stones Flashcards
stages
nucleation
aggregation
crystal growth
manifestation
different medical names
urolithiasis- general term
nephroliathiasis - kidney
urterolithiasis
cystolithiasis
staghorn
takes up the shape of the renal calyces and pelvis
struvite stones
infectious stones caused by bacteris KEB favour an alkaline environment
x ray negative stones
uric acid and xanthine stones
classifcation
simple
<5
5-10
10-20
complex
>20
and if you have any congenital anomaly
unilateral /bilaeral
inflammatory /obstructive
what ph indicates infectious stones
> 8.5 is suggestive
activators and inhibitors
activators is sulfonamides (one of there side effects )
inhibitors
magneisum
citrate
rf
BPH - especially bladder stones
lack of drinking water
congenital abnormality like horseshoe kidney , ureterocele
medullary sponge disease
extrinsic and intrisic factors
intrinsic
- congentilsa
- dehrdation
- gout
extrinsic
- climate
- career (hot places)
- mineral content of water
renal colic
wors pain ever , typically colic but can be constant
radiates to groin, labia majora , tesiticles
pstive succosio renalis
dysuria, hematuria , oligouria
secondary effects
migration
ulceration
malignancy
hydronephrosis due to obstruction
UTI - urosepsis
obstruction of the calcyces (hyrocalcinosis)
investigations
history
image - x ray , ct (gold standard) was previously IVU
ULTRASOUND- but can miss stones
ureteroscope - both diagnostic and therapeutic
dx
appendicitis if on RHS
cholecystitis
ectopic pregnancy
cystitis - especially if in lower ureter
bladder stones
usually asymptomatic
usually passed
associated with stasis of urine like in bPH
WHERE IS THE MSOT COMMON SITE OF OBSTRUCTION
THE NARROWEST PART WHICH IS THE VESICOURETERIC JUNCTION
WHAT makes having stones more urgent
a congenital anomly
only having one kidey
big size
bilateral obstruction
tx
if small can just give fluids
spasomlytics to add expuslion
pain releief - NOT OPIODS
ecswl-
ureteroscope - has theureupitcs effects can break up the stone
intracroprpreal
percutaneous nephrolithotomy- incision in flank region
indications for ECSWL
stones are x ray +
> 2cm
intracorporeal
uretroscope- felxible and rigid
open surgery techniques
nephrolithotomy
ureterolithotmy
cystolithotomy
pyelolithotomy -pelvis
litholipaxy
The removal of a vesical calculus by first crushing it and subsequently washing out the fragments.
bladder stone(s) using telescopic fragmentation devices or a laser passed through your urethra (waterpipe). Once the stone has been broken up, the small fragments produced can be removed using suction.
vivilite ( double check)
ca monohydrate
videliti ( double check )
ca dihydrate
appetite (double check )
ca oxalate
nephrocalcinosis
stones in the renal parenchyma
why do we put in a stent with kidney stones
- helps reduce the pain of renal colic
- allows for drainage
- after surgery to allow healing process to occur as edema is a side effect
apart from stones what can block the ureters
tumours
BLOOD CLOTS
STRICUTRES/STENOSIS
post op sweeling
infection-nb
cysteine stones points
prevention
suffer from condition callled cysteinuria
drink more water
eat foods to make urine more BASSI=(stones form in more acidic urine) so avoid meats which make urine more acidic
reduce salt intake
ca n take certain meds that work in different ways,
name for struvite
Magnesium ammonium phosphate
different geentic conditions and how they relate to stones
xathinuria - runs in families
cysteinuria- runs in families
xantheniuria facts
genetics, high levels of xanthine but conversely low levels of uric acid
drug induced stones
sulfoanmides
ceftriazone
hIV drugs
poor radiopaque
STRUVITE
risk factors
diet- meat, salt (high uric)
hyperparathyrodiism
chrones
FH
Inheritied codnitons
blacck tea
risk factors
diet- meat, salt
hyperparathyrodiism
chrones
FH
Inheritied codnitons
Anatomical abnormalities leading to stone formation:
pelvic ureteric junction obstruction —> PUJ obs - stenosis as a congenital anomaly
* Horseshoe kidney
* Ureterocele
*** know detailed d
why is prgenancy a risk factor
stasis of urine
mechanical compression of ureters but also because hormonal changes like progesterone which relaxes peristalsis
why is prgenancy a risk factor
stasis of urine
mechanical compression of ureters but also because hormonal changes like progesterone which relaxes peristalsis
classification of stasis
mechanical - obstruction like ureteropelvis , stone
dynamic - pregnancy
1st line for big stones
percutanoeous nephrolithotomy >1.5 cm
calculus anuria
bascilaly when you have a complete obstruction in either 1 kindey(other one is non functional) or both kidneay so not only is there stasis but now kidneys are not making the urine?
stasis vs retention
upper/lower urinary tract
classifctaion of renal colic
uncomplicated
complicated
- prolonged course
- YOU HAVE FEVER NOW
-ANURIA
