#6. Urolithiasis - Clinical Picture, Diagnosis Flashcards

1
Q

What Classification approaches are used for Stones?

A

1) Chemical Composition
- Calcium Containing Calculi
- Calcium NOT Containing Calculi

2) Location
- Upper / Middle / Lower CALCYX
- Renal Pelvis
- Proximal / Middle / Distal 1/3 of URETER
- Bladder
- Urethra

3) Size
- 5mm / 5 - 10 mm / 10 - 20 mm / over 20

4) X-Ray Characteristics
- Radiopaque = Calcium Oxalate Dihydrate, Monohydrate, Phosphate

  • Sometimes Radiopaque / Radiolucent = Struvite / Apatite / Cystine
  • Radiolucent = Uric Acid / Ammonium Urate / Xanthine

5) Etiology
- Non Infectious = Calcium Oxalate / Phosphate / Uric Acid

  • Infectious = Magnesium Ammonium Phosphate / Carbonate
  • Genetic = Cystine / Xanthine
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2
Q

Which Stones are Radiopaque?

A
  • Calcium Oxalates
  • Phosphate Calculi
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3
Q

Which Stones are Radiolucent?

A

Urate Stones / Calculi are Radiolucent

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4
Q

For Which Stones is Infection a Necessary Condition for their Formation?

A

Magnesium Phosphate Calculi

  • They’re found in CHRONIC Urinary Infections such as - Pyelonephritis / Cystitis
  • DUE to Urea-Splitting Organisms such as - Proteus / Klebsiella
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5
Q

What is the Mechanism of Occurrence of Renal Colic?

A
  • DUE to DISTENDED Fibrous Renal Capsule, RICHLY Innervated by Branches of SYMPATHETIC Plexus of Spinal Cord Segments Th12 - L2
  • CAUSED BY Complete / Partial Obstruction of Ureter by MIGRATING Urinary Stone
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6
Q

What are the Symptoms of Cast Stones?

A
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7
Q

What are the Symptoms of Renal Colic?

A
  • Strong, sometimes Stabbing, with Intervals of Increasing / Decreasing Colicky Pain
  • Located in the Lumbar Region
  • Mainly felt in the Costovertebral Angle, radiating along the Ureter, and sometimes towards to Testicle
  • Patients are excited to move as they’re constantly moving for a relieving position in the body.
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8
Q

What are the Chances for a Stone Measuring 4 - 5mm to pass Spontaneously through the Urinary Tract?

A

Stones measuring 4 - 5mm have 40 - 50% chance of spontaneous passage

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9
Q

A Stone in which Part of the Excretory System is most likely to cause Painful Urges to Urinate with a feeling of Incomplete Micturition?

A
  • URETERAL Lithiasis in the DISTAL Part
  • AKA Juxtavesical / Intramural
  • Feel a DULL Ache, accompanied by SHORT-TERM Stabbing in the Lower Abdomen / Behind the Symphysis
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10
Q

Which Imaging Method is MOST Informative in the Diagnosis of Urolithiasis?

A

CT is the GOLD STANDARD in Diagnosis of Urolithiasis

  • BOTH Radiopaque + Radiolucent Calculi can be visualised
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11
Q

Which Stones CANNOT be Found Using CT?

A

EXCEPT for Calculus CONTAINING INDINAVIR

  • Which is a DRUG used to Treat HIV Infections
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12
Q

What are the Contraindications for the Use of Intravenous Contrast Agents?

A
  • Patient Hypersensitivity to Contrast Agent
  • Renal Failure
  • Patients with Renal Colic
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13
Q

Does it matter whether the Calculi are Radiopaque or Radiolucent for the Ultrasound Examination?

A

No, Calculi can either be Radiopaque or Radiolucent (MORE than 5mm), REGARDLESS of Ultrasound Examination

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14
Q

What will be found on the Ultrasound in a Patient with an Obstructive Stone in the Middle 3rd of the Ureter?

A
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15
Q

What are the Indications for Retrograde Ureterography in Urolithiasis?

A
  • Calculus Obstruction
  • Urethral Trauma
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16
Q

What is the Role of Isotope Studies in Urolithiasis?

A
  • Obtains info of the FUNCTIONAL STATE such as - Secretion + Excretion
  • Of the 2 Kidneys SEPARATELY
17
Q

What are Phleboliths?

A

Phleboliths are small, round lumps of calcium that form in a person’s veins

18
Q

What is the Role of MRI in the Diagnosis of Urolithiasis?

A

MRI Provides a Diagnostic VALUE that is LOW