b-late changes in severe degree of obstruction : the intrapelvic pressure becomes closure or higher...
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B-Late changes In severe degree of obstruction : The intrapelvic pressure becomes closure or higher than the glomerular filtration rate(6-12mm Hg), -less urine can be secreted.
-Glomerular filtration rate and renal plasma flow are reduced. -Concentration ability is gradually reduced. -In severe unilateral obstruction fluid and soluble substances reabsorbed through either the tubules or the lymphatic and will excreted by other kidney.
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• Irreversible progression of loss of function may occur as early as 7days(dilatation and necrosis of the proximal tubules.
• Recovery of renal function may take up to 4weeks after release of complete obstruction.• The extent of recovery is difficult to asses before release of
the obstruction.
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• Common causes of urinary tract obstruction: 1-Lower &Mid tract: Urethral stricture. B.P.H. Neurogenic bladder. Bladder neck Tumor. Bladder neck stenosis.. In neonates posterior urethral valve. 2-Upper tract: Ureteropelvic junction stenosis,ureteral or renal pelvis stone,ureteral stricture.
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• Symptoms: 1-Lower and mid tract symptoms: In stage of compensation :with hypertrophied detrusor the contraction is so strong producing symptoms of the irritable bladder: urgency, urge incontinence,and frequency,dysuria. In stage of decompensation :vesical tone become impaired, or urethral
resistance exceed detrussor power producing symptoms of obstruction: Hesitancy, week stream, urinary retention,terminal dribbling
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• Upper and Lower tract symptoms: - Flank and radiated pain. -Gross hematuria. -Gastrointestinal symptoms. -Chills ,Fever. -Cloudy urine,Dysuria.
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• Signs: 1-Lower &Mid tract : -Induration in urethra(Urethral stricture). -DRE: atony of the anal sphincter(damage to sacral nerve
roots). -Enlarged prostate. -Vesical distention. -Observation of the force and caliber of the urinary stream.
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•2-Upper tract: -Enlarged kidney.
- Large pelvic mass(pregnancy,tumor).- Children's with advanced urinary tract
obstruction may develop ascites.•Laboratory Findings:
-Anemia. - Microscopic hematuria.
- In significant bilateral hydronephrosis: Urea-Creatinine ratio is above 10.
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–X-RAY : Plain film of the abdomen:
Enlargement of the renal shadow. Calcified shadows :renal or ureteral,tumor or metastases to the bones of the pelvis or spine.
Intravenous pyelogram: Information about the function. degree and level of obstruction.
Radiopaque and radio lucent stones. Bladder trabeculation and and diverticuli.
Tumors Residual urine .
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•Retrograde urethro-cystogram:
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Ultrasound
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Renal Isotopes scan
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C.T
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C.T
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Treatment
1-Relief of the obstruction.
2-Eradication of the infection.