Friday, July 31, 2009
Friday, July 17, 2009
Petang ni..with my fren Zura..kami ke Seremban 2 dengan nawaitu..ke casamoda n Jusco.
Friday, July 10, 2009
Inilah my studen yang amat2 i sayang.walau banyak kerenah tapi u all tetap menghiburkan.mudah2an senang perjalanan hidup kalian.jangan lupa berdoa dan ingat Tuhan.
Wednesday, July 8, 2009
At Hogwarts, Snape is unexpectedly announced as the new Defense Against the Dark Arts instructor, with Slughorn becoming the Potions teacher. Harry and Ron’s O.W.L.s are good enough to enroll in Slughorn’s class, which has lower standards, but neither had purchased a textbook, so Slughorn lends them old Potions textbooks. Harry's book has notes and corrections scribbled all over the pages. Harry discovers that these corrections yield better results than the textbook's instructions, and that the book is inscribed as having previously belonged to the "Half-Blood Prince". As the year continues, Ron dates Lavender Brown but eventually realizes his feelings for Hermione and breaks up with her. Harry realizes that he has feelings (that are conflicting with his friendship with Ron) for Ginny, who has stopped pursuing him and is dating Dean Thomas.
During the school year at Hogwarts, Dumbledore privately tutors Harry, using his Pensieve to show Harry collected memories about Voldemort's past. Dumbledore asks Harry to retrieve a key memory from Slughorn that Slughorn has resisted providing, regarding Slughorn's conversation with a sixth-year Tom Riddle. After disappointing Dumbledore once by not getting the memory from Slughorn, Harry uses Felix Felicis potion (which bestows luck on its drinker) that he had been rewarded with for his newfound "skill" (derived almost entirely from written hints from the Half-Blood Prince) in potion making to gain the memory.
The series of memories reveals that to attain immortality, Voldemort splintered his soul (through committing murders) into six fragments attached to objects called Horcruxes, while leaving a seventh piece in his body. As long as any of the Horcruxes exist, Voldemort cannot be killed. Two Horcruxes have been destroyed: Tom Riddle's diary by Harry in the Chamber of Secrets[HP2] and Marvolo Gaunt's ring by Dumbledore (the ring Harry noticed on his hand earlier). The memories indicate that three other Horcruxes are most likely a locket formerly owned by Salazar Slytherin, a cup formerly owned by Helga Hufflepuff, and the snake Nagini; but the last of the six Horcruxes remains unidentified. Dumbledore speculates that it may be a possession of Gryffindor or Ravenclaw, as Tom Riddle would have wanted a possession of each of the founders of Hogwarts, his first and only real home.
After seeing Harry cast an unusual curse, "Sectumsempra" (a dark curse which leaves deep gashes) against Draco Malfoy, Snape attempts to repossess Harry's Potions book, but Harry gives him Ron's copy instead and hides his copy in the Room of Requirement, noting several other items hidden there over the years. He then distinguishes the cabinet that the book is in with an old bust wearing a wig and a strange looking tiara. Harry gets detention from Snape and misses the Quidditch finals, but Gryffindor wins the Cup with Ron and Ginny starring in the match. During the victory celebration, Harry spontaneously kisses Ginny and they begin dating with Ron's approval.
Hydronephrosis is dilation or stretching of the area of kidneys where urine collects that can occur when there is an obstruction of urine flow somewhere along the urinary tract, most often in the upper section.
Normally, urine flows from the kidneys down through the ureters and into the bladder. But, if there is some kind of a blockage that prevents urine from draining properly into the bladder or out of the bladder, the kidney overfills with urine and hydronephrosis occurs. The blockage may be partial, letting urine pass, but at a slower rate and with increased pressure.
Another cause of hydronephrosis is vesicoureteral reflux, when urine that dwells in the bladder flows back into the ureters and often back into the kidneys. Most children with hydronephrosis are born with the condition although it can develop during childhood. It is the most common urinary tract anomaly (abnormality) and ranges in severity. In mild hydronephrosis, the pelvic (the part of the kidney that collects the urine) dilation is barely noticeable, whereas in severe hydronephrosis the swelling occupies much of the abdomen
Facts about hydronephrosis
It is four to five times more common in males than females.
It can occur in one or both kidneys.
Most mild cases and even some moderate cases may resolve on their own. More severe cases may require surgery.
What causes hydronephrosis?
There are many different kinds of urinary tract obstructions that lead to hydronephrosis, but the most common type is found where the ureter joins with the kidney, an area known as the ureteropelvic junction. (See ureteropelvic junction obstruction.) A blockage at this juncture is usually due to an abnormal narrowing at the top of the ureter. The second most common site of obstruction is at the ureterovesical junction (the position where the ureter joins with the bladder). Other types of blockage may be at the junction of the ureter with the bladder or in the urethra which empties the bladder. A condition that may appear similar to an obstruction by causing hydronephrosis in some children is vesico-ureteral reflux (a backwash of urine from the bladder).
It is unknown why some babies are born with the kinds of anomalies that lead to hydronephrosis. Neither hydronephrosis nor its causes have ever been linked to anything the parents did during pregnancy. Not all children with hydronephrosis are born with it. Hydronephrosis can, for example, rarely develop as a result of stones or after an injury to the urinary tract or previous surgery
What are the symptoms of hydronephrosis?
