surgery Flashcards
breast Fibroadenoma examination appearance
small, mobile, smooth, firm, swell circumscribed lump. usually up to 3cm
fibroadenoma hormone dependent?
yes, regresses after menopause commonly.
fibrocystic breast disease (fibroadenosis) hormone related?
yes
fibrocystic breast disease (fibroadenosis) symptoms
bilateral breast lumpiness, pain and fluctuating size
Tx for fibrocystic breast disease (fibroadenosis)
supportive clothing, NSAIDS, weight loss and consider stopping hormonal contraception
breast abscess symptoms
acute. associated with fever and pus with tenderness and heat.
fat necrosis examination presentation
firm, irregular, fixed lump with skin dimpling or nipple inversion
phyllodes tumour presentation
large fast growing periductal stromal neoplasm
phyllodes tumour Tx
local excision
breast cancer examination presentation
hard, irregular, painless, fixed lesion and tethered to skin or chest wall. ma cause nipple retraction, skin dimpling or oedema
what would make you consider a two week wait referral (urgent) for breast
discrete lump with fixation that enlarges.
women >30yrs with persistent lumpiness after menstruation
prior breast cancer with new symptoms
skin or nipple changes that are suggestive
unilateral bloody nipple discharge
mammary duct ectasia presentation
blood stained discharge, mastalgia, nipple inversion/retraction.
mammary duct ectasia Tx
conservatively or surgical excision if necessary
intraductal papilloma presentation
post menopausal, serous or bloody discharge with wart like lesion.
intraductal papilloma Ix
breast ductography
intraductal papilloma Tx
surgical excision and breast screening
what hormone blocks prolactin
dopamine
symptoms of a prolactinoma
gynaecomastia, sexual dysfunction, amenorrhoea, infertility, bitemporal hemianopia and galactorrhoea
prolactinoma is associated with which genetic condition
MEN1
Tx for prolactinoma
bromocriptine or surgery
drugs that may cause galactorrhoea include
Female contraceptives SSRIs Antipsychotics, domperidone and metoclopramide (dopamine antagonists) Methyldopa Beta blockers Digoxin Spironolactone
other causes of galactorrhoea include
liver failure and CKD
RF for breast cancer
Female (99% of breast cancers) Oestrogen Exposure (years of menstruation, few/no children/no breastfeeding) Alcohol Obesity Family history (first-degree relatives)
breast cancer occurrence
1/8
BRCA1 chromosome location
17
BRAC1 increase risk of
breast cancer as well as ovarian, bowel and prostate
BRAC2 is located on chromosome
13
breast cancer metastasis
Lungs, Liver, Bones, Brain
invasive breast cancer originates from cells in the
breast ducts
differential for breast abscess or mastitis
inflammatory breast cancer
eczema of the nipple/areolar makes you consider
Paget’s disease of the nipple, DCIS-> Ductal carcinoma in situ
follow up for Paget’s disease of the nipple includes
biopsy, staging and treatment
NHS screening for breast cancer
50-70yr, mammogram every 3 years
high risk breast cancer groups receive screening at what age?
