Renal Calculi

Question 1

Which medications can cause stones?

Answer 1

Vitamin A B and C, antacid, diuretic, calcium

Question 2

What is the role of alpha-adrenergic receptor blockers in renal calculi?

Answer 2

Cause relaxation of smooth muscle in the ureters to facilitate stone passage and decrease pain

Question 3

Who do you send home and who do you treat?

Answer 3

Home: painfree after 3 hours

Not: If febrile

If only one kidney or if both kidneys are obstructed

If the pain doesn’t settle

Question 4

What are some good options for home analgesic management of renal colic?

Answer 4

Endocet suppository

Endone

Question 5

How are cysteine stones treated?

Answer 5

Increase urine pH

Fluids

penicillamine

Question 6

What are the most useful biochemical Ix for stones?

Answer 6

Stone biochemistry

24 urine Ca

Question 7

How long do you give someone to pass their stone?

Answer 7

3-6 weeks

Question 8

Is US valuable for the diagnosis of renal calculi?

Answer 8

No

Question 9

How does a person with renal colic appear on observation and examination?

Answer 9

Restless

Non tender at the site of pain

No peritonism

Question 10

When is lithotripsy indicated?

Answer 10

When the stone isn’t too large and in the renal pelvis

Question 11

What type of xray is used for investigation of renal calculi? Why is it indicated?

Answer 11

XrayKUB

To avoid having to do another CT to follow up

Question 12

Does the location of pain reflect the location of the stone?

Answer 12

No

Question 13

How do you dissolve uric acid stones?

Answer 13

Increase urine pH with bicarb

Flush with water

Allopurinol

Question 14

What are some treatment option for stones?

Answer 14

Conversative management

Dissolve

Destroy - US

Stent

Question 15

Which stones form in acidic conditions? And which form in basic conditions?

Answer 15

Acidic :Uric acid

Cysteine

Basic: Calcium phosphate

Struvite

Question 16

What is stemitil?

Answer 16

Prochlorperazine

Question 17

Which type of diuretic causes hypercalcaemia?

Answer 17

Thiazide

Question 18

Which stones are radiolucent?

Answer 18

Uric acid

Cystine

Question 19

What is a phlebolith?

Answer 19

Calcification of a venous valve

• can complicate diagnosis

Question 20

What is the typical medical regimen for acute management of renal colic?

Answer 20

10mg morphine (or 100mg pethadine)

10mg metaclopramide

Question 21

What is the best investigation for stones?

Answer 21

Non-contrast CTKUB

Question 22

What is the character of renal colic?

Answer 22

Colicky/constant

Flank/groin

Question 23

How do you investigate the formation of stones?

Answer 23

Water consumption

Gout

Other conditions that cause it

FHx

Question 24

What percentage of renal colic has haematuria?

Answer 24

90%

Question 25

Which stones will pass?

Answer 25

If the diameter is \<4mm

Question 26

How is calcium intake related to stone formation?

Answer 26

Inversely

Question 27

How do you advise people on how much water to drink?

Answer 27

Drink until your urine is light yellow

Question 28

What are treatment options for large stones?

Answer 28

Ureteroscopy and disintegration with laser mainly

Question 29

How are some types of stones?

Answer 29

Calcium oxalate Calcium phosphate Uric acid Cysteine stones Struvite

Question 30

What are some lifestyle and medical modifications that can be made?

Answer 30

Remove source 3L urine output per day Low Na input Low animal protein Thiazide Allopurinol

Question 31

What are some DDx for flank pain?

Answer 31

Appendicitis Testicular torsion Biliary colic Ovarian cyst Diverticulitis

Question 32

What type of stones can be dissolved medically?

Answer 32

Uric acid