LO: WEEK 2

1) Clinical findings of cholecystitis

• Cholelithiasis (Gallstones)
-Gallstones formation
-Clinical manifestation:
-epigastric and right hypochondrium pain and intolerance to fatty foods
-Vague symptoms include (heartburn, flatulence, epigastric discomfort, pruritus, jaundice, biliary
colic pain)
- The pain usually located in the right upper quadrant and radiates to the mid-upper back.
- jaundice indicates that the stone is located in the common bile duct.

• Cholecystitis
-Caused by the lodging of a gallstone in the cyctic duct.
-obstruction caused the gallbladder to become distended and inflamed
-Pressure against the distended wall of the gallbladder decreases blood flow
-Fever, leukocytosis, rebound tenderness and abdominal muscle guarding are common findings.
-serum bilirubin and alkaline phosphates levels may be elevetad.
-Murphy sign (+)

2) Hasil lab

3) Serum creatinine & Creatinine clearance

a) creatinine
Nilai normal : 0.6 - 1.3 mg/dL SI: 62-115 umol/L
b) creatinine clearance
nilai normal : pria : 1-2 g/24 jam
wanita : 0.8-1.8 g/24 jam

Creatinine is a waste product produced by muscles from the breakdown of a compound called
creatine. Creatinine is filtered from the blood by the kidneys and released into the urine. A
creatinine clearance test measures creatinine levels in both a sample of blood and a sample of
urine from a 24-hour urine collection. The results are used to calculate the amount of creatinine
that has been cleared from the blood and passed into the urine. This calculation allows for a
general evaluation of the amount of blood that is being filtered by the kidneys in a 24-hour time
period.
The amount of creatinine produced in the body is dependent on muscle mass and is
relatively constant for an individual. The amount of creatinine removed from the blood
depends on both the filtering ability of the kidneys and the rate at which blood is carried to
the kidneys.

The amount of blood filtered per minute by the kidneys is known as the glomerular filtration
rate (GFR). If the kidneys are damaged or diseased, or if blood circulation is slowed, then
less creatinine will be removed from the blood and released into the urine and the GFR will
be decreased.

A decreased creatinine clearance may suggest kidney disease or other conditions that can
affect kidney function. These can include:
• Damage to or swelling of blood vessels in the kidneys (glomerulonephritis) caused
by, for example, infection or autoimmune diseases
• Bacterial infection of the kidneys (pyelonephritis)
• Death of cells in the kidneys' small tubes (acute tubular necrosis) caused by, for
example, drugs or toxins
• Prostate disease, kidney stone, or other causes of urinary tract obstruction
• Reduced blood flow to the kidney due to shock, dehydration, congestive heart
failure, atherosclerosis, or complications of diabetes
For more on these, see Kidney Disease.
Increased creatinine clearance rates may occasionally be seen during pregnancy,
exercise, and with diets high in meat, although this test is not typically used to monitor
these conditions.

Perhitungan Klirens Kreatinin dari Konsentrasi Kreatinin Serum

. 1) Menurut Traub SL dan Johnson CE, untuk anak 1 – 18 tahun 


Clcr=[0,48×(tinggi)]/Scr

Keterangan; Clcr = kreatinin klirens dalam mL/min/1,73 m2 

Scr = serum kreatinin dalam mg/dL 

 . 2) Metode Jelliffe, memperhitungkan umur pasien, pada umumnya dapat dipakai
untuk pasien dewasa yang berumur 20-80 tahun. Dengan metode ini makin tua
pasien makin kecil klirens kreatinin untuk konsentrasi kreatinin serum yang sama. 

Pria : Clcr=[98-0,8x(umur-20)]/Scr 

Wanita: Hendaknya menggunakan 90% dari Clcr yang diperoleh pada pria atau
hasil dari pria x 0,90 


. 3) Metode Cockroff dan Gault juga digunakan untuk memperkirakan klirens

kreatinin dari konsentrasi kreatinin serum pasien dewasa. Metode ini melibatkan
umur dan berat badan pasien. 


Pria : Clcr={[140-umur(tahun)]×berat badan (kg)}/[72×Scr(mg/dL)]

Wanita : Untuk pasien wanita menggunakan 85 % dari harga Clcr yang diperoleh pada
pria atau hasil dari pria x 0,85

6) REFER PAIN PADA KIDNEY DISEASE

7) CVA (costo vertebral angle) NYERI DIMANA

an angle made by the vertebral column and the costal margin (12th rib). Because the kidney is
directly anterior to this area, tapping disturbs the inflamed tissue causing pain.

8) BASIC RADIOGRAPHY FOR KIDNEY

• Plain radiographs (x-rays)

Is used during the initial assessment for kidney stones and to measure the size and shape of the
kidney

• Intravenous Urography (IVU)

Is a test that uses an X-ray and dye and is used to measure kidney size, shape and evaluation of the
pelvis and ureters.

• Angiography (angiogram)

It uses contrast dye like the IVU but can provide mor information about the blood vessels. It helps
to assess for renal artery stenosis. best use in renal hypertension

• Ultrasonography (Ultrasound)

Is used to evaluate native kidneys and transplanted kidneys. It can measure the size, appearance of
the kidneys and detect tumors, congenital anomalies, swelling and blockage of urine flow. best use
in ARF (acute renal failure), renal mass and renal transplant

• Computed tomography (CT scan)

It is best to used to detect kidney stones and tumors but this has the risk of radiation exposure. best
use in Renal vein thrombosis, renal infection, renal stones, rena mass

• Magnetic reasonance imaging (MRI), best use in renal vein thrombosis

9) GFR

10) AKI