In mild cases and even some moderate cases of hydronephrosis, children will have no symptoms and the condition may disappear on its own within the first year of life. In more severe cases, when kidney function is affected, the infant or child can experience pain, bleeding and infections. These symptoms may not develop until months or years after hydronephrosis is first detected
How is it diagnosed?
Hydronephrosis may first be discovered on a routine prenatal ultrasound. Hydronephrosis is not a specific diagnosis, but a finding that indicates an obstruction. In diagnosing hydronephrosis, doctors search for the cause of the obstruction, which dictates the appropriate treatment.
In most cases, if hydronephrosis is detected on a prenatal ultrasound, you will be referred to a pediatric urologist for further evaluation and a more detailed ultrasound. Usually, a precise diagnosis cannot be made right away. Your pediatric urologist may want you to be monitored periodically to note any changes that occur over time, providing further evidence of a particular diagnosis or risk of affecting kidney function. While you are being monitored, doctors will be taking precise measurements of the fetus, fetus' kidney and the level of amniotic fluid.
At some point, the hydronephrosis will be classified as either mild, moderate, severe unilateral (occurring in one kidney) or bilateral (occurring in both kidneys.) Based on these classifications, the urologist will look for clues of any urinary tract anomalies that could cause the hydronephrosis. Here are some examples of more common conditions responsible for hydronephrosis, but virtually any type of blockage can be responsible:
Ureteropelvic junction obstruction (obstruction where kidney and ureter meet) - signs can include swelling of pelvic region without any swelling of the ureter.
Vesico-ureteral reflux (backwash of urine) - signs include a varying degree of hydronephrosis during one ultrasound evaluation or between exams.
Posterior urethral valves (abnormal flaps of tissue in the urethra) - ultrasound findings can include bladder distention, bilateral kidney and ureteral dilation, and sometimes, decreased amniotic fluid level (oligohydramnios).
Ectopic ureter (abnormal flaps of tissue in the urethra) - signs include hydronephrosis of the ureter and usually the upper part of the kidney.
Ureterocele (a cystic or balloon-like end of the ureter in the bladder that obstructs the ureter and may obstruct the bladder) - signs include a cystic structure in the bladder associated with hydronephrosis of the ureter and usually the upper part of the kidney.
If a diagnosis is not made prior to birth or if a child develops hydronephrosis, doctors will use a combination of the following tests on your newborn or child, depending on the severity of the problem, to help determine the underlying cause:
Voiding cystourethrogram (VCUG) - a specific X-ray that examines the urinary tract. A catheter (hollow tube) is placed in the urethra (tube that drains urine from the bladder to the outside of the body) and the bladder is filled with a liquid dye. X-ray images will be taken as the bladder fills and empties. The images will show if there is any reverse flow of urine into the ureters and kidneys and how well the bladder empties. It is also used to determine if there is obstruction in the urethra.
Renal ultrasound (RUS) - a non-invasive test in which a transducer is passed over the kidney, producing sound waves which bounce off the kidney and transmit a picture of the organ on a video screen. The test is used to determine the size and shape of the kidney, and to detect a mass, kidney stone, cyst, or other obstruction or abnormalities.
Intravenous polygram (IVP) - a special x-ray of the kidneys, ureters and bladder that involves injection of a contrast agent that fills the urinary tract on the x-ray and helps the doctor to see the organs. The IVP shows how well the kidneys drain urine.
A renal (kidney) scan (MAG 3 with lasix) - This scan provides very sensitive quantitative information regarding kidney function and drainage characteristics. Along with the IVP, it is particularly helpful in identifying and assessing the degree of blockage.
How is hydronephrosis treated?
Treatment depends on the severity and cause of the hydronephrosis. Children with mild hydronephrosis caused by mild obstructions may simply be monitored by renal ultrasound and VCUG and receive no treatment, as the problem is likely to correct itself. Infants will probably undergo these imaging tests at around 2-3 months of age.
If doctors find moderate to severe hydronephrosis, severe unilateral hydronephrosis or severe bilateral hydronephrosis during the prenatal ultrasound, your child will receive antibiotics during the first days after birth. At one to three months of age, depending on the severity of the hydronephrosis, your child will undergo imaging studies to confirm the cause and determine if surgery is needed.
Surgery is usually needed to correct the problem only in severe unilateral or severe bilateral hydronephrosis, although it may be considered in some moderate cases. Surgery relieves the obstruction or reflux causing hydronephrosis. For descriptions of surgical treatments used to correct specific conditions causing hydronephrosis, see treatment sections for the following entries: ureteropelvic junction obstruction, ureterovesical junction obstruction, vesicoureteral reflux or posterior urethral valves.
WHAT PARTS OF THE KIDNEYS ARE WIDENED IN HYDRONEPHROSIS?
The parts of the kidney(s) that are widened in hydronephrosis are the renal calyces and renal pelvis. The word "renal" refers to the kidneys. The renal calyces are narrow tubes that carry urine from the kidneys to the renal pelvis. The renal pelvis is a funnel-shaped opening that drains urine from the renal calyces to the ureters.
The ureters are two thin, tube shaped structures that connect to the kidneys and carry urine to the bladder. One ureter is attached to each kidney. The bladder is a stretchable structure in the body that holds urine. Urine travels from the kidneys to the renal calyces, then to the renal pelvis, then to the ureters, then to the bladder, and then to the urethra where it is drained outside of the body. The urethra is a tube shaped structure in the body that drains urine from the bladder. The kidneys, ureters, bladder, and urethra make up the urinary tract.
