism problem

• climate
• Dietary
• Foreign object
exogen •
•
Occupation
drugs
• disorders of urination
• Infection
PATOFISIOLOGI
Faktor endogen / eksogen

Pembentukan inti batu

Obstruksi aliran urin

Distensi kandung kemih Hiperperistaltik Luka pada saluran kemih

Nyeri Nyeri kolik Hematuria

suprapubik
Mual muntah Anemia
Penghentian
aliran urin
mendadak

Keinginan
miksi berulang
DIAGNOSIS
History
 Painful urination / dysuria hematuria An uneasy feeling
when urinating Pee suddenly stopped and then become
smooth again with changes in body position .
DIAGNOSIS
History
 Pain during urination ( refered pain) at the tip of the penis
, scrotum , perineum , waist - leg . In children tugging at
his penis ( male ) Rubbing of the vulva ( female )
Physical examination
Suprapubic examination
 Inspection : bladder seems full
Palpation : palpable bladder is full due to urinary retention
PEMERIKSAAN PENUNJANG

blood
• Hb low +/-
• Leucositosis +/-

urine
• Leucosit +
• Eritrosit +

BNO-IVP
• Only able to identify radio -opaque picture of the urinary bladder
USG
 To see radiolucent stones that are not visible in BNO - IVP .
Seen as an echoic shadow .
Treatment

Conservative
<5mm

Lithotripsy
<20mm

Surgery
Terimakasih