Question

After the test results came back, Dr. T tells Y that the kidney anomaly in her fetus is likely the result of a congential defect in one kidney. However, he orders consultations with pediatric cardiologists and nephrologists to make sure there are not any other issues related to this defect. Consensus is that the full extent of the issue is not knowable until after the baby girl is born. Y's water breaks at week 35 of her pregnancy. Her daughter, A, is born at 2925 grams and 47 centimeters, with a normal Apgar score. Baby A is given urinary and renal ultrasounds, and given daily antibiotics as prophylaxis to reduce the chance of kidney and urinary tract infections. After a few weeks, Drs. Note that baby A likely have ureterocele. This is when the distal end of the ureter balloons into the bladder and forms a second, fluid-filled structure within the bladder itself. If not treated, it can cause UTIs, obstruction, or in severe cases, renal failure. To treat, Drs. Recommend a transuretral puncture. Baby A undergoes to procedure at 3 months old, but has complications resulting in kidney reflux, where some of the urine goes backwards up the ureter toward the kidney rather than into the bladder. At 3 years of age, A will need to undergo another surgery for her left (affected) kidney, to stop the kidney reflux. This surgery has a 98% success rate. Y underwent sucessful cervical conization surgery after her pregnancy.

7. What is an Apgar score? What is the scale for the score, and what information does it provide to medical professionals?

8. Describe the anatomy of the urinary tract from the kidney to the urethra.

9. How common is development of ureterocele? What is the general long-term outcome for surgical treatment to repair one?

10. How common is development of kidney reflux? What are some causes of this issue?

Paragraph explanation for each please!

Answer 1

7.The Apgar score is a test given to newborns soon after birth. This test checks a baby's heart rate, muscle tone, and other signs to see if extra medical care or emergency care is needed.The test is usually given twice: once at 1 minute after birth, and again another at 5 minutes after birth. Sometimes, if there are concerns about the baby's condition, the test may be given again.

In the test, five things are used to check a baby's health. Each is scored on a scale of 0 to 2, with 2 being the best score:

1. Appearance (skin color)
2. Pulse (heart rate)
3. Grimace response (reflexes)
4. Activity (muscle tone)
5. Respiration (breathing rate and effort)

Doctors, midwives, or nurses add up these five factors for the Apgar score each from 0 to 2 .The total Scores are between 10 and 0. Ten is the highest score possible, but few babies get it. That's because most babies' hands and feet remain blue until they have warmed up.A baby who scores a 7 or above on the test is considered in good health. A lower score does not mean that the baby is unhealthy. It means that the baby may need some immediate medical care, such as suctioning of the airways or oxygen to help him or her breathe better. Perfectly healthy babies sometimes have a lower-than-usual score, especially in the first few minutes after birth.

A slightly low score (especially at 1 minute) is common, especially in babies born:

• after a high-risk pregnancy
• through a C-section
• after a complicated labor and delivery
• prematurely

At 5 minutes after birth, the test is given again. If a baby's score was low at first and hasn't improved, or there are other concerns, the doctors and nurses will continue any necessary medical care and  The baby will be monitored closely.

8.The kidneys remove urea from the blood through tiny filtering units called nephrons. Each nephron consists of a ball formed of small blood capillaries, called a glomerulus, and a small tube called a renal tubule. Urea, together with water and other waste substances, forms the urine as it passes through the nephrons and down the renal tubules of the kidney.

Two ureters. These narrow tubes carry urine from the kidneys to the bladder. Muscles in the ureter walls continually tighten and relax forcing urine downward, away from the kidneys. If urine backs up, or is allowed to stand still, a kidney infection can develop. About every 10 to 15 seconds, small amounts of urine are emptied into the bladder from the ureters.

Bladder. This triangle-shaped, hollow organ is located in the lower abdomen. It is held in place by ligaments that are attached to other organs and the pelvic bones. The bladder's walls relax and expand to store urine, and contract and flatten to empty urine through the urethra. The typical healthy adult bladder can store up to two cups of urine for two to five hours.

Two sphincter muscles. These circular muscles help keep urine from leaking by closing tightly like a rubber band around the opening of the bladder.

Nerves in the bladder. The nerves alert a person when it is time to urinate, or empty the bladder.

Urethra. This tube allows urine to pass outside the body. The brain signals the bladder muscles to tighten, which squeezes urine out of the bladder. At the same time, the brain signals the sphincter muscles to relax to let urine exit the bladder through the urethra. When all the signals occur in the correct order, normal urination occurs.

9.Ureteroceles occur in about 1 of every 500 to 1000 births and are more common in girls. They are also more common in people with a duplex kidney, or a kidney that has two ureters that drain into the bladder.

the primary purpose for patients with ureterocele, especially of the ectopic type, is to reconstruct the original pathology of the lower urinary tract that gives rise to reflux, obstruction, and abnormalities of urination. The morphological findings of ectopic ureterocele indicate that musculature at the bladder neck and posterior urethra is normal in anterior, but severely compromised in posterior quadrants. In cases of broad based ureteroceles, weakness of musculature extends cranially in the involved trigone and medially to the contralateral ureterovesical junction. A muscle defect may predispose to incontinence and, paradoxically, to outlet obstruction from protrusion of the bladder neck and posterior urethra similar to congenital bladder diverticulum in neonates or infants. The hypomuscularity of the trigone and the bladder outlet that backs the ectopic ureterocele should be repaired by adaptation of the normal detrusor muscle bordering. High re-operation rate following the upper tract approach has been considered to result from leaving these anatomical defects at the bladder level with persistent or delayed onset reflux or bladder outlet obstruction.Surgery at the bladder level on ectopic ureterocele can be technically challenging in that it consists of several procedures required by expert pediatric urologists. Management of the distal lip of the ureterocele and realignment of defective muscle at the bladder neck and deep in the posterior urethra differs in each case. In addition, tapering of the cele ureter is needed in most patients.

10.About 50 percent of babies and 30 percent of older children with infections will have reflux. The back flow of urine to the kidney can cause a urinary infection to spread to the kidney, which can make your child very sick and can lead to kidney damage.

kidney reflux can develop in two types, primary and secondary:

• Primary vesicoureteral reflux. Children with primary vesicoureteral reflux are born with a defect in the valve that normally prevents urine from flowing backward from the bladder into the ureters. Primary vesicoureteral reflux is the more common type.

  As your child grows, the ureters lengthen and straighten, which may improve valve function and eventually correct the reflux. This type of vesicoureteral reflux tends to run in families, which indicates that it may be genetic, but the exact cause of the defect is unknown.

• Secondary vesicoureteral reflux. The cause of this form of reflux is most often from failure of the bladder to empty properly, either due to a blockage or failure of the bladder muscle or damage to the nerves that control normal bladder emptying.