#6. Urolithiasis - Clinical Picture, Diagnosis Flashcards
What Classification approaches are used for Stones?
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
Which Stones are Radiopaque?
- Calcium Oxalates
- Phosphate Calculi
Which Stones are Radiolucent?
Urate Stones / Calculi are Radiolucent
For Which Stones is Infection a Necessary Condition for their Formation?
Magnesium Phosphate Calculi
- They’re found in CHRONIC Urinary Infections such as - Pyelonephritis / Cystitis
- DUE to Urea-Splitting Organisms such as - Proteus / Klebsiella
What is the Mechanism of Occurrence of Renal Colic?
- 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
What are the Symptoms of Cast Stones?
What are the Symptoms of Renal Colic?
- 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.
What are the Chances for a Stone Measuring 4 - 5mm to pass Spontaneously through the Urinary Tract?
Stones measuring 4 - 5mm have 40 - 50% chance of spontaneous passage
A Stone in which Part of the Excretory System is most likely to cause Painful Urges to Urinate with a feeling of Incomplete Micturition?
- 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
Which Imaging Method is MOST Informative in the Diagnosis of Urolithiasis?
CT is the GOLD STANDARD in Diagnosis of Urolithiasis
- BOTH Radiopaque + Radiolucent Calculi can be visualised
Which Stones CANNOT be Found Using CT?
EXCEPT for Calculus CONTAINING INDINAVIR
- Which is a DRUG used to Treat HIV Infections
What are the Contraindications for the Use of Intravenous Contrast Agents?
- Patient Hypersensitivity to Contrast Agent
- Renal Failure
- Patients with Renal Colic
Does it matter whether the Calculi are Radiopaque or Radiolucent for the Ultrasound Examination?
No, Calculi can either be Radiopaque or Radiolucent (MORE than 5mm), REGARDLESS of Ultrasound Examination
What will be found on the Ultrasound in a Patient with an Obstructive Stone in the Middle 3rd of the Ureter?
What are the Indications for Retrograde Ureterography in Urolithiasis?
- Calculus Obstruction
- Urethral Trauma