2. Wilm tumor
Definition
wilms tumor, or nephroblastoma is the most
common malignant renal and intra abdominal tumor
of childhood. Frequancy is estimated to be 7.6 cases
per million in caucasian children less than 15 years of
age.
3. Etiology
Wilms tumor probably arises from a malignant.
Its occurrence slightly favors the left kidney.which is
advantageous because surgically this kidney is easier
to manipulate and remove.
In about 10% of cases both kidneys are involved.
4. Diagnosticevaluation
History collection
Physical examination for the presence of congenital
anomalies.
Family history of cancer and signs of malignancy eg: wt
loss,size of liver and spleenindiuation of anemia,
lymphadenopathy.
Abdominal swelling or an abdominal mass.
Specific tests radiographic studies.
Abdominal ultra sound.
Abdominal and chest CT scan, hematologic studies.
5. Staging of wilms tumor
Stage I- Tumor is limited to kidney and completely
resected.
Stage II- Tumor extends beyond kidney but is
completely resected.
Stage III- residul nonhematogenous tumor is confined
to abdomen.
Stage IV- Hemalogenous metastases, deposits are
beyond stageIII namely, to lung, liver,bone, brain.
Stage V- bilateral renal involvement is present at
diagnosis.
6. Therapeutic management
Surgical management:
Combined treatment with surgery and
chemotherapy with or without radiation is based on
the histologic pattern and clinical stages.
Partial or comlete nephrectomy is done for unilateral
and for bilateral partial nephrectomy is done.
After surgical management, chemotherapy and
radiation therapy is given if indicated.
7. Cut......
Radiation therapy:
Wilms tumor may be bilateral or large in size, may be
inoperable, for such cases radition therapy may be
used to reduce the size of tumor, so that surgery can be
performed.
Chemotherapy:
The objective of chemotherapy is to treat any
metastatic lesions that may exist and destroy any cells
in blood stream. Before they get implanted.
The drugs used for chemotherapy are Actinomycin
D,Doxorubicin and vincristine.
8. Nursing management
Prepare the parents and child for surgery.
Explain parents not to palpate the abdomen of the
child
Explain child about post operative care, if he or she is
old enough.
Post operative care:
Monitor vital signs
Monitor renal functioning by monitoring wt, intake
and output and KFT values,
Use aseptic techniques while doing dressing.
Explain parents about followup up and continuing
treatment at the time of discharge.
9. Congenital disorders
Bladder exstrophy
Definition
Eversion of posterior bladder through anterior
bladder wall and lower abdominal wall, associated
with open pubic arch, severe defect involving the
musculoskeletal system and the urinary, reproductive,
and intestinal tracts.
10. Incidence
Incidence of cloacal exstrophy is low-less than 1 per
100,000 live birth.
Classic bladder exstrophy typically includes findings of
diatasis (separation)of the symphysis pubis, low set
umbilicus, anteriorly displaced anus, defects of the
genitalia,and inguinal hernia.
Bladder exstrophy ranges from 3.3-5 per 100,000 live
births and is more common in males than females.
11. pathophysiology
Failure of abdominal wall,ventral wall of urinary
bladder to fuse inuters
Exposure of reddened urinary tract to exterior
Constant seepage of urine, leading to male odours and
infection.
In males with atrophy bladder there is epispadias with
upward curvature of penis,undescended testicles, and
inguinal hernia,separate pubic bones normal upper
urinry tract.
12. Cut......
In females, epispadias, bifida clitoris, small labia major,
separate pubic bones short vagina.
In cloacal extrophy there are more abnormalities in
both sexes.
Fertility is possible in females,not males(semen
abnormalities and ejaculatory disturbances.
Role of assisted reproductive techniques in both sexes
is a viable option.
13. Therapeutic management
Objective
Preservation of renalmfunction.
Attainment of urinary control.
Adequate reconstructive repair for acceptable
appearance.
Prevrntion of uti
Preservation of optimum extrnal genitaliawith
continence and sexual function