40-59
triple diagnostic assessment involves
clinical assessment, imaging and biopsy
before breast cancer surgery every patient is offered what assessment
axillary US and US biopsy of abnormal nodes
breast cancer T1
<2cm
breast cancer T2
2-5cm
Breast cancer T4
skin or chest wall
breast cancer surgical clear margin is
2mm
SE of breast cancer RT
fatigue, skin irritation, fibrosis, shrinking of tissue and skin colour changes
premenopausal breast cancer ER +ve chemotherapy involves
tamoxifen
postmenopausal breast cancer ER +ve chemotherapy involves
aromatase inhibitor letrozole
HER2 positive women breast cancer Tx
trastuzumab (herceptin)
HER2 positive women Tx requires monitoring
heart function
trastuzumab CI
congestive heart failure
trastuzumab SE
diarrhoea, tumour pain and headache
Reconstructive breast surgery options
implants, latissimus dorsi flap, transverse rectus abdominis flap and deep inferior epigastric perforator flap
reconstructive breast surgery Transverse rectus abdominis flap (TRAM flap) risks
abdominal hernia
surveillance mammography for early breast cancer regime
yearly mammogram for 5 years
rule for limbs with lymphoedema
do not take blood
primary lymphoedema is due to
idiopathic
venous ulcers are due too
pooling of venous blood and waste products
arterial ulcers are due to
poor blood supply to skin
features of an arterial ulcer
absent pulses, pallor, smaller, regular border, grey, less likely to bleed, painful, pain at night with leg elevation, improved with hanging
features of a venous ulcer
oedema, hyperpigmentation, varicose eczema, larger, broader, likely to bleed, relieved by elevation and worse on hanging
varicose veins arise form pathology within
perforator vein valves that run between deep and superficial veins, results in blood pooling in superficial veins
in venous disease haemoglobin breaks down into
haemosiderin, which is deposited around the shins leading to discolouration
in venous disease the process of skin and soft tissue becoming fibrotic is called
lipodermatosclerosis
what test is positive in venous disease
trendelenburg’s test
simple measures for varicose veins
mobilising, elevation and compression stockings
surgical options for varicose veins
endothermal ablation, sclerotherapy and stripping.
presentation of aortic dissection is
tearing chest pain, radiates to back, initial hypertension that progresses to hypotension
RF for aortic dissection are
Ehlers-danlos syndrome and marfans.
presentation of an abdominal aortic aneurysm is
asymptomatic, non specific abdo pain, palpable expansile pulsation,
surgical options for AAA
endovascular stenting, laparoscopic repair and open surgery
what size of an AAA would you consider surgical intervention
> 5cm
AAA rupture presentation
pulsatile mass, severe abdo pain radiation to back and loin and haemodynamic instability
RF for atherosclerosis
age, FH, male, lifestyle, obesity and diabetes
Critical Limb Ischaemia definition
is the end-stage of peripheral arterial disease, where there is an inadequate supply of blood to a limb to allow it to function normally at rest.
intermittent claudication definition
symptom of having ischaemia in a limb during exertion that is relieved by rest. It is typically a crampy, achy pain in the calf muscles associated with muscle fatigue when walking beyond a certain intensity.
Leriche’s syndrome refers too
clinical triad of thigh/buttock claudication, absent femoral pulses, male impotence due to occlusion of distal aorta or proximal common iliac artery
what assessment may you perform for peripheral vascular disease?
Buerger’s test
Ix for peripheral vascular disease
Ankle-Brachial Pressure Index (ABPI)
Arterial Doppler
Angiography (CT or MRI)
normal ankle brachial pressure index is
> 0.9
severe ankle brachial pressure index is
<0.3
critical limb ischaemia 6 P’s are
Pain, pallor, pulseless, paralysis, paraethesia and perishingly cold
medical Tx for peripheral vascular disease
atorvastatin 80mg, clopidrogrel 75mg once daily, naftidrofuryl oxalate
surgical Tx for peripheral vascular disease
angioplasty, stenting and bypass
critical limb ischaemia Mx
urgent referral, analgesia, urgent revascularisation with bypass, angioplasty or stenting
Tx dose for DVT
LMWH enoxaparin 15mg/kg for >5days
target warfarin INR for DVT
2-3
long term anticoagulation for DVT should continue for how long?