IS HYDRONEPHROSIS A DISEASE?
Hydronephrosis is not a disease. Rather, hydronephrosis is a physical consequence of a disease that causes the urine to have difficulty draining out of the kidneys, ureters, and bladder.
WHAT IS THE DIFFERENCE BETWEEN UNILATERAL AND BILATERAL HYDRONEPHROSIS?
Unilateral hydronephrosis is hydronephrosis that affect one kidney. Bilateral hydronephrosis is hydronephrosis that affects both kidneys.
WHAT ARE SIGNS AND SYMPTOMS OF HYDRONEPHROSIS?
Signs and symptoms of hydronephrosis can vary, depending on whether the condition occurs suddenly or develops slowly over a period of time. If hydronephrosis occurs suddenly, the person may experience severe back pain.
If hydronephrosis develops slowly over a period of time, it may not cause any signs or symptoms until the ureter is completely blocked and kidney failure results. If the kidney becomes infected, it can become filled with pus and lead to a fever. Pus is a yellow or green creamy substance sometimes found at the site of infections.
General signs and symptoms of hydronephrosis include pain in the sides, a mass in the belly, very high fever, blood in the urine, nausea, vomiting, and a high number of white blood cells in the urine. White blood cells help protect the body against diseases and fight infections. In the newborn, an infection of the urinary tract is a sign that some type of blockage in the kidney is present that may lead to hydronephrosis. In older children, repeated infections of the urinary tract may reflect a blockage of the kidney.
Feeling a frequent urge to pee and peeing very often are other signs and symptoms of hydronephrosis. Painful and burning sensation while peeing is another symptom of hydronephrosis that is usually caused by an infection of the urinary tract. It should be noted that in many people, there are no signs or symptoms of a blockage in the urinary tract. This is especially true for children with mild hydronephrosis.
WHAT CAUSES HYDRONEPHROSIS?
In hydronephrosis, the kidneys become widened with urine (pee) that cannot pass by a blockage or narrowing. The blockage or narrowing is usually in the ureter or urethra, but can also be in the bladder. Blockages can occur at the uretovesical junction, which is where the ureter meets the bladder. Since the urine has difficulty getting past the blockage, it backs up into the kidney and becomes trapped. This causes areas inside the kidney to stretch. The blockages can occur suddenly or slowly over time. In infants with this condition, the areas inside of the kidney may appear very wide because the infant's tissues are stretchier than adults
There are many possible reasons why the structures mentioned above can become blocked or narrowed. One reason is the formation of stones in the kidney (known as kidney stones). Another reason is the formation of scar tissue in the ureter or urethra. A blockage where the bladder connects to the urethra can lead to hydronephrosis. This type of blockage is known as bladder outlet obstruction.
A tumor in the kidney or other parts of the urinary tract can cause blockage of the ureter(s). Tumors are abnormal masses of tissue that form when cells in a certain area of the body reproduce at an increased rate. Tumors outside or in back of the peritoneum can lead to hydronephrosis. The peritoneum is a layer of tissue that lines the belly and covers most of the organs in the belly.
As was mentioned earlier, the widening in hydronepohrosis is most common at the point where the renal pelvis connects with the ureters (known as the uretopelvic junction). A blockage in the area where the renal pelvis connects with the ureters can cause widening in this area to occur. A blockage in this area is known as a uretopelvic junction obstruction. A uretopelvic junction obstruction usually develops in the first four months that a mother is pregnant, in children born with this type of blockage.
The presence of abnormal folds in a specific part of the urethra can lead to hydronephrosis. This condition is known as posterior urethral valves. Also, fibrosis of structures behind the peritoneum and of connective tissue that often makes up the ureters can lead to hydronephrosis because it can cause the ureters to be blocked. Fibrosis is an overgrowth of scar tissue or connective tissue. Connective tissue is any tissue that surrounds and supports specialized structures in the body.
Displacement of the kidneys from its normal position can lead to hydronephrosis as can pressure from adhesions outside of the urinary tract. Adhesions are fibrous types of tissue that join body parts that are normally unconnected. Fibrous tissue is a type of connective tissue.
Sometimes, the kidney may contain many cysts, which can lead to hydronephrosis. A cyst is an abnormal lump, swelling, or sac that contains fluid, a part solid material, or a gas, and is covered with a membrane. A blood clot can also lead to a blockage of the ureters and cause hydronephrosis. A blood clot is a collection of a mass of blood.
Pressure from abnormal arteries in the kidneys can lead to hydronephrosis. An artery is a blood vessel that carries blood away from the heart. Aneurysms of the arteries of the kidney are one type of abnormality that can lead to hydrnephrosis. An aneursym is a weakening of the wall of a blood vessel, causing it to expand like a balloon, sometimes leading it to burst.
Neurogenic bladder can lead to hydronephrosis. Neurogenic bladder is dysfunction of the bladder that is caused by damage in the nervous system (the system of nerves in the body). Neurogenic bladder is characterized by retaining or emptying too much urine.
