Tuesday, May 17, 2011

Management of Normal Delivery



Many obstetric units now use a combined labor, delivery, recovery, and postpartum (LDRP) rooms, so That the woman, support person, and neonate Remain In The Same Room Throughout Their stay. Some units use a traditional separate labor rooms and delivery suites, to the which the woman is Transferred Pls delivery is imminent. The father or other support person Should Be Offered the opportunity to accompany her. In the delivery room, the perineum is washed and draped, and the neonate is delivered. After delivery, the woman May Remain there or be Transferred to a postpartum unit. Management of complications During delivery requires additional measures (see abnormalities and Complications of Labor and Delivery ).

Anesthesia

Options include regional, local, and general anesthesia. Local anesthetics and opioids are commonly Used. These drugs pass through the placenta, thus, During the hour before delivery, Should Be Such drugs given in small doses to Avoid toxicity (eg, CNS depression, bradycardia) in the neonate. Opioids Used alone do not Provide adequate analgesia and so are most Often used with anesthetics.

Regional anesthesia: Several methods are available.

Lumbar epidural injection of a local anesthetic (see Normal Pregnancy, Labor, and Delivery: Analgesia ) is the most commonly Used method. Epidural injection is being increasingly Used for delivery, Including cesarean section, and has essentially Replaced pudenda and paracervical blocks. The local anesthetics for epidural injection Often used (eg, bupivacaine
MARCAINE
SENSORCAINE
Click for Drug Monograph
) Have a longer duration of action and slower onset Than Used for those pudenda block (eg, lidocaine
XYLOCAINE
Click for Drug Monograph
.)

Other methods include caudal injection (into the sacral canal), the which is rarely Used, and spinal injection (into the paraspinal subarachnoid space). Spinal Injection May be Used for cesarean section, but it is Used Less Often for vaginal deliveries Because it is short-lasting (preventing its use During labor) and has a small risk of spinal headache afterward. When spinal injection is Used, Patients must be Constantly Attended, and Vital Signs must be checked every 5 min to detect and treat possible hypotension.

Local anesthesia: Methods include pudenda block, perineal infiltration, and paracervical block.

Pudenda block, rarely Used Because epidural injections are Used instead, involves injecting a local anesthetic through the vaginal wall so That the anesthetic bathes the pudenda nerve as it crosses the ischial spine. This block anesthetizes the lower vagina, perineum, and posterior to the vulva, the anterior vulva, innervated by lumbar dermatomes, is not anesthetized. Pudenda block is a safe, simple method for uncomplicated spontaneous vaginal deliveries if women wish to bear down and push or if labor is advanced and there is no time for epidural injection.

Infiltration of the perineum with an anesthetic is commonly Used, although this method is not as effective as a well-administered pudenda block.

Paracervical block is rarely Appropriate for delivery Because incidence of fetal bradycardia is> 15%. It is Used mainly for 1st-or early 2nd-trimester abortion. The technique involves injecting 5 to 10 mL of 1% lidocaine
XYLOCAINE
Click for Drug Monograph
at the 3 and 9 o'clock positions; the analgesic response is short-lasting.

General anesthesia: Because potent and volatile inhalation drugs (eg, isoflurane) cans cause marked depression in mother and fetus, general anesthesia is not recommended for routine delivery. Rarely, 40% nitrous oxide with O 2 May be Used for analgesia During vaginal delivery as long as verbal contact with the woman is maintained. thiopental
Pentothal
Click for Drug Monograph
, A hypnotic, is commonly given IV with other drugs (eg, succinylcholine
ANECTINE
QUELICIN
Click for Drug Monograph
, Nitrous oxide plus O 2) for induction of general anesthesia During cesarean delivery; Used alone, thiopental
Pentothal
Click for Drug Monograph
Provides inadequate analgesia. With thiopental
Pentothal
Click for Drug Monograph
, Induction is rapid and recovery is prompt. It Becomes concentrated in the fetal liver, preventing from Becoming high levels in the CNS; high levels in the CNS May cause neonatal depression. Increased interest in preparation for Childbirth has reduced the need for general anesthesia except for cesarean section.