3 months
prophylactic dose of LMWH is
40mg of enoxaparin
tenesmus refers too
symptoms of full rectum/needing to open bowels after having emptied bowels
hartmann’s procedure refers too
removing rectum and/or sigmoid colon and forming a colostomy
Kocher incision refers too
open cholecystectomy
mercedes benz incision is for
liver transplant
rooftop incision is for
iver transplant, Whipples/ pancreatic surgery, upper GI surgery
McBurney incision is for
open appendicectomy
battle incision is for
appendicectomy
lanz incision is for
open appendicectomy
Rutherford Morrison incision is for
renal transplant
Pfannenstiel incision is for
Caesarean section and abdominal hysterectomy
RUQ pain differentials
Biliary Colic
Acute Cholecystitis
Acute Cholangitis
RIF pain differentials
Acute Appendicitis
Ectopic Pregnancy
Ovarian Cyst
Meckel’s Diverticulitis
epigastric pain differentials
Pancreatitis
Peptic Ulcer Disease
Abdominal Aortic Aneurysm
central abdominal pain differentials
Abdominal Aortic Aneurysm
Intestinal Obstruction
Ischaemic Colitis
LIF pain differentials
Diverticulitis
Ectopic Pregnancy
Ovarian Cyst
suprapubic pain differentials
Acute Urinary Retention
Pelvic Inflammatory Disease
loin to groin pain differentials
Renal Colic (kidney stones) Abdominal Aortic Aneurysm Pyelonephritis
what test would you want for an indication of pancreas inflammation
amylase
symptoms of appendicitis
RIF pain, loss of appetite, nausea and vomiting
sign’s of appendicitis
tender to Mcburney’s point, guarding RIF, rebound tenderness, and Rovsing’s sign (palpation of left iliac fossa causes pain in RIF)
Dx of appendicits is through
blood tests revealing inflammatory markers, CT and US
common differentials of appendicitis
ectopic, ovarian cysts, meckel’s diverticulitis, mesenteric adenitis
mesenteric adenitis is associated with
cough or cold, inflammation via abdo lumph nodes.
appendix mass Tx
supportive treatment and antibiotics with appendicectomy once acute condition resolved
three causes of intestinal obstruction
adhesions, malignancy and hernia
signs and symptoms of intestinal obstruction
Increasing abdominal distention and diffuse pain
Absolute constipation and lack of flatulence
Vomiting
initial management of intestinal obstruction
Nil by mouth
IV fluids
NG tube on free drainage
Ix for intestinal obstruction
X-ray, CT
upper limits of normal size for the bowel is
Upper limits of normal are: 3 cm small bowel, 6 cm colon, 9 cm caecum
small bowel markings on X-ray are
valvulae conniventes, mucosal folds that cover full width of the small bowel
large bowel markings on x-ray are demarcated by
haustra
causes of ileus
post surgery, infection, trauma, pneumonia, and electrolyte imbalance
Mx of ileus
Nil by mouth / sips of water NG tube if vomiting Mobilise (to stimulate peristalsis) IV fluids to prevent dehydration Consider parenteral nutrition
sigmoid volvulus twists
counter clockwise
caecal volvulus twists
clockwise
RF for volvulus
Psychiatric disorders Neurological disorders Nursing home residents Chronic constipation Pelvic masses (including pregnancy) Adhesions
Dx of volvulus involves
AXR coffee bean sign (sigmoid) and CT
Tx of volvulus is
endoscopic decompression or laparotomy (hartmann’s for sigmoid or right hemicolectomy for caecal)
1st degree haemorrhoids
none
2nd degree haemorrhoids
prolapse on straining, returns on relaxing
3rd degree haemorrhoids
prolapse when straining, requires pushback
4th degree haemorrhoids
permanent prolapse
symptoms of haemorrhoids
constipation, painless red bleeding, sore itchy nus and anal lump
differentials for haemorrhoids
inflammatory bowel disease, fissure and cancer
Tx for haemorrhoids include
cream, laxatives, band ligation and surgical haemorrhoidectomy
third most prevalent cancer in the u.k. is
colorectal
symptoms of colorectal cancer are
change in bowel habit, weight loss, PR bleeding, tenesmus, iron deficiency anaemia and bowel obstruction
gold standard Ix for colorectal cancer
colonoscopy