Another cause of hydronephrosis is an enlarged prostate gland. The prostate is a organ near the bladder that produces a fluid that is part of semen. Semen is a fluid that is discharged from a male's penis in order to reproduce with a female. If the prostate is enlarged, the fluid that it produces can be blocked, which would cause the urine in the bladder to be under pressure.
Cancer of the prostate gland can cause blockage that leads to hydronephrosis. Cancer is an abnormal growth of new tissue characterized by uncontrolled growth of abnormally structured cells that have a more primitive form. One type of cancer in the prostate that can lead to hydronephrosis is a carcinoma.
A carcinoma is any malignant cancer that arises from cells in the covering surface layer or membrane (outer covering) that lines an organ of the body. When describing cancer, malignant means that the newly formed tissues are made of abnormally structured and primitive-looking cells that grow uncontrollably, spread throughout the body, and invade surrounding tissues.
Vesicouretal reflux is another possible cause of hydronephrosis. Vesicouretal reflux is a backward flow of urine from the bladder into the ureter, when the bladder fills or empties.
The urine can also flow black into the renal pelvis. This condition is caused when the valve between the ureter and bladder does not function. A valve is a natural structure or man-made device in a passageway, tube, vessel, or hollow organ that allows fluid or partly fluid contents to travel in one direction, but closes to prevent the flow of those contents in the opposite direction.
About 75% or people with vesicouretal reflux outgrow this condition during childhood. However, many children will need to be treated with antibiotics to prevent kidney damage before outgrowing the condition.
Edema that is caused by an infection of the urinary tract can lead to hydronephrosis. Edema is an abnormal buildup of too much watery fluid in the cells, tissues, and or openings inside the body. Pregnancy can cause changes in the urinary tract that lead urine to be backed up, which can cause hydronephrosis.
A condition known as prune-belly syndrome is associated with hydronephrosis. In prune belly syndrome, certain muscles in the belly are missing, the kidneys are small and abnormally developed, the testicles do not drop down, and the ureters and bladder are usually greatly enlarged. The condition is called prune-belly syndrome because the belly sticks out and is wrinkly like a prune.
There are several disorders of the muscles, brain, and/or spinal cord that can lead to hydronephrosis, such as paraplegia, tabes dorsalis, spina bifida, and multiple sclerosis. Paraplegia is a loss of the ability to move and/or feel both legs and generally, the lower trunk (stomach area and lower back). Tabes dorsalis is damage to the spinal cord due to infection from the sexually transmitted disease, syphilis.
Spina bifida is a birth defect in which part of the bones that surround the spinal cord do not form properly, leaving part of the spinal cord exposed. Multiple sclerosis (MS) is a condition in which multiple areas of abnormal patches (known as plaques) develop in the brain and/or spinal cord (depending on the stage of the illness).
Sometimes, in adults and children, the ureters can become narrowed at the area of the renal pelvis with no apparent cause. In some children with hydronephrosis, there is no blockage that is apparent. Some of these cases may be due to abnormal smooth muscle in the renal pelvis or ureter, which causes these areas to widen.
A rare cause of hydronephrosis can occur when there are two ureters collecting urine from a single kidney. In 99% of people, there is one ureter that collects urine from each kidney. In the 1% of people that have 2 ureters for one kidney, a uterocele may be present which causes hydronephrosis. A uterocele is a balloon-like blockage at the end of one of the ureters.
HOW MANY PEOPLE HAVE HYDRONEPHROSIS?
It is estimated that one in 100 people have hydronephrosis affecting one kidney. Less people have hydronephrosis affecting both kidneys. In approximately 2% of all ultrasounds performed before the child is born, hydronephrosis is detected. The cases detected in this manner are usually males.
HOW IS HYDRONEPHROSIS DIAGNOSED?
Hydronephrosis is diagnosed with an ultrasound of the kidneys or belly, especially in unborn children. An ultrasound is a procedure that uses types of sound waves to produce images of the body. The ultrasound used to diagnose hydronephrosis will produce a picture of the kidneys and the ureters. An ultrasound can detect hydronephrosis in an unborn child as early as the first three months that the mother is pregnant. It will be able to show blockages that are causing hydronephrosis as well as many of the other causes described above, such as uretopelvic junction obstruction, posterior urethral valves, and prune belly syndrome.
Another technique used to diagnose hydronephrosis is an intravenous pyelogram. An intravenous pyelogram (commonly abbreviated as IVP) is a technique in which x-rays are used to take pictures of the urinary tract, after a liquid substance called contrast is injected into a vein (a blood vessel that caries blood to the heart). X-rays are a type of radiation, which is a form of energy. To better distinguish between organs, a liquid substance called contrast is used that x-rays cannot pass through. Contrast helps to form an artificial distinction between organs in the body so that the doctor can tell them apart.
Other techniques that can be used to diagnose hydronephrosis are retrograde pyelography and cystoscopy. A retrograde pyelography is another visualization technique that uses x-rays to examine structures in the kidneys after a contrast material has been injected into the ureters and renal calyces. A cystoscopy is a direct examination of the urinary tract by inserting a viewing tube into the ureter.
A renal (kidney) scan is also used to diagnose hydronephrosis in some cases. A renal scan (also known as a flow and function scan) is a technique in which detailed pictures are produced after a radioactive substance is injected into the body, which provides information about kidney functioning. A radioactive substance is a substance that sends out radiation (a type of energy).
