L2: Stones Flashcards

2
Q

Genetic Causes of Urinary Stones

A

Cystinuria & familial RTA (Ca Phosphate stones).

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3
Q

RF for Urinary Stones

A
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4
Q

RF for Urinary Stones

  • dehydration
A

a major factor in stone formation.

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5
Q

RF for Urinary Stones

  • Diet
A
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6
Q

RF for Urinary Stones

  • Urine Stasis
A
  • A fair rate of urine flow would expel crystals before they have the chance to coalesce and grow.
  • As in: Ureteric stricture. BPH (SPE), Neurogenic bladder.
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7
Q

RF for Urinary Stones

  • UTI
A

Stones associated with chronic UTI are called “Struvite Stones”

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8
Q

RF for Urinary Stones

  • Metabolic Conditions
A

a- Renal tubular acidosis.
b- Gout.
c- Cystinuria.

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9
Q

Types of Stones

A
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10
Q

Types of Calcium containing stones

A
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11
Q

Compare between Ca-Containing, Struvite, Uric Acid, Cystine stones in terms of

  • Incidence
  • Structure
  • Etiology
  • pH of Urine
  • X-Ray
  • NB
A
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12
Q

CP of Urinary Stones

A
  • Renal
  • Ureteric
  • Bladder
  • Urethral
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13
Q

CP of Renal Stones

A
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14
Q

CP of Ureteric stones

A
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15
Q

Complications of Urinary Stones

A
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16
Q

CP of Bladder stones

A

1) Suprapubic pain.
2) Pain during micturition.
3) Lower Urinary Tract Symptoms (LUTS): Frequency , BM.

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17
Q

CP of Urethral stone

A

1) Sudden interruptions of urine stream.

2) Urinary retention.

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18
Q

INVx for Urinary stone

A
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19
Q

INVx for Urinary stone

  • Labs (urine analysis)
A
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20
Q

INVx for Urinary stone

  • Labs
A
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21
Q

INVx for Urinary stone

  • Labs (Urine Culture)
A

Only if urine analysis showed pyuria or bacteriuria

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22
Q

INVx for Urinary stone

  • Labs (Blood Tests)
A
  • Serum creatinine, CBC
  • Detection of underlying metabolic abnormalities (uric acid).
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23
Q

INVx for Urinary stone

  • Rads
A

1) Kidney, Ureter & Bladder (KUB) X-Ray.

2) Abdominal and Pelvic Ultrasonography.

3) Intravenous urography “IVU” (Intravenous pyelography “IVP”).

4) Spiral CT (Non-Contrast CT of the abdomen and pelvis) “The Most sensitive”

5) Diuretic renogram.

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24
Q

Causes of RO Shadow in Hypocondrium

A
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25
Q

Causes of RO Shadow Along the course of the ureter

A
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26
Q

Advantages of Renal US

A

1) Kidneysite,size.

2) Grade of hydronephrosis, Cortical thickening.

3) Cortico-medullary differentiation.

4) Detection of Renal stones, cysts, tumors, perinephric collections.

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27
Q

Disadvantages of Renal US

A
  • Operator dependent
  • Ureteric stones may not be seen by US but the hydronephrosis resulting from obstruction is seen.
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28
Q

Appearence of Stones in Renal US

A

Renal stones appear as Hyper-echoic (white) with posterior acoustic shadow (black)

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29
Q

Renal US & Ureteric Stones

A

Ureteric stones may not be seen by US but the hydronephrosis resulting from obstruction is seen.

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30
Q

Advantages of Intravenous Pyelogram (IVP)

A
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31
Q

Disadvantages of Intravenous Pyelogram (IVP)

A
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32
Q

Appearence of Stones in Non-Contrast CT (NCCT)

A

Stones appear as hyperdense (white) area

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33
Q

What is the most sensitive investigation in detection of urinary calculi?

A

NCCT

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34
Q

Advantages of Non-Contrast CT (NCCT)

35
Q

Disadvantages of Non-Contrast CT (NCCT)

A

Radiation exposure

36
Q

Aspects of TTT of Acute Renal Colic

A
  • Medical
  • Renal drainage
37
Q

TTT of Acute Renal Colic

  • Medical
38
Q

TTT of Acute Renal Colic

  • Medical (Analgesics)
39
Q

Indications for emergency drainage of the obstructed kidney in a case presenting with acute renal colic

40
Q

Procedure for emergency drainage of the obstructed kidney in a case presenting with acute renal colic

A

1) Ureteric stent

2) Percutaneous Nephrostomy tube

41
Q

Options for Treatment of Renal Stones

42
Q

TTT of RENAL Stones

43
Q

Indications of Conservative TTT of RENAL Stones

A

For incidentally discovered calyceal stones < 5 mm & not causing :

  • Infection,
  • Obstruction
  • Hematuria.
44
Q

Follow Up in TTT of RENAL Stones

A

By ultrasonography, every 3 months

45
Q

Indications for active treatment of Renal stones

A

1) Developed pain.
2) Infection.
3) Obstruction.
4) Increased in size.

