[vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][ultimate_heading main_heading=”Candidate brief” main_heading_color=”#000000″ sub_heading_color=”#000000″ main_heading_style=”font-weight:bold;” main_heading_font_size=”desktop:36px;”]

“This patient has presented to the acute medical take complaining of loin discomfort.  Please examine their abdomen and present your findings to the examiners.”

[/ultimate_heading][vc_empty_space image_repeat=”no-repeat”][vc_video link=”https://vimeo.com/138191649″][vc_empty_space image_repeat=”no-repeat”][vc_row_inner row_type=”row” type=”full_width” use_row_as_full_screen_section_slide=”no” text_align=”left” css_animation=””][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Station time” counter_value=”20″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Time for this encounter” counter_value=”10″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Maximum time to examine your patient” counter_value=”6″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][vc_column_inner width=”1/4″][stat_counter icon_size=”32″ counter_title=”Minimum time for discussion and questions” counter_value=”4″ counter_suffix=” minutes” speed=”3″][/vc_column_inner][/vc_row_inner][vc_empty_space image_repeat=”no-repeat”][/vc_column][/vc_row][vc_row row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” oblique_section=”no” text_align=”left” css_animation=””][vc_column][vc_accordion style=”accordion”][vc_accordion_tab title=”Common examiner questions”][vc_column_text]Common examiner questions include the following:

  1. What do you think this patient has?
  2. How would you like to investigate this patient next?
  3. What do you think the underlying cause of this patient’s signs is?

[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Diagnosis and clinical signs”][vc_column_text]This patient has had a right nephrectomy or adrenalectomy.

The clinical signs exhibited in this video include:

  • A right nephrectomy scar.

Note is also made of an old appendicectomy scar and subtle lower abdominal striae.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Discussion”][vc_column_text]

Indications:

Nephrectomy is the surgical removal of a kidney. The procedure is done to treat kidney cancer as well as other kidney diseases and injuries. Nephrectomy is also done to remove a healthy kidney from a donor (either living or deceased) for transplantation.

Indications for nephrectomy include renal cell carcinoma, severe trauma and benign disease such as hydronephrosis, chronic infections, polycystic kidney disease, shrunken kidney, hypertension and renal calculi, Wilm’s tumor and transitional cell cancer.

Contraindications:

Post-transplant lymphoproliferative (PTLD) disorder is the only contraindication. Patients with renal graft complications with disseminated PTLD do not benefit from nephrectomy.

Procedure:

There are two types of nephrectomy for a diseased kidney: partial and radical. The affected part of the kidney is removed in a partial nephrectomy whereas in radical nephrectomy the entire kidney is removed, along with a section of the ureter, part of the adrenal gland and the fat surrounding the kidney. Removal of both kidneys is called bilateral nephrectomy and removal of kidney for transplantation is called donor nephrectomy.

The procedure is done under general anaesthesia, hence written consent and GA fitness is required. The patient is evaluated for hypertension and diabetes post operatively.

There are two ways with which nephrectomy can be done: Laparoscopic (minimally invasive) and open nephrectomy. Laparoscopic nephrectomy is the preferred method for donor nephrectomy, but it can be used for partial or radical nephrectomy as well. It has the following advantages: quick recovery, shorter hospital stay, smaller incisions and fewer post-operative complications. Open nephrectomy is used when laparoscopic surgery is not appropriate, or there is a complex tumor to be removed, like renal cell carcinoma that has metastasized to other organs. In this case it is called a cytoreductive radical nephrectomy.

Complications:

Possible complications of nephrectomy include: infection, haemorrhage, post-operative pneumonia, and anaesthesia related problems. These complications can be prevented by monitoring blood pressure, electrolytes and fluid balance. The urinary bladder is catheterised until recovery.[/vc_column_text][/vc_accordion_tab][vc_accordion_tab title=”Specimen case presentation”][vc_column_text]”This patient has had a previous nephrectomy or adrenalectomy.  As they are presenting with loin pain I would review their previous history to determine what this was for.  Possible causes for the acute presentation include surgical complications or invasive recurrence of a malignancy.”[/vc_column_text][/vc_accordion_tab][/vc_accordion][/vc_column][/vc_row]