The kidney filters this radioactive substance, which is detected by the scanning procedure.
The renal scan will be able to detect differences in functioning between the right and left kidney. It can estimate the size of a blockage that is present and how well the urine is draining out of the kidney. A small tube is inserted in the bladder to keep it empty. Renal scans are usually not performed until one month after birth for the most accurate results.
A CT scan of the kidneys or belly can be used to diagnose hydronephrosis. CT (computerized tomography) scanning is an advanced imaging technique that uses x-rays and computer technology to produce more clear and detailed pictures than a traditional x-ray.
An MRI (Magnetic Resonance Imaging) scan can also be used to diagnose hydronephrosis. MRI scans produce extremely detailed pictures of the inside of the body by using very powerful magnets and computer technology. MRI scans are more detailed, but more expensive than CT scans.
A cystourethogram can be used to help determine if the cause of hydronephrosis is vesicourethral reflux. A cystourethogram is an examination of the urethra and bladder after a contrast substance is injected inside the body. Remember that contrast is a liquid substance that helps to form an artificial distinction between organs in the body so that the doctor can tell them apart. The contrast is passed into the child's bladder through a small tube inserted in the child's urethra.
HOW IS HYDRONEPHROSIS TREATED?
There is currently no accepted method for how all children with hydronephrosis should be treated. This is because there is presently no way to predict which cases will go away on its own and which will require surgery to remove the blockage. Thus, doctors may differ in their opinion as to whether surgery should be performed or whether the child should be monitored over time. Most doctors today, however, are choosing to observe the child over time (even in moderate to severe cases) before opting for surgery.
In most cases, no specific changes need to be made in caring for the unborn child that is diagnosed with hydronephrosis. Rather, the hydronephrosis and kidney growth of the unborn child will need to be monitored closely as it develops. Another ultrasound is usually done the third day after the child is born to monitor the situation. Repeat ultrasounds may be performed every three months. The condition will likely continue to be monitored (without surgery) if it seems to be improving and if no blockages are seen.
The cause of hydronephrosis is what is treated. Treatment will differ depending on the cause. If the ultrasound (see earlier section) reveals a blockage and the kidney is at least somewhat healthy, the blockage may be removed or decreased by surgery. After surgery, the kidney resumes normal functioning shortly.
The surgery mentioned above usually involves removing the blocked part of the ureter and reconnecting the healthy part of the ureter to the kidney. This type of surgery is known as a pyeloplasty. After the surgery, the child is in the hospital for 3 to 5 days. This type of surgery is successful in about 90 to 95% of the cases. Thus, the surgery is generally safe and effective.
In some patients, a rod-like or thread-like device known as a stent is placed in the ureter. The stent will widen the ureter and help urine get through any blockages that are there. In other patients with a blockage in the ureter, a nephrostomy tube can be used. A nephrostomy tube is a tube that is placed in the kidney, which bypasses (goes around) the ureter, and drains it through the back.
However, some doctors prefer to observe the child for a given period of time and hold off on surgery, since the condition may go away by itself without the risks of surgery. Doctors are more likely to hold off on surgery in cases where it does not appear kidney functioning is declining and that the kidneys are growing normally
Antibiotics are used to prevent and treat urinary tract infections. If the patient is known to have recurring infections of the urinary tract, he/she may be given antibiotics to prevent further infections. Patients with vesicoureteral reflux (see earlier section) are often treated with antibiotics, follow-up ultrasounds, and follow-up cystourethograms (see here).
If the kidney is severely damaged, it may need to be removed. Removal of the kidney is known as a nephrectomy. If a kidney needs to be removed, the other kidney takes over for the functioning of the removed kidney. Some doctors recommend removing a kidney with many cysts on it because it does not work. Other doctors do not recommend removing a kidney with many cysts on it unless its large size causes problems or if there is something present that is blocking the urine.
For some unborn children with severe hydronephrosis, some hospitals are experimenting with surgeries to decrease blockages or pressure in the unborn child when it is still in the uterus. The uterus is a hollow organ in a female's body where the egg is implanted and the baby develops. This type of surgery is usually only done when the kidneys are very abnormal and their lungs are usually not well developed.
WHAT ELSE IS HYDRONEPHROSIS KNOWN AS?
Hydronephrosis is also known as pelvocaliectasis and pyeloureterectasis.
Monday, July 6, 2009
When a stone travels through a ureter, it may cause no pain. Or it may cause great pain and other symptoms.
See pictures of a kidney stone and a stone traveling through a ureter .
Kidney stones form when a change occurs in the normal balance of water, salts, minerals, and other things found in urine. The most common cause of kidney stones is not drinking enough water. Try to drink enough water to keep your urine clear (about 8 to 10 glasses of water a day). Some people are more likely to get kidney stones because of a medical condition or family history.
Kidney stones may also be an inherited disease. If other people in your family have had them, you may have them too.
Kidney stones often cause no pain while they are in the kidneys, but they can cause sudden, severe pain as they travel from the kidneys to the bladder.
Call a doctor right away if you think you have kidney stones. Watch for severe pain in your side, belly, or groin or for urine that looks pink or red. You may also feel sick to your stomach (nausea) and may vomit.
You may first find out that you have kidney stones when you see your doctor or go to an emergency room with pain in your belly or side. Your doctor will ask you questions about your pain and lifestyle. He or she will examine you and may do imaging tests such as X-rays to look at your kidneys and urinary tract.