Delivery Procedures

A vaginal examination is done to determine position and station of the fetal head, the head is usually the presenting part (see Fig. 2: Normal Pregnancy, Labor, and Delivery: Sequence of events in delivery for vertex presentations. Figures .) When effacement is complete and the cervix is ​​fully dilated, the woman is toll to bear down and strain with EACH contraction to move the head through the pelvis and progressively dilate the vaginal introitus so That more and more of the head appears. When about 3 or 4 cm of the head is visible During a contraction in nulliparas (Somewhat less in multiparas), the Following maneuvers cans facilitate delivery and reduce risk of perineal laceration.

The clinician, if right-handed, places the left palm over the infant's head During a contraction to control and, if Necessary, Slightly slow progress.
Simultaneously, the clinician places the curved fingers of the right hand against the dilating perineum, through the which the infant's Brow or chin is felt.
To advance the head, the clinician cans wrap a hand in a towel and, with curved fingers, apply pressure against the underside of the chin or Brow (modified Ritgen maneuvers).

Thus, the clinician controls the progress of the head to effect a slow, safe delivery.

Fig. 2


Sequence of events in delivery for vertex presentations.
Sequence of events in delivery for vertex presentations.

Forceps or a vacuum extractor (see abnormalities and Complications of Labor and Delivery: Operative vaginal delivery ) is Often used for vaginal delivery Pls the 2nd stage of labor is likely, to be prolonged (eg, Because the mother is too exhausted to bear down adequately or Because regional epidural anesthesia precludes vigorous bearing down). If general anesthesia is local (pudenda block or infiltration of the perineum), forceps or a vacuum extractor is usually not needed unless complications develop; local anesthesia May not interfere with bearing down. Indications for forceps and vacuum extractor are essentially the Same.

An episiotomy is not routine and is done only if the perineum does not stretch adequately and is obstructing the delivery, usually only for first deliveries at term. A local anesthetic infiltrated few cans if epidural analgesia is inadequate. Episiotomy prevents excessive stretching and possible tearing of the perineal tissues, Including anterior tears. The incision is Easier to repair than a tear. The most common type is a midline incision made from the midpoint of the fourchette directly back toward the rectum. Extension into the rectal sphincter or rectum is a risk, but if Recognized promptly, the extension cans be repaired successfully and heals well. Tears or extensions into the rectum cans usually be prevented by keeping the infant's head well flexed Until the occipital Prominence passes under the symphysis pubis. Another type of episiotomy is a mediolateral incision made ​​from the midpoint of the fourchette at a 45 ° angle laterally on Either Side. This type usually does not extend into the sphincter or rectum, but it causes the Greater postoperative pain and takes longer to heal Than midline episiotomy. Thus, for episiotomy, a midline cut is preferred. However, use of episiotomy is decreasing Because extension or tearing into the sphincter or rectum is a concern. Episioproctotomy (intentionally cutting into the rectum) is not recommended Because rectovaginal fistula is a risk.

When the head is delivered, the clinician determines whether the umbilical cord is wrapped around the neck. If it is, the clinician Should try to Unwrap the cord, if the cord can not be rapidly removed this way, the cord clamped and cut some of May. After delivery of the head, the infant's body rotates so That the shoulders are in an anteroposterior position; gentle downward pressure on the head delivers the anterior shoulder under the symphysis. Gently The head is lifted, the posterior shoulder slides over the perineum, and the rest of the body follows without difficulty. The nose, mouth, and pharynx are aspirated with a bulb syringe to remove mucus and fluids and help start respirations. The cord Should Be double-clamped and cut Between the clamps, and a plastic cord clip Should Be applied about 2 to 3 cm distal from the cord insertion on the infant. If fetal or neonatal compromise is suspected, a segment of umbilical cord is doubly clamped so That cans arterial blood gas analysis be done. An arterial pH> 7.l5 to 7:20 is Considered normal. The infant is thoroughly dried, then placed on the mother's abdomen or, if resuscitation is needed, in a warmed resuscitation bassinet.

