Pyelonephritis is an infection of the kidney that is usually bacterial in nature. Pyelonephritis can occur in one or both kidneys and is typically due to an infection that started from the bladder and spreads up the ureters to involve the kidney. Another common cause is pyelonephritis that occurs due to an obstruction caused by a urinary stone.
The symptoms of pyelonephritis include severe back pain on the side of the affected kidney in conjunction with a high fever and pain during urination.
Diagnostic tests for Pyelonephritis will require a CT scan for confirmation. The treatment of pyelonephritis is with intravenous antibiotics. Removal of the obstructing stone will be necessary to prevent a recurrence of the infection.
Kidney and Ureteric stones are collectively known as Urinary stones. Urinary stones will cause pain when it causes an obstruction in the kidney or ureter. The pain related to urinary stones are known as Ureteric Colic and this is characteristically a pain that starts from the affected flank leading down to the groin. The pain is usually very severe and can bring the patient down to the hospital rolling in pain. Painful urination and blood in the urine are two other associated symptoms.
Urinary stones can be detected on an X-ray or a CT scan. Small urinary stones can be treated with medical therapy/medications to allow the stone to pass out in the urine. Larger stones will require either external shockwave treatment or formal surgery to fragment and remove the stone.
Kidney tumours can be benign or cancerous in nature. Benign tumours include Angiomyolipomas and cancerous tumours include Renal Cell Carcinoma (RCC) and Transitional Cell Carcinoma (TCC).
The symptoms of a Kidney tumour include a long-standing back pain on the side of the affected kidney. Blood in the urine is often associated with cancerous tumours. A CT scan is required for diagnosis and staging for cancerous tumours.
Ovarian cancers can arise from the ovaries on either side of the lower abdomen, and arise primarily from cells of the ovary or secondarily from cancer spread from other cancers such as gastric and colorectal cancers. These secondary tumours are known as Krukenberg tumours.
The symptoms of an enlarging ovarian cancer include lower abdominal discomfort, pain and an enlarging abdomen with increasing girth. In the late stages of the disease, shortness of breath and loss of weight are also possible symptoms.
Ovarian cancers from secondary spread may require a Gastroscopy and Colonoscopy to rule out primary tumours in these organs
Ovarian Cysts are water-filled sacs that arise from either of the ovaries. Ovarian cysts can be benign or cancerous in nature. Benign Ovarian Cysts include functional, endometriotic, corpus luteal, follicular, dermoid cysts and cystadenomas. Cancerous Ovarian Cysts are essentially ovarian cystadenocarcinomas, of which there are different subtypes.
Ovarian cysts can be diagnosed on ultrasound, CT scans and MRI scans. The characteristics of the cyst on these imaging methods coupled with the CA125 tumour marker level will often give a good idea of whether a cyst is benign or cancerous. Large cysts will often need removal as there is a risk of cyst rupture or twisting of the cyst (torsion) in addition to the risk of harbouring a cancerous component.
Ovarian Torsion refers to the twisting of the ovary around its blood supply, also known as the pedicle. Ovarian Torsion can result in the death of the associated ovary if the diagnosis was delayed and the torsion is not treated in time. Ovarian torsion usually occurs in the presence of a sizeable ovarian cyst or some fibrous bands (adhesions) attached to the ovary.
The initial symptom of ovarian torsion is a non-specific lower abdominal discomfort. This often progresses to a pain that is clearly localised to the lower abdomen on the affected site. This pain can last for several days and may have periods of improvement and subsequent deterioration as the ovary undergoes periodic twisting and untwisting. The pain then progresses to severe and constant pain if the ovary has subsequently died.
Ovarian torsion is a surgical emergency and requires emergency surgery. The surgery can usually be performed via a keyhole/laparoscopic approach though an open approach may be needed for severe cases
Pelvic Inflammatory Disease (PID) refers to an infection of one or more gynaecological/female reproductive organs. The infected organs include the fallopian tubes, ovaries, uterus and the lining of the pelvis (peritoneum). Pelvic Inflammatory Disease often occurs in association with a urinary tract infection. The common bacteria involved in PID include chlamydia and gonorrhoea, which are sexually transmitted. Additionally, other bacteria like Streptococcus can also cause PID but are not sexually transmitted.
Pelvic Inflammatory Disease starts off as lower abdominal discomfort which then progresses to severe pain. The pain can also localise to the centre or either side of the lower abdomen depending on the affected organs.
The treatment of Pelvic Inflammatory Disease usually involves oral or intravenous antibiotics. In cases with abscess formation, radiologically-guided tube drainage or open surgical drainage may be necessary.
An Ectopic Pregnancy refers to the implantation of the embryo outside of the uterus. The most common site of ectopic pregnancy is the fallopian tube. The ovary and other sites in the abdomen are much rarer sites of ectopic pregnancy.
An Ectopic Pregnancy invariably results in a rupture of the embryo as these sites outside of the uterus are not able to support the pregnancy till maturity. A ruptured Ectopic pregnancy will result in severe lower abdominal pain. The patient often also experiences low blood pressure, a racing heart rate and may have had fainting spells prior to admission.
Emergency surgery is needed for a ruptured Ectopic Pregnancy. This can often be done as a keyhole/laparoscopic surgery though an open surgery may be necessary if the patient is very unstable.
Uterine fibroids are benign (non-cancerous) tumours/growths arising from the muscle of the wall of the uterus.
The majority of fibroids do not cause symptoms. If symptomatic, the commonest symptom is that of heavy menstrual flow with some associated pain. Any acute pain related to fibroids is usually due to fibroid degeneration whereby the centre of the
fibroid undergoes cell death due to inadequate blood supply. This will manifest as pain over the lower central abdomen.
Acute fibroid degeneration does not require any surgical intervention. It is usually treated with anti-inflammatory medications.
Uterine cancers can arise from either the lining of the uterus (endometrial cancer) or much less commonly, from the muscle wall of the uterus (leiomyosarcoma cancer)
The common symptoms of Uterine Cancers include vaginal bleeding in between the usual menstrual periods or new onset after undergoing menopause. In more advanced stages, some lower abdominal pain can be expected.
The treatment of uterine cancer will be surgical removal with possible clearance of the involved lymph nodes.
A urinary tract infection usually starts from the bladder and is a result of a bacterial infection. If left untreated, the infection can ascend to the kidneys.
The symptoms of a Urinary Tract Infection include pain over the lower central abdominal region with a burning sensation on urination. Blood in the urine and frequent urination are also common symptoms
A Urinary Tract Infection of the bladder can usually be treated with oral antibiotics. In severe cases whereby the infection had spread to the kidneys, intravenous antibiotics will be required.
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