You may need more tests if you have more than one stone or have a family history of stones. To find out the cause of your kidney stones, your doctor may order a blood test and ask you to collect your urine for 24 hours. This can help your doctor find out if you are likely to have more stones in the future.
Kidney stones may not cause any pain. If this is the case, you may learn you have them when your doctor finds them during a test for another disease.
If a stone is too large to pass on its own, or if it gets stuck in the urinary tract, you may need more treatment. About 1 or 2 out of every 10 kidney stones needs more than home treatment.1The most common medical treatment is extracorporeal shock wave lithotripsy (ESWL). This uses shock waves to break a kidney stone into small pieces. The bits can pass out of your body in your urine. Other times, a doctor will need to remove the stone or place a small flexible plastic tube (called a stent) in the ureter to keep it open while stones pass
Nearly 80% of all kidney stones are made of calcium compounds, especially calcium oxalate.1 Calcium phosphate and other minerals also may be present. Conditions that cause high calcium levels in the body, such as hyperparathyroidism, increase the risk of calcium stones. High levels of oxalate also increase the risk for calcium stones.
Certain medicines may prevent calcium stones.
About 5% to 10% of kidney stones are made of uric acid, a waste product normally passed out of the body in the urine.1 You are more likely to have uric acid stones if you have:
· Low urine output.
· A diet high in animal protein, such as red meat.
· An increase in how much alcohol you drink.
· Inflammatory bowel disease.
Certain medicines may prevent or dissolve uric acid stones.
About 10% to 15% of kidney stones are struvite stones.1 They can also be called infection stones if they occur with kidney or urinary tract infections (UTIs). These types of kidney stones sometimes are also called staghorn calculi if they grow large enough.
Struvite stones can be serious because they are often large stones and may occur with an infection. Medical treatment, including antibiotics and removal of the stone, is usually needed for struvite stones. Women are affected more than men because of their higher risk of urinary tract infections.
Less than 1% of kidney stones are made of a chemical called cystine.1 Cystine stones are more likely to develop in families with a condition that results in too much cystine in the urine (cystinuria).
Cystine stones may be prevented or dissolved with medicine, but this may be difficult and not very effective. If the stones cause blockage in the urinary tract or are too large, then removal of the stone will be needed.
Kidney Stones - Treatment Overview
Your first diagnosis of kidney stones often occurs when you see your doctor or go to an emergency room because you are in great pain. Your doctor may suggest that you wait for the stone to pass and take pain medicine or have a procedure to remove the stone.
Most small stones [less than 5mm] move out of the body (pass) without the need for any treatment other than drinking extra fluids and taking pain medicine.1
· The smaller a stone is, the more likely it is to pass on its own. About 9 out of every 10 stones smaller than 5mm and about 5 out of every 10 stones 5mm to 10mm pass on their own.1 Only 1 or 2 out of every 10 kidney stones need more than home treatment.1
· The average time a stone takes to pass ranges between 1 and 3 weeks,1 and two-thirds of stones that pass on their own pass within 4 weeks of when the symptoms appeared.2
Not all kidney stones are diagnosed because of immediate symptoms. Your stone may not be causing you pain, and your doctor may find it during a routine exam or an exam for another condition or disease. In this case, you have the same treatment options as noted below.
Treatment for your first stone
If your doctor thinks the stone can pass on its own, and you feel you can deal with the pain, he or she may suggest home treatment, including:
· Drinking more fluids. You need to drink enough water to keep your urine clear, about 8 to 10 glasses a day. Try to drink 2 glasses of water every 2 hours while you are awake. If you have kidney, heart, or liver disease and are on fluid restrictions, talk with your doctor before increasing your fluid intake.
· Not drinking grapefruit juice. Drinking grapefruit juice may increase your risk for developing kidney stones.
· Using pain medicine. Nonprescription medicine, such as nonsteroidal anti-inflammatories (NSAIDs), may relieve your pain. Your doctor can prescribe stronger pain medicine if needed.
Your doctor may prescribe medicine to help your body pass the stone. Calcium channel blockers and alpha-blockers have been shown to help kidney stones pass more quickly with very few side effects.11 Ask your doctor if one of these medicines can help you.
If your pain is too severe, if the stones are blocking the urinary tract , or if you also have an infection, your doctor will probably suggest medical or surgical treatment. Your options are:
· Extracorporeal shock wave lithotripsy (ESWL). ESWL uses shock waves that pass easily through the body but are strong enough to break up a kidney stone. This is the most commonly used medical treatment for kidney stones. See a picture of ESWL .
· Percutaneous nephrolithotomy or nephrolithotripsy. The surgeon puts a narrow telescope into the kidney through a cut in your back. He or she then removes the stone (lithotomy) or breaks it up and removes it (lithotripsy). This procedure may be used if ESWL does not work or if you have a very large stone. See a picture of nephrolithotomy .
· Ureteroscopy. The surgeon passes a very thin telescope tube (ureteroscope) up the urinary tract to the stone's location, where he or she uses instruments to remove the stone or break it up for easier removal. Occasionally, you may need a small hollow tube (ureteral stent) placed in the ureter for a short time to keep it open and drain urine and any stone pieces. Ureteroscopy is often used for stones that have moved from the kidney to the ureter. See a picture of ureteroscopy .