After delivery of the infant, the clinician places a hand Gently on the abdomen over the fundus to detect uterine contractions, placental separation usually occurs During the 1st or 2nd contraction, Often with a Gush of blood from behind the separating placenta. The mother cans usually help deliver the placenta by bearing down. If she can not and if substantial bleeding occurs, the placenta usually be evacuated cans (expressed) by Placing a hand on the abdomen and exerting firm downward (caudal) pressure on the uterus, this procedure is done only if the uterus feels firm Because pressure on a flaccid uterus cans cause it to invert. If this procedure is not effective, the umbilical cord is held on the link while a hand placed on the abdomen pushes upward (cephalad) on the firm uterus, away from the placenta; traction on the umbilical cord is avoided Because it May invert the uterus. If the placenta has not been delivered Within 45 to 60 min of delivery, manual removal May be Necessary; the clinician inserts an entire hand into the uterine cavity, separating the placenta from its attachment, then extracts the placenta. In Such cases, an abnormally adherent placenta (placenta accreta-see abnormalities and Complications of Labor and Delivery: Placenta Accreta ) Should be suspected.

The placenta is examined for completeness Should Be Because fragments left in the uterus cans cause hemorrhage or infection later. If the placenta is incomplete, the uterine cavity Should Be explored manually. Some obstetricians routinely EACH explore the uterus after delivery. However, exploration is uncomfortable and is not routinely recommended. Immediately after delivery of the placenta, an oxytocic drug ( oxytocin
PITOCIN
SYNTOCINON
Click for Drug Monograph
10 units IM or as an infusion of 20 units/1000 mL saline at 125 mL / h) is given to help the uterus contract firmly. oxytocin
PITOCIN
SYNTOCINON
Click for Drug Monograph
Should not be given as an IV bolus Because cardiac arrhythmia May occur.

The cervix and vagina are inspected for lacerations, the which, if present, are repaired, as is episiotomy if done. Then if the mother and infant are recovering normally, cans They begin bonding. Many mothers wish to begin breastfeeding soon after delivery, and Should Be encouraged this activity. Mother, infant, and father Should Remain together in a warm, private area for an hour or more to enhance parent-infant bonding. Then, the infant May be taken to the nursery or left with the mother depending on her wishes. For the first hour after delivery, the mother Should Be observed closely to make sure the uterus is contracting (detected by palpation During abdominal examination) and to check for bleeding, BP abnormalities, and general well-being. The time from delivery of the placenta to 4 h postpartum has been Called the 4th stage of labor; most complications, especially hemorrhage (see abnormalities and Complications of Labor and Delivery: Postpartum Hemorrhage ), occur at this time, and frequent observation is mandatory.
heart disease

syamrina

Heart disease is a broad term Used to DESCRIBE a range of diseases That Affect your heart. The Various diseases That fall under the umbrella of heart disease include diseases of your blood vessels, Such as coronary artery disease, heart rhythm problems (arrhythmias), heart infections, and heart defects're born with (congenital heart defects).

The term "heart disease" is Often used interchangeably with "cardiovascular disease." Cardiovascular disease refers to conditions Generally Involve That narrowed or blocked blood vessels cans That leads to a heart attack, chest pain (angina) or stroke. Other heart conditions, infections and conditions Such as That Affect your heart's muscle, valves or beating rhythm, Also Are Considered forms of heart disease.

Many forms of heart disease be prevented or treated cans with healthy lifestyle choices.
Heart Anatomy


Simply click on a region of the heart "on the diagrams or the hyperlinks listed below to learn more about the structures of the heart.


Right Coronary
Left Anterior Descending
Left Circumflex
Superior Vena Cava
Inferior Vena Cava
Aorta
Pulmonary Artery
Pulmonary Vein



Right Atrium
Right ventricle
Left Atrium
Left ventricle
Papillary Muscles
Chordae Tendineae
Tricuspid valve
Mitral Valve
Pulmonary Valve
Aortic Valve (Not pictured)

Coronary arteries

Because the heart is composed primarily of cardiac muscle tissue contracts and relaxes That continuously, it must have a constant supply of oxygen and nutrients. The coronary arteries are the network of blood vessels carry That oxygen-and nutrient-rich blood to the cardiac muscle tissue.

Leaving The blood exits the left ventricle through the aorta, the body's main artery. Two coronary arteries, Referred to as the "left" and "right" coronary arteries, emerge from the beginning of the aorta, near the top of the heart.

