Capsule cases Flashcards
Which stones do not show up on a CT?
Stones caused by indinavir (HIV drug)
Complications of renal stones
Sepsis - gram negative E.coli sepsis
Renal damage and need for dialysis!
Anatomical problems associated with kidney stones
PUJ-O - congenital
MSK
Horseshoe kidney
Ureteric stricture
Underlying metabolic problems associated with kidney stones
Hyperparathyroidism
Gout
Cysteinuria
Differentials for renal colic
AAA Biliary colic Constipation Bowel obstruction Ectopic pregnancy
Investigations
Bloods - calcium PTH Urate Non-contrast CT KUB Xray
Acute management
NSAIDs and opiates
e.g. diclofenac
When do you admit a patient?
Single kidney Pyrexia Continuing pain Renal impairment Pregnancy (can trigger premature labour) Large stone / severe obstruction on CT
Which are the areas where stones can form?
Pelvic-uretal junction
Where iliac blood vessels cross over ureter
Uretal-bladder junction i.e. vesicoureteric junction
Medical treatment of stones
Tamsulosin (alpha blocker reduces smooth muscle tone in bladder) - medical expulsive therapy
Other interventions
Extra-corporeal shock wave procedule
PCNL? percutaneous nephro…?
Advice for patients with stones
Less salt
High fluid intake
DO NOT cut out dairy products
Less animal proteins esp red meat
Return if pain not controlled by analgesia
or pyrexia
Once you’ve given analgesia, what do you do?
If under 5mm send home
Anything above, unlikely to not pass automatically so move onto intervention
What is ESWL?
Sound waves are shocked from the outside (pt only takes painkillers, no anaesthetics)
CI if pt on blood thinning or pregnancy or AAA
What are the devices used to remove stones
Ureterorenoscopy
Flexible uretoscope - used also in kidney to remove stones
Uretoscope - straight, not as flexible