· Open surgery. The surgeon makes a cut in the side or the belly to reach the kidneys and remove the stone. This treatment is rarely used.
Kidney stones form in the kidney and if they stay in the kidney, they do not typically cause pain. When they travel out of the body through the tubes of the urinary tract (including the ureters, which connect the kidney to the bladder, or the urethra, which leads outside the body), their movement may cause:
· No symptoms, if the stone is small enough.
· Sudden, severe pain that gets worse in waves. Stones may cause intense pain in the back, side, abdomen, groin, or genitals. People who have had a kidney stone often describe the pain as "the worst pain I've ever had."
· Feeling sick to the stomach (nausea) and vomiting.
· Blood in the urine (hematuria), which can occur either with stones that stay in the kidney or with those that travel through the ureters.
· Frequent and painful urination, which may occur when the stone is in the ureter or after the stone has left the bladder and is in the urethra. Painful urination may occur when a urinary tract infection is also present.
Kidney stones, one of the most painful of the urologic disorders, have beset humans for centuries. Scientists have found evidence of kidney stones in a 7,000-year-old Egyptian mummy. Unfortunately, kidney stones are one of the most common disorders of the urinary tract. Each year, people make almost 3 million visits to health care providers and more than half a million people go to emergency rooms for kidney stone problems.
Most kidney stones pass out of the body without any intervention by a physician. Stones that cause lasting symptoms or other complications may be treated by various techniques, most of which do not involve major surgery. Also, research advances have led to a better understanding of the many factors that promote stone formation and thus better treatments for preventing stones.
A kidney stone is a hard mass developed from crystals that separate from the urine within the urinary tract. Normally, urine contains chemicals that prevent or inhibit the crystals from forming. These inhibitors do not seem to work for everyone, however, so some people form stones. If the crystals remain tiny enough, they will travel through the urinary tract and pass out of the body in the urine without being noticed.
Kidney stones may contain various combinations of chemicals. The most common type of stone contains calcium in combination with either oxalate or phosphate. These chemicals are part of a person’s normal diet and make up important parts of the body, such as bones and muscles.
A less common type of stone is caused by infection in the urinary tract. This type of stone is called a struvite or infection stone. Another type of stone, uric acid stones, are a bit less common, and cystine stones are rare.
Urolithiasis is the medical term used to describe stones occurring in the urinary tract. Other frequently used terms are urinary tract stone disease and nephrolithiasis. Doctors also use terms that describe the location of the stone in the urinary tract. For example, a ureteral stone—or ureterolithiasis—is a kidney stone found in the ureter. To keep things simple, the general term kidney stones is used throughout this fact sheet.
Gallstones and kidney stones are not related. They form in different areas of the body. Someone with a gallstone is not necessarily more likely to develop kidney stones
For unknown reasons, the number of people in the United States with kidney stones has been increasing over the past 30 years. In the late 1970s, less than 4 percent of the population had stone-forming disease. By the early 1990s, the portion of the population with the disease had increased to more than 5 percent. Caucasians are more prone to develop kidney stones than African Americans. Stones occur more frequently in men. The prevalence of kidney stones rises dramatically as men enter their 40s and continues to rise into their 70s. For women, the prevalence of kidney stones peaks in their 50s. Once a person gets more than one stone, other stones are likely to develop.
What causes kidney stones?
Doctors do not always know what causes a stone to form. While certain foods may promote stone formation in people who are susceptible, scientists do not believe that eating any specific food causes stones to form in people who are not susceptible.
A person with a family history of kidney stones may be more likely to develop stones. Urinary tract infections, kidney disorders such as cystic kidney diseases, and certain metabolic disorders such as hyperparathyroidism are also linked to stone formation.
In addition, more than 70 percent of people with a rare hereditary disease called renal tubular acidosis develop kidney stones.
Cystinuria and hyperoxaluria are two other rare, inherited metabolic disorders that often cause kidney stones. In cystinuria, too much of the amino acid cystine, which does not dissolve in urine, is voided, leading to the formation of stones made of cystine. In patients with hyperoxaluria, the body produces too much oxalate, a salt. When the urine contains more oxalate than can be dissolved, the crystals settle out and form stones.
Hypercalciuria is inherited, and it may be the cause of stones in more than half of patients. Calcium is absorbed from food in excess and is lost into the urine. This high level of calcium in the urine causes crystals of calcium oxalate or calcium phosphate to form in the kidneys or elsewhere in the urinary tract.
Other causes of kidney stones are hyperuricosuria, which is a disorder of uric acid metabolism; gout; excess intake of vitamin D; urinary tract infections; and blockage of the urinary tract. Certain diuretics, commonly called water pills, and calcium-based antacids may increase the risk of forming kidney stones by increasing the amount of calcium in the urine.
Calcium oxalate stones may also form in people who have chronic inflammation of the bowel or who have had an intestinal bypass operation, or ostomy surgery. As mentioned earlier, struvite stones can form in people who have had a urinary tract infection. People who take the protease inhibitor indinavir, a medicine used to treat HIV infection, may also be at increased risk of developing kidney stones.
Foods and Drinks Containing Oxalate
People prone to forming calcium oxalate stones may be asked by their doctor to limit or avoid certain foods if their urine contains an excess of oxalate.
black Indian tea
Foods that have medium amounts of oxalate may be eaten in limited amounts.