The initial segment of the left coronary artery is Called the left main coronary. This blood vessel is approximately the width of a soda straw and is Less than an inch long. It Slightly Smaller branches into two arteries: the left anterior descending coronary artery and the left circumflex coronary artery. The left anterior descending coronary artery is embedded in the surface of the front side of the heart. The left circumflex coronary artery circles around the left side of the heart and is embedded in the surface of the back of the heart.

Just like branches on a tree, the coronary arteries branch into progressively Smaller vessels. The larger vessels travel along the surface of the heart, however, the Smaller branches penetrate the heart muscle. The smallest branches, Called capillaries, are so narrow That the red blood cells must travel in single file. In the capillaries, the red blood cells and oxygen Provide nutrients to the cardiac muscle tissue and bond with carbon dioxide and other metabolic waste products, Them taking away from the heart "for disposal through the lungs, kidneys and liver.

When cholesterol plaque accumulates to the point of blocking the flow of blood through a coronary artery, the cardiac muscle tissue fed by the coronary artery beyond the point of the blockage is deprived of oxygen and nutrients. This area of ​​cardiac muscle tissue ceases to function properly. The condition Pls Becomes a blocked coronary artery Causing damage to the cardiac muscle tissue it serves is Called a myocardial infarction or heart attack.
Superior Vena Cava

The superior vena cava is one of the two main veins Bringing de-oxygenated blood from the body to the heart. Veins from the head and upper body feeds into the superior vena cava, the which empties into the right atrium of the heart.
Inferior Vena Cava

The inferior vena cava is one of the two main veins Bringing de-oxygenated blood from the body to the heart. Veins from the legs and lower torso feeds into the inferior vena cava, the which empties into the right atrium of the heart.
Aorta

The aorta is the Largest single blood vessel in the body. It is approximately the diameter of your thumb. This vessel carries oxygen-rich blood from the left ventricle to the Various parts of the body.
Pulmonary Artery

The pulmonary artery is the vessel Transporting de-oxygenated blood from the right ventricle to the lungs. A common misconception Is That all arteries carry oxygen-rich blood. It is more Appropriate to classify arteries as vessels carrying blood away from the heart.
Pulmonary Vein

The pulmonary vein is the vessel Transporting oxygen-rich blood from the lungs to the left atrium. A common misconception Is That all veins carry de-oxygenated blood. It is more Appropriate to classify veins as vessels carrying blood to the heart.
Right Atrium

The right atrium receives de-oxygenated blood from the body through the superior vena cava (head and upper body) and inferior vena cava (legs and lower torso). The sinoatrial node sends an impulse That causes the cardiac muscle tissue of the atria to contract in a coordinated, wave-like manner. The tricuspid valve, the which separates the right atrium from the right ventricle, opens to allow the de-oxygenated blood collected in the right atrium to flow into the right ventricle.
Right ventricle

The right ventricle receives de-oxygenated blood as the right atrium contracts. The pulmonary valve leading into the pulmonary artery is closed, allowing the ventricle to fill with blood. Once the ventricles are full, They contract. As the right ventricle contracts, the tricuspid valve closes and the pulmonary valve opens. The closure of the tricuspid valve prevents blood from backing into the right atrium and the opening of the pulmonary valve allows the blood to flow into the pulmonary artery toward the lungs.
Left Atrium

The left atrium receives oxygenated blood from the lungs through the pulmonary vein. As the contraction triggered by the sinoatrial node progresses through the atria, the blood passes through the mitral valve into the left ventricle.
Left ventricle

The left ventricle receives oxygenated blood as the left atrium contracts. The blood passes through the mitral valve into the left ventricle. The aortic valve leading into the aorta is closed, allowing the ventricle to fill with blood. Once the ventricles are full, They contract. As the left ventricle contracts, the mitral valve closes and the aortic valve opens. The closure of the mitral valve prevents blood from backing into the left atrium and the opening of the aortic valve allows the blood to flow into the aorta and flow Throughout the body.
Papillary Muscles

The papillary muscles attach to the lower portion of the interior wall of the ventricles. They connects to the chordae tendineae, the which attach to the tricuspid valve in the right ventricle and the mitral valve in the left ventricle. The contraction of the papillary muscles opens these valves. When the papillary muscles relax, the valves close.
Chordae Tendineae