Ix for colorectal cancer
colonoscopy, Ct colonography, staging CT, and carcinoembryonic antigen
colorectal classification is
dukes
T1 colorectal cancer
submucosal
T2 colorectal cancer
muscularis propria
T3 colorectal cancer
invasion of subserosa
covering loop ileostomy refers too
temporary ileostomy created to protect a distal anastomosis
Typically left for 6-8 weeks to allow healing
cancer of the low sigmoid colon or higher rectum would require what procedure
anterior resection
cancer of the lower rectum are excised with what procedure
Abdominoperineal Resection (APR)
follow up to curative colorectal resection are
CT T.A.P. at 1 and 2 or 3 years
Colonoscopy at 1 and 5 years
CEA 6 monthly for 3 years
diverticulitis signs and symptoms
Left iliac fossa / lower left abdominal pain and tenderness Fever Diarrhea PR blood / mucus Nausea and vomiting
diverticulitis Mx
Consider admission if unwell Antibiotics Analgesia Fluid resuscitation May require surgical resection
diverticulitis management
Haemorrhage Perforation Abscess Fistula (e.g. between colon and bladder / vagina) Ileus / obstruction
celiac artery supplies
Stomach and part of duodenum, biliary system, liver, pancreas
superior mesenteric artery supplies
Duodenum to 1st half of transverse colon
inferior mesenteric supplies
2nd half of transverse colon to rectum
acute mesenteric ischaemia presents with
raised lactate, abdominal pain, shock, peritonitis
RF for acute mesenteric ischaemia
Older age
Atrial fibrillation
Atherosclerosis
Coagulation disorders
MX for acute mesenteric ischaemia
Fluid resuscitation
Thrombolysis
Surgical intervention
Cholelithiasis refers too
gallstones present
Choledocholithiasis refers too
gallstone(s) in the bile duct
Biliary colic refers too
Intermittent right upper quadrant pain caused by gallstones irritating bile ducts
Cholecystitis refers too
Inflammation of the gallbladder
Cholangitis refers too
Infection and obstruction of the biliary system
Gallbladder empyema refers too
Pus in the gallbladder
Gallstone RF
Fat
Fair
Female
Forty
step 1 for Ix gallstone disease
Liver function tests and ultrasound
step 2 gallstone disease investigations indication
Indicated if USS doesn’t show ductal stones but the is bile duct dilitation or raised bilirubin
Step 2 gallstone Ix
MRCP
Step 3 gallbladder Ix indication
Indicated for established CBD stones / obstructing ductal tumours on USS or MRCP
Step three gallstone IX
ERPC
step 4 gallstone IX
cholecystectomy
Acute cholecystitis us finding
thickened gallbladder wall, stones / sludge in gallbladder and fluid around the gallbladder
LFT’s for the biliary tree
raised bilirubin, raised ALK P and raised aminotransferase
raised bilirubin in gallbladder disease indicates
obstruction
raised ALK P indicates in gallbladder disease
cholestasis, or liver/bone metastasis (none specific)
raised ALT/AST indicates
hepatocellular injury =, slight rise in obstructive jaundice
acute cholecystitis symptoms and signs
Murphy’s sign:
RUQ tenderness exacerbated by deep inspirationMurphy’s sign:
RUQ tenderness exacerbated by deep inspiration
Tx for acute cholecystitis
fasting, fluids, antibiotics (if evidence of infection) and eventual laparoscopic cholecystectomy
acute cholangitis symptoms and signs
Charcot’s triad: Right Upper Quadrant Pain, Fever, Jaundice
Tx for acute cholangitis
antibiotics, treatment of sepsis and mechanical intervention (ERCP or PTC)
acute pancreatitis causes
alcohol, gallstones and post ERCP
Glasgow score for pancreatitis
P – Pa02 < 60 A – Age > 55 N – Neutrophils (WBC > 15) C – Calcium < 2 R – uRea >16 E – Enzymes (LDH > 600 or AST/ALT >200) A – Albumin < 32 S – Sugar (Glucose >10)
pancreatitis complications
Pancreatitic necrosis
Infection in necrotic areas
Pseudocysts
Chronic pancreatitis
majority of pancreatic cancer are
adenocarcinomas
pancreatic cancer metastasize to
liver, peritoneum, lungs and bones
presentation of pancreatic cancer is
