KIDNEY URETER Tumour Wilms

Wilm's Tumour (Adenomyosarcoma Nephroblastoma) 

The  tumour  is  most  likely  present  at  birth  and  manifests

clinically when the patient is still under the age of two.

The  usual presentation is a unilateral flank  mass.  Haematuria,

weight loss and pain are usual manifestations and occur later  in

the natural history of the disease.

A plain abdominal radiograph shows displacement of the intestinal

gas  shadows  to the contralteral side and  obliteration  of  the

psoas shadow on the side of the lesion.

Excretory urography may show a small rim of displaced functioning

renal tissue the distinct IVP features are shown in Fig. 25.11c.

Kidney  on  the side of the lesion may not be visualised  by  the

intravenous pylogram.

Ultrasonography  can differentiate a hydronephrosis from a  solid

Wilm's  tumour and a CT scan can establish the diagnosis and  aid

staging the disease.

Treatment usually consistes of transperitoneal surgical  excision

followed by postoperative radiation therapy of chemotherapy.

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Spleen congenital haemolytic anaemia

5. CONGENITIAL HAEMOLYTIC ANAEMIA

Hereditary  spherocytosis is a relatively common  genetic  linked

disorder characterized by :

*  Small dense, spheroid erythrocytes

*  Increased  osmotic  fragility because of a red  cell  membrane

   defect

*  These cells are impeded through the spleen and destroyed

Patients  frequently  present  with a  family  history  and  past

history of attacks of jaundice in childhood and in early life.

Besides anaemia the patients:

*  In acute crisis have accompanied fever and chills

*  In later life may have bilirubin gallstones

*  Show splenomegaly as a characteristic feature

*  Spherocytes can be demonstrated in the peripheral blood smear

*  Osmotic fragility of the R.B.C. is readily demonstrable

TREATMENT

Patients  are benefitted by splenectomy and is recommended  after

the age of six.

Basic  cellular defect persists after splenectomy; but the  cells

survive normally.

Cholecystectomy  is  recommended when stones are present  in  the

gallbladder

Any questions be sent to drmmkapur@gmail.com
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