The chordae tendineae are tendons linking the papillary muscles to the tricuspid valve in the right ventricle and the mitral valve in the left ventricle. As the papillary muscles contract and relax, the chordae tendineae transmit the resulting increase is and Decrease in tension to the respective valves, Causing Them to open and close. The chordae tendineae are string-like in appearance and are Sometimes Referred to as "heart strings."
Tricuspid valve

The tricuspid valve separates the right atrium from the right ventricle. It opens to allow the de-oxygenated blood collected in the right atrium to flow into the right ventricle. It closes as the right ventricle contracts, preventing blood from Returning to the right atrium, thereby, forcing it to exit through the pulmonary valve into the pulmonary artery.
Mitral Value

The mitral valve separates the left atrium from the left ventricle. It opens to allow the oxygenated blood collected in the left atrium to flow into the left ventricle. It closes as the left ventricle contracts, preventing blood from Returning to the left atrium, thereby, forcing it to exit through the aortic valve into the aorta.
Pulmonary Valve

The pulmonary valve separates the right ventricle from the pulmonary artery. As the ventricles contract, it opens to allow the de-oxygenated blood collected in the right ventricle to flow to the lungs. It closes as the ventricles relax, preventing blood from Returning to the heart.
Aortic Valve

The aortic valve separates the left ventricle from the aorta. As the ventricles contract, it opens to allow the oxygenated blood collected in the left ventricle to flow Throughout the body. It closes as the ventricles relax, preventing blood from Returning to the heart.

kinds of intrauterine device.

kinds of intrauterine device.

Student of midwifery have to know about is assorted is way of and contraception type, including the way of usage, way of job/activity, excess and his/its weakness
Utilize him
1. For ownself
2. To giving tuition / konseling to Family acceptor candidate of Berencana ( KB
3. Giving counselling about KB to [common/ public] society, for example student and student, fertile age woman group, industrial worker, worker of office, woman dharma, PKK, and others

HISTORY CONTRACEPTION

Early usage of contraception have never been known categorically, because human desire [in order] not to have child ( with various reason) have emerged since existence of itself human being
Though now have been met is assorted of intrauterine device and also modern contraception method, but simple contraception method still used by them which fear to side effects generated by modern intrauterine device, because if will be downright it is true in fact until this saar [there] no intrauterine device which is totally secure or free from side effects

TYPE CONTRACEPTION
Method Contraception can be grouped according to
1. Its user/ wearer that is woman or men
2. Its method that is modestly or is modern
3. Target of usage that is to delay pregnancy, arranging pregnancy, or to terminate fertility
Pursuant to its [user/ wearer]
1. Contraception for woman
a) mechanical Method
• serviks kap ( cervical [of] chop
• diaphragm
• Intrauterine Device In Womb ( AKDR) / Intra Uterine Device ( IUD)
b) Method of hormonal / kimiawi
• Pill of KB
• Injection of KB
• Implant / KB susuk
• Spermaticide
c) Method of operatif:
• Medical Operatif Woman ( MOW) / Tubektomi
2. Contraception for men:
a) mechanical Method: Condom of KB
b) Method of operatif: Medical [of] Operatif Man ( MOP) / Vasectomy
Pursuant to its method
1. simple Contraception method / Natural / Traditional:
a) Method calendar / Periodic prohibition / Method of Ritmil of Knaus and of Ogino ( The Safe Period)
b) Method dropsy temperature
c) Method Mucus of serviks
d) broken Method coitus ( interuptus coitus)
e) Indirectly have contraception effect [to]: method of Laktasi ( suckling)
f) Aborsi
2. modern Method Contraception / Conventional:
a) mechanical Method
• Condom of KB
• Kap Serviks ( cervical [of] chop
• Diaphragm "
• Intrauterine Device In Womb ( AKDR) / Intra Uterine Device ( IUD)
b) Method hormonal
• Pill of KB
• Implant / KB susuk
• Inseminating KB
c) Kimiawi
• Suppositorial
• Jelly / cream / pasta
• Tissue
• Foamy Tablet
• Aerosol
d) Method of operatif
• Medical of Operatif Woman ( MOW) / Tubektomi.
• Medical of Operatif Man ( MOP) / Vasectomy
Pursuant to target of its usage:

In fact no an compulsion wear an certain intrauterine device if/when wishing to delay, arranging, or terminating pregnancy, but there suggestion to use certain intrauterine device in line with each [so that/ to be] maximal efektifitas can reach.