46
Q

TTT of RENAL Stones

  • Procedure of Extracorporeal Shock Wave Lithotripsy (ESWL)
47
Q

TTT of RENAL Stones

  • Indications of Extracorporeal Shock Wave Lithotripsy (ESWL)
48
Q

TTT of RENAL Stones

  • Advanatges of Extracorporeal Shock Wave Lithotripsy (ESWL)
49
Q

TTT of RENAL Stones

  • CI of Extracorporeal Shock Wave Lithotripsy (ESWL)
50
Q

TTT of RENAL Stones

  • Complications of Extracorporeal Shock Wave Lithotripsy (ESWL)
51
Q

TTT of RENAL Stones

  • Procedure of Percutaneous Nephrolithotomy (PCNL)
52
Q

TTT of RENAL Stones

  • Indications of Percutaneous Nephrolithotomy (PCNL)
53
Q

TTT of RENAL Stones

  • Advantages of Percutaneous Nephrolithotomy (PCNL)
54
Q

TTT of RENAL Stones

  • CI of Percutaneous Nephrolithotomy (PCNL)
55
Q

TTT of RENAL Stones

  • Complications of Percutaneous Nephrolithotomy (PCNL)
56
Q

TTT of RENAL Stones

  • Procedure of Flexible Ureteroscopy
A

1) Reach the renal stones through the urethra, bladder, and ureter.

2) Disintegrate the stone using Laser.

3) Then fragments can be removed by a basket.

57
Q

TTT of RENAL Stones

  • Indications of Flexible Ureteroscopy
A

Renal stones < 20 mm at any site

58
Q

TTT of RENAL Stones

  • Advantages of Flexible Ureteroscopy
59
Q

TTT of RENAL Stones

  • Disadvantages of Flexible Ureteroscopy
A
  1. Expensive instruments (flexible URS, Laser, Basket).
  2. Needs experienced surgeon.
60
Q

TTT of RENAL Stones

  • Open Surgery
A
  • The role of open surgery for treatment of urinary stones is markedly decreased because of development of many endoscopic methods such as URS & PCNL.
61
Q

TTT of RENAL Stones

  • Laproscopy
62
Q

TTT of RENAL Stones

  • The possible operations include ……
A

1) Pyelolithotomy
2) Nephrolithotomy
3) Pyelonephrolithotomy
4) Lower polar partial nephrectomy
5) Nephrectomy

63
Q

Options in Treatment of Ureteric Stones

64
Q

Treatment of Ureteric Stones

  • Indications of Conservative TTT
A

Stones of < 5 mm that did not cause hydronephrosis or infection.

65
Q

Treatment of Ureteric Stones

  • Methods of Conservative TTT
A

The patient is treated with analgesics

66
Q

Treatment of Ureteric Stones

  • What to do if Conservative TTT Fails?
A

If the stone did not pass spontaneously within 2 weeks another line of treatment is indicated.

67
Q

Treatment of Ureteric Stones

  • Indications of MET
A

for Distal Ureteric stones 5 - 10 mm.

68
Q

Treatment of Ureteric Stones

  • Examples of MET
A
  1. Use of medications to facilitate spontaneous stone passage.
  2. Alpha-receptorBlockers:Tamsulosin
69
Q

Treatment of Ureteric Stones

  • Indications of ESWL
A
  • Stone size: < 10 mm.
  • Stone Site: in the upper (proximal) ureter.
70
Q

Treatment of Ureteric Stones

  • CI of ESWL
A

As renal stones

71
Q

Treatment of Ureteric Stones

  • Indications of Rigid URS
72
Q

Treatment of Ureteric Stones

  • Complications of Rigid URS
A
  • Hematuria.
  • Sepsis.
  • Ureteric wall injury (Perforation, Avulsion).
73
Q

Treatment of Ureteric Stones

  • Surgery
A

Ureterolithotomy

74
Q

Treatment of bladder calculi

75
Q

First line treatment for of each stone

  • Renal < 20 mm (not in lower calyx)
A

ESWL or Flexible URS

76
Q

First line treatment for of each stone

  • Renal < 10 mm in lower calyx
A

ESWL or Flexible URS

77
Q

First line treatment for of each stone

  • Renal > 20 mm
78
Q

First line treatment for of each stone

  • Renal Staghorn stones
79
Q

First line treatment for of each stone

  • Ureteric proximal < 10 cm
A

ESWL or Flexible URS

80
Q

First line treatment for of each stone

  • ureteric Proximal > 10 cm
A

Flexible URS or push back and PCNL

81
Q

First line treatment for of each stone

  • Ureteric Distal 5-10 cm
82
Q

First line treatment for of each stone

  • Ureteric Distal > 10 cm
83
Q

First line treatment for of each stone

  • Huge stone or failed other treatments
A

Laparoscopic or open surgery