Non-specific upper abdominal/back pain Painless obstructive jaundice Unintentional weight loss Pale stools (due to lack of bile) Steatorrhoea (greasy stools due to malabsorption due to lack of bile) Dark urine (due to obstructive jaundice) Palpable mass in epigastric region
Dx for pancreatic cancer
CA19-9, CT and endoscopic US with biopsy
Courvoisier’s law refers too
Painless jaundice plus a non-tender palpable gallbladder is pancreatic cancer until proven otherwise
whipple’s procedure involves
removing head of pancreas, gallbladder, duodenum and pylorus
Permanent (end) Ileostomy often used for
After total colectomy for Inflammatory Bowel Disease (UC/Crohns) or Familial Adenomatous Polyposis (FAP)
Permanent (end) Ileostomy often located
lower right abdomen
Colostomy often used for
After abdomino-perineal resections (APR) for low rectal cancers
colostomy often located
Most often in lower left abdomen
three complications of hernias
incarceration (cannot be reduced), obstruction and strangulation
three options for hernia repair
conservative, tension repair and tension free repair (mesh)
indirect inguinal hernia herniates via
the inguinal canal via the superficial ring and deep ring. due to failure of the processus vaginalis not being obliterated.
inguinal canal (hasselbach’s triangle boundaries)
Recus abdominis (medial)
inferior epigastric vessels (superior and lateral border)
poupart’s ligament (inferior border)
femoral triangle boundaries
Sarorius (lateral), adductor longus (medial) and inguinal ligament (superior)
direct inguinal hernia is due to
weakness in the abdominal wall around hasselbach’s triangle
inguinal hernia differentials
Femoral hernia Lymph node Saphena varix (dilation of saphenous vein at junction with femoral vein in groin) Femoral aneurysm Abscess Undescended/ectopic testes Kidney transplant
lateral to medial groin surface
nerve
artery
vein
Y fronts and femoral canal
borders of the femoral canal
Femoral vein laterally
Lacunar ligament medially
Inguinal ligament superiorly
Pectineal ligament posteriorly
why is the femoral hernia at higher risk of complications?
narrow base
site of femoral hernia is
below the inguinal ligament
Spigelian hernia is one that occurs
Through abdominal wall between lateral border of rectus abdominis and linea semilunaris.
Spigelian hernia Dx
US
Diastasis Recti refers too
the space between the rectus abdominis diastasis and recti divarication
Diastasis Recti hernia arises due to
gap is created because the linea alba is stretched and broad
appearance of the diastasis recti hernia
protruding bulge along the middle of the abdomen
what can extenuate the diastasis recti hernia
when the patient lies on their back and lifts their head off
howship–Romberg sign is for
obturator hernia
howship–Romberg sign
Pain extending from the inner thigh to the knee when the hip is internally rotated due to compression of the obturator nerve
type 1 hiatus hernia is
sliding - stomach slides up along with the oesophagus through the diaphragm
type 2 hiatus hernia is
rolling - separate portion of the stomach (i.e. the fundus), folds around and enters through the diaphragm opening along with the oesophagus
type 3 hiatus hernia is
sliding and rolling
type 4 hiatus hernia is
A large hernia allows other intraabdominal organs to pass through the diaphragm opening
Richter’s hernia refers too
a incarcerated and ischaemic hernia
upper urinary tract obscuration refers too
Loin to groin / flank pain on affected side (result of stretching / irritation of ureter and kidney
Reduced / no urine output
Non-specific symptoms (e.g. vomiting)
Reduced renal function on bloods
lower urinary tract obstruction refers too
Acute urinary retention (unable to pass urine and increasingly full bladder)
Lower urinary tract symptoms (e.g. poor flow, difficulty initiating urination, terminal dribbling)
Reduced renal function on bloods
common causes of upper urinary tract obstruction
Kidney stones
Local cancer masses pressing on the ureters
Ureter strictures (scar tissue narrowing tube