1. To delay pregnancy:
for the purpose of this [is] usually used [by] guaranteed intrauterine device or method have refersibilitas ( ability to return fertil) high.
Intrauterine device which can wear
• Condom of KB
• Pill of KB
• Injection of KB which must be repeated each;every one months once
• Simple method which combination with usage of Condom ,or Pill of KB, or Diaphragm, or serviks kap, or suppositorial, jelly, foamy tablet, aerosol, cream, pasta
2. To arrange pregnancy
• Intrauterine Device In Womb ( AKDR)/ Intra Utrine Device ( IUD)
• Pill of KB
• Injection of KB ( which can three monthly or one monthly)
• Implant / KB susuk
3. To terminate fertility
• Medical Operatif Woman ( MOW) / Tubektomi
• Medical [of] Operatif Man ( MOP) / Vasectomy
To study about contraception, have to comprehend in front conception
1. Ovulasi: hormone of FSH, LH, and Gnrh
2. cycle of Menstruasi/Haid: estrogen, progesteron
SIMPLE METHOD CONTRACEPTION ( WITHOUT APPLIANCE)
1. Method Calendar
• its Mechanism [Job/Activity]: [counting/calculating] a period of/to fertility and a period of/to not fertility
• Its weakness: incompatible for woman with cycle menstruate not regular and husband cooperation butuh and wife
• Its excellence: without side effects ( except sometime stress)dan without expense
• Failure number + 14
2. Method Temperature Dropsy
• its Mechanism [Job/Activity]: determining moment of ovulasi with measuring body temperature
• Its weakness: careful butuh and if/when pain, wife husband cooperation butuh
• Its excellence: without side effects ( except sometime stress " Failure number + 1%

Result of measurement each;every awaking up sleep morning noted by at graph paper ( chart) like example of following

Temperature Body.
Day
1 2 3 4 5 6 7 8 9 11 12

x x X

x x x x x x X

X
↓ ↓
Ovulasi Menstruate
3. Method Perception Of Mucus of Serviks ( Method of Ovulasi)
• its Mechanism [Job/Activity]: determining a period of/to fertility with measuring storey;level dilution of mucus of serviks
• Its weakness: limitation of eye
• Its excellence: without side effects " Failure number: unknown
4. Coitus Iinteruptus
• its Mechanism [Job/Activity]: [releasing] penis of vagina before ejakulasi
• Its weakness: wife husband cooperation butuh, stress, do not be guaranteed by there no yg spermatozoa have entered in uterus
• Its excellence: can be [done/conducted] any time without [counting/calculating] a period of/to fertility and [do] not fertility
• Failure number: unknown
5. Suckling ( Laktasi " its Mechanism [Job/Activity]
• International suckle < four clock or minimize milk baby six times one day the each left and right bosom by bergantian
• Baby only getting ASI or most ASI
• Do not be allowed there is time interval desist to suckle since baby born six-month until.
• There no blood of pervaginal since finishing of a period of/to child bed.
 Its weakness: lazy baby is milk, lazy mother suckle, mother work, ASI do not go out
 Its excellence: can be [done/conducted] any time, without expense
 Failure number + 1

MODERN METHOD CONTRACEPTION
1. Hormonal
a. Pill: Pill Combination and Pill of KB mini
b. Inseminating KB
c. Implant/ KB susuk/ Norplan
2. Spermatizide ( Kimiawi)
a. Tissue KB
b. Jelly, pasta
c. Foamy tablet
d. Suppositoria
3. Mechanical
a. Condom
b. AKDR ( IUD)
c. Diaphragm
d. Kap Cervik ( cervical chop)
e. Woman condom
4. Medical operatif
a. Tubektomi ( MOW): with operation [at] tuba
 Bound later;then cut
 To be burned ( cauterized
 Nipped
 To be bound to arch
 To be inseminated chemical Iihat vitamin which can ossify and can melt again
b) Vasektomi ( MOP): with operation [at] deverens vas in the same way with MOW
