Source: The Oxalosis and Hyperoxaluria Foundation.
Kidney stones often do not cause any symptoms. Usually, the first symptom of a kidney stone is extreme pain, which begins suddenly when a stone moves in the urinary tract and blocks the flow of urine. Typically, a person feels a sharp, cramping pain in the back and side in the area of the kidney or in the lower abdomen. Sometimes nausea and vomiting occur. Later, pain may spread to the groin.
If the stone is too large to pass easily, pain continues as the muscles in the wall of the narrow ureter try to squeeze the stone into the bladder. As the stone moves and the body tries to push it out, blood may appear in the urine, making the urine pink. As the stone moves down the ureter, closer to the bladder, a person may feel the need to urinate more often or feel a burning sensation during urination.
If fever and chills accompany any of these symptoms, an infection may be present. In this case, a person should contact a doctor immediately.
Sometimes “silent” stones—those that do not cause symptoms—are found on x rays taken during a general health exam. If the stones are small, they will often pass out of the body unnoticed. Often, kidney stones are found on an x ray or ultrasound taken of someone who complains of blood in the urine or sudden pain.
These diagnostic images give the doctor valuable information about the stone’s size and location. Blood and urine tests help detect any abnormal substance that might promote stone formation.The doctor may decide to scan the urinary system using a special test called a computerized tomography (CT) scan or an intravenous pyelogram (IVP). The results of all these tests help determine the proper treatment
A person who has had more than one kidney stone may be likely to form another; so, if possible, prevention is important. To help determine their cause, the doctor will order laboratory tests, including urine and blood tests. The doctor will also ask about the patient’s medical history, occupation, and eating habits. If a stone has been removed, or if the patient has passed a stone and saved it, a stone analysis by the laboratory may help the doctor in planning treatment.
The doctor may ask the patient to collect urine for 24 hours after a stone has passed or been removed. For a 24-hour urine collection, the patient is given a large container, which is to be refrigerated between trips to the bathroom. The collection is used to measure urine volume and levels of acidity, calcium, sodium, uric acid, oxalate, citrate, and creatinine—a product of muscle metabolism. The doctor will use this information to determine the cause of the stone. A second 24-hour urine collection may be needed to determine whether the prescribed treatment is working.
Saturday, July 4, 2009
Friday, July 3, 2009
Kadang2 tidak tercapai dek akal.Tak tergapai dek tangan dan tak terpandang dek mata betapa hebatnya kekuasaan Allah.
Seharusnya kita merenung seketika, segala perjalanan seorang manusia itu telah diatur dengan sempurna olehNya. Oleh itu,jangan sesekali merungut dan menyesali apa yang menimpa diri kerana segalanya mengandungi hikmah.
Bila dilihat pada rentetan kehidupannya, manakan mungkin dia akan kembali kepadaNya sebagai seorang muslim. Hidup dengan segalanya berasaskan dan bertunjangkan agama kristian, beliau menjadi seorang manusia yang begitu gah di mata dunia dalam dunia seni.
Sementelah lagi ditambah dengan kekayaan harta yang melimpah ruah dan sesekali kedengaran suara sumbang tentang kesongsangan hidupnya.malahan untuk kita bermimpi beliau akan menjadi seorang muslim adalah mustahil. Sekadar seorang ahli keluarga yang memilih Islam...huh!jauh panggang dari api jawabnya.
Namun...Allah itu berkuasa ke atas segala kejadian dan perjalanan makhluknya..maka pada suatu hari yang indah setelah dilanda dengan pelbagai kontroversi, beliau menukar kehidupan menjadi seorang Islam. Walaupun begitu, masih menjadi persoalan apakah benar beliau muslim? Atau hanya sekadar mahu melariskan jualan album?
Al-Fatihah buat Mikhael @ Michael
(1) Dengan menyebut nama Allah Yang Maha Pemurah lagi Maha Penyayang. (2) Segala puji bagi Allah, Tuhan semesta alam, (3) Maha Pemurah lagi Maha Penyayang, (4) Yang menguasai hari pembalasan. (5) Hanya kepada Engkaulah kami menyembah dan hanya kepada Engkaulah kami mohon pertolongan (6) Tunjukilah kami jalan yang lurus, (7) (yaitu) jalan orang-orang yang telah Engkau anugerahkan nikmat kepada mereka, bukan (jalan) mereka yang dimurkai dan bukan (pula jalan) mereka yang sesat.
Thursday, July 2, 2009
After the events of Ice Age: The Meltdown, life begins to change for Manny (Ray Romano) and his friends. Scrat (Chris Wedge) is still on the hunt to hold onto his beloved acorn, while finding a possible romance in a female sabre-toothed squirrel named Scratte. Manny and his new mate Ellie (Queen Latifah) are expecting a baby, which leaves Manny anxious to ensure that everything is perfect for when his baby arrives. Diego (Denis Leary) is fed up with being treated like a house-cat and ponders the notion that he is becoming too laid-back. Sid (John Leguizamo) begins to wish for a family of his own, and so steals some dinosaur eggs which leads to Sid ending up in an underground world where dinosaurs roam free, and where his herd must rescue him, while dodging dinosaurs and facing danger left and right, and meeting up with a weasel known as Buck (Simon Pegg) who hunts dinosaurs intently