renal calculi Flashcards
Men are more frequently affected by urolithiasis than women, with a ratio of what?
2.5 to 1
Initial presentation predominates between what decades of life?
third and fifth decade
There are five major types of urinary stones. The most common types are composed of _______, and for that reason most urinary stones are ___________ on plain abdominal radiographs.
calcium (85%)
radiopaque (visible)
True/False
Incidence of symptomatic ureteral stones is greatest in high humidity and elevated temperatures during hot summer months
True
True/False
Lower incidence rates of stones have been associated with sedentary lifestyle, hypertension, carotid calcification, and cardiovascular disease.
False
Higher
__________ as well as inadequate hydration appear to be the most important dietary factors in the development of urinary stones.
High protein and salt intake
Metrorrhagia- means what?
bleeding between periods.
S/S of wat issue
(1) Pain most often occurs suddenly
(2) It is typically localized to the flank.
(a) May be associated with nausea and vomiting.
(b) Patients with kidney stones are constantly moving trying to find a comfortable
position.
(3) The pain may occur episodically and may radiate anteriorly over the abdomen.
(a) As stone progresses down the ureter pain may be referred into the ipsilateral groin.
(4) Obstructing urinary stones usually present with acute, unremitting and severe colic.
(5) Typically, minimal pain with passage through the urethra.
Renal calculi
DDx for Renal Calculi
(1) Appendicitis
(2) Ectopic pregnancy
(3) Ovarian torsion
(4) Diverticular disease
(5) Bowel obstruction
(6) Epididymitis
(7) Other abdominopelvic diseases that cause unilateral pain
Laboratory findings for renal calculi
Urinalysis
(a) Usually reveals microscopic or gross hematuria (~90%).
(b) Absence of hematuria DOES NOT exclude urinary stones.
(c) Urinary pH is a valuable clue into the cause of the possible stone.
The UA came back negative for Hematuria.
Does this R/o urinary stones?
No
What imaging would you consider for urinary stones?
1) KUB radiograph
2) Renal ultrasound
3) Spiral CT with patient in prone position.
What imaging modality has increased sensitivity and specificity over other tests for urinary stones?
Spiral CT with patient in prone position
KUB with renal ultrasound will diagnose up to what percentage of stones?
80%
KUB with renal ultrasound will diagnose up to what percentage of stones?
80%
True/False
Forced intravenous fluids will help push stones down the ureter
False
will not push
True/False
Forced diuresis can be counterproductive and exacerbate pain
True
True/False
Forced diuresis can be counterproductive and exacerbate pain
True
Stones smaller than ____ mm in diameter on a plain abdominal radiograph usually pass spontaneously.
5-6 mm
True/False
Medical expulsive therapy may increase the rate of spontaneous stone passage and appears to be most effective for distal stones.
True
Medication tx for stones
Alpha-blockers (tamsulosin, 0.4 mg orally once daily)
NSAIDS
With or without a short course of a low-dose oral corticosteroid
-Prednisone 10 mg orally daily for 3-5 days
Stones that require surgical removal include those that are showing signs of
obstruction or infection
Procedures for stone removal include:
a) Ureteroscopic stone extraction
b) Extracorporeal shock wave lithotripsy
Prevention
Increasing fluid intake to ensure a voided volume of ____ L/day.
2.5