BIBLIOGRAPHY

Part Of Obstetri & Gynaecology Faculty Of Mediciness University of Padjadjaran, 1980. Technique Family of Berencana ( Treatment Of Fertility). Elstar Offset, Bandung.
Soedarto, 1994. Diktat Family of Berencana. Submitted by at: Courses Demography carried out by Center Research of Kependudukan and Development Of Institute Research Of University of Airlangga.
Faculty Of Mediciness University of Airlangga, 1980. Atlas Education Of Sex, Information of Biologis About Sexualitas Human Being. FK - University of Airlangga.
Baverly Winikoff Suzanne Wymelenberg and, 1977. The Whole Truth About Contraseption. Joseph Henry of Press, Washington, D.C

Kidney

Kidney



The kidneys are organs of excretion in vertebrates shaped like peanuts. As part of the urinary system, kidney function filter wastes (especially urea) from the blood and threw it together with water in the form of urine. Branch of medicine that studies the kidneys and the disease is called nephrology.
Table of contents
[Hide]

A basic anatomy
1.1 Location
1.2 Structural details
1.3 Organization
1.4 Functions of kidney homeostasis
2 Diseases and disorders
2.1 Default
2.2 Acquired
3 Dialysis and kidney transplants
3.1 Statistics kidney transplant
4 References
5 See also
6 External links

[Edit] Anatomical basis
[Edit] Location

Human beings have a pair of kidneys are located behind the stomach or abdomen. The kidneys are located on the right and left spine, below the liver and spleen. At the top (superior), the kidney is an adrenal gland (also called the suprarenal gland).

The kidneys are retroperitoneal, which means that lie behind the peritoneum lining the abdominal cavity. Both kidneys are located in the vicinity of vertebrae T12 to L3. Right kidney usually lies slightly below the left kidney to make room for the heart.

Some of the top of the kidneys are protected by the eleventh and twelfth ribs. Both kidneys wrapped by two layers of fat (perirenal and pararenal fat) which help reduce shock.
Pieces of kidney longitudinal
[Edit] Structural details

In adults, each kidney has a length of about 11 cm and 5 cm thick, weighing about 150 grams. Kidneys have a shape like a bean with the indentation facing the inside. In each kidney is an opening called the hilum of the renal artery that connects, renal vein, and ureter.
[Edit] Organization

Outermost part of the kidney called the cortex, the deeper part is called the medulla. Innermost part is called the pelvis. In the medulla of human kidney can also be seen the pyramids, which is opening channels gatherer. Kidney wrapped by a layer of loose connective tissue called the capsule. The basic functional unit of the kidney is the nephron that could be more than one million in each normal adult human kidney. Nephron function as regulator of water and solutes (especially electrolytes) in the body by filtering the blood, then mereabsorpsi fluid and molecules that are still needed for the body. Molecular and other liquid remaining will be discarded. Reabsorption and disposal are conducted using the countercurrent exchange mechanism and kotranspor. The final result is then excreted called urine. A nephron consists of a filter component called korpuskula (or Malpighian body), followed by the channels (tubules). Each roll contains korpuskula blood capillaries called the glomerulus within Bowman's capsule. Each glomerulus receive blood flow from afferent arteries. Of glomerular capillary walls have pores for filtration or filtration. Blood can be filtered through the porous walls thin epithelium of the glomerulus and Bowman's capsule due to the pressure of the blood which promote blood plasma. The resulting filtrate will go to Dalan kidney tubules. Blood that has been filtered to leave the kidney through efferent arteries. Among the blood in the glomerulus and the room filled with fluid in Bowman's capsule, there are three layers:

capillary endothelium cell layer of the glomerulus
rich layer of basement membrane proteins as
layer of epithelial cells lining Bowman's capsule (podosit)

With the help of pressure, fluid blood Dalan pushed out of the glomerulus, through the third layer and into the room in Bowman's capsule in the form of glomerular filtrate. Filtrate of blood plasma contains no blood cells or large protein molecules. Protein in the form of a small molecule can be found in this filtrate. Human blood through the kidneys 350 times a day with a rate of 1.2 liters per minute, resulting in glomerular filtrate 125 cc per minute. Glomerular filtration rate is used for diagnostic tests of renal function.
Kidney tissue. The blue color indicates a single tubule

Renal tubules is a continuation of the Bowman's capsule. The segment that drains glomerular filtrate from Bowman's capsule is called the proximal convoluted tubule. The next section is the loop which empties into the distal convoluted tubule. Loop of Henle was named by the inventor of Friedrich Gustav Jakob Henle at the beginning of the 1860s. Loop of Henle to maintain osmotic gradients in the countercurrent exchange used for filtration. Cells lining the tubules have many mitochondria that produce ATP and allow for active transport to reabsorb glucose, amino acids, and various mineral ions. Most of the water (97.7%) in the filtrate into the convoluted tubules and collecting tubules by osmosis. Fluid flows from the distal convoluted tubule into the collecting system consisting of:

connecting tubule
cortical collecting tubule
tubules kloektivus medularis

Place the loop of Henle intersect with afferent artery called the juxtaglomerular apparatus, containing the macula densa and juxtaglomerular cells. Tues juxtaglomerular is the site of synthesis and secretion of renin into the more viscous fluid along the tubules and channels to form urine, which is then brought into the bladder through the ureter.
[Edit] The function of kidney homeostasis

The kidneys regulate the pH, mineral ion concentration, and composition of water in the blood.

The kidneys maintain blood plasma pH in the range of 7.4 through the exchange of hydronium and hydroxyl ions. As a result, urine can be produced acid at pH 5 or alkaline at pH 8.

Sodium ion concentration is controlled by a homeostatic process involving aldosterone to increase the absorption of sodium ions in the convoluted tubule.

Increase or decrease in blood osmotic pressure due to excess or shortage of water will soon be detected by the hypothalamus signals the pituitary gland by negative feedback. The pituitary gland to secrete antidiuretic hormone (vasopressin, to suppress the secretion of water) that resulted in changes in the level of water absorption in the kidney tubules. As a result the concentration of tissue fluid will return to 98%.
[Edit] Diseases and disorders
[Edit] Default

Renal tubular acidosis
Congenital hydronephrosis
Congenital obstruction of urinary tract
Duplicated ureter
Horseshoe kidney
Polycystic kidney disease
Renal dysplasia
Unilateral small kidney

[Edit] Acquired

Diabetic nephropathy
Glomerulonephritis
Hydronephrosis is the enlargement of one or both kidneys caused by obstruction of urine flow.
Interstitial nephritis
Kidney stones are a common abnormality and usually painful.
Kidney Tumor
Wilms tumor
Renal cell carcinoma
Lupus nephritis
Minimal change disease
In nephrotic syndrome, the glomerulus has been damaged so much protein in the blood into the urine. Other frequent features of the nephrotic syndrome include swelling, low serum albumin, and high cholesterol.
Pyelonephritis is a kidney infection and is often caused by complications of urinary tract infection.
Renal failure
Acute renal failure
Chronic renal failure

[Edit] Dialysis and kidney transplants

Generally, a person can live a normal life with only one kidney. If both kidneys are not functioning normally, then someone needs to get a Renal Replacement Therapy (TPG). TPG can be done either temporarily or continuously. TPG consists of three, namely: Hemodialysis (Wash Blood), Peritoneal Dialysis (Wash cavity Stomach) and Renal Transplant (transplant). The basic principle of hemodialysis is to clean the blood by using the Artificial Kidney. While peritoneal dialysis using a membrane of the abdominal cavity (peritoneum) as a filter between the blood and fluid Dianial.

Kidney transplants are now quite common. The first successful transplant was announced on March 4, 1954 at Peter Bent Brigham Hospital in Boston, Massachusetts. The operation was conducted by Dr. Joseph E. Murray, who in 1990 received the Nobel Prize in physiology or medicine.

Kidney transplant can be done "cadaveric" (from someone who has died) or from a living donor (usually a family member). There are several advantages for transplantation from a living donor, including a better match, the donor can be thoroughly tested before transplant and the kidney is likely to have a longer lifespan. [1].
[Edit] Statistics kidney transplant
State kadaverik Transplantation Transplantation Transplantation of living donor total
Canada 724 388 1.112 (2000) [2]
France 1.991 2.127 136 (2003) [3]
Italy 1.489 1.624 135 (2003)
Spain 1.991 60 2.051 (year 2003)
United Kingdom 1.297 1.736 439 (2003) [4]
United States 8.670 6.468 15.138 (2003) [5]