stones

Question 1

1

what are 2 main diet risks

Answer 1

1. low fluid

2. high salt and protein

Question 2

1

what is epi

Answer 2

most common in middle aged men

Question 3

1

**3 main stone types, how common and how they show on ultrasound

Answer 3

1. calcium oxalate (80%) - radio-opaque
2. uric acid (10%) - lucent
3. struvite (10) - opaque

Question 4

1

*3 other types of stone

Answer 4

1. cystine - opaque
2. matrix - lucent
3. medications stones (inudivir - old HIV med) - faintly opaque

Question 5

1

behavioral and env. risks for stones

Answer 5

• low fluid
• live in hot places or work hot
• high protein, high salt

Question 6

1

what are 2 main factors in stone dev.

Answer 6

1. excessive stone promoters

2. insuff. stone inhibs

Question 7

1

4 stone promoters

Answer 7

1. fluid low
2. high urine Ca, oxalate
3. urine stasis
4. infection

Question 8

1

4 stone inhibitors

Answer 8

1. citrate
2. magnesium
3. pyrophasphae
4. glycoprotein

Question 9

1

2 main types of Ca stone

Answer 9

1. oxalate - most common

2. phosphate - rare

Question 10

1

3 factors that increase Ca

Answer 10

1. renal Ca leak
2. increased GI absorbtion
3. leach Ca from bone

Question 11

1

what is hyperoxaluria

Answer 11

5% of Ca stone formers

• IBD and short bowel syndrome
• increase in bile salts and fatty acids in coon- more oxalete absrobed

Question 12

1

diet methods to prevent Ca oxalte stones

Answer 12

1. fuids
2. low animal proteins
3. low Na
4. low oxalate foods
   DO NOT reduce Ca

Question 13

1

2 meds for Ca oxalte

Answer 13

1. hydrochlorothiazide

2. K citrate

Question 14

1

what causes struvate stones

Answer 14

• infection with urea splititng bugs
• proteus, klebsiella, pseudomonas
• NOT E. coli
• get alkaline urine

Question 15

1

features of struvite stones

Answer 15

staghorns

- opaque

Question 16

1

features of uric acid stones

Answer 16

• lucent on x-ray
• assoc. with gout and acidic urine
• can be disolved with alkaline urine
• K citrate

Question 17

1

what are cystine stones

Answer 17

• autosomal recc. defect intubular transport

- aggressive- in childhood

Question 18

1

*** what are causes of cystine stones

Answer 18

decreased reabsorption of COLA
Cystine
Ornitihine
Lysine
Arginine

Question 19

1

how define stone type

Answer 19

patient strains out a stone and sent for testing

Question 20

1

3 tests for anyone who passes a stone

Answer 20

1. serum Cr, Ca, uric acid
2. urine R+M
3. urine C+S

Question 21

1

what to do for recurrent formers

Answer 21

full metabolic workup

- 2x 24 hour urine

Question 22

1

4 presentations of stone

Answer 22

1. renal colic
2. N/V
3. urinary freq/urg
4. hematuria

Question 23

1

DDx for renal colic

Answer 23

• acute uteric obst.
• pyelo
• acute abdo crisis
• ruptured AAA
• gyne
• radiculitis

Question 24

1

4 investigations for someone with renal colic

Answer 24

1. urinalysis
2. blood tests
3. non- contract CT
   - most sens and spec
4. KUB x-ray

Question 25

1

what is medical mgmt of actue renal colic

Answer 25

1. anagesia
2. gravol
3. NSAID
4. ABx if UTI
5. IV fluids
6. medical expulsive therapy (a-blockers)

Question 26

1

*** red flags that need urgent admission (5)

Answer 26

1. pain not controlled
2. fever and UTI with obst. stone
3. refractory vomiting
4. solitary kidney with obst.
5. severe hematuria

Question 27

1

4 steps to ureteric stone

Answer 27

1.

Question 28

1

2 options for those that don’t pass

Answer 28

1. shockwave - most - 70% success
2. uretoscopy - 99%
   - failed shockwave

Question 29

1

4 options for renal stones

Answer 29

1. 2.5 cm , staghorn, struvite

Question 30

1

** 5 things to prevent stones

Answer 30

1. metabolic eval. to ID abnormality
2. incr. fluid
3. less salt
4. minimize oxalte
5. minimize protein
   DO NOT reduce Ca intake

Question 31

1

4 main locations for stones to stick

Answer 31

1. uretovesicular jct
2. calyx of kidney
3. uretopelvic jct
4. ureter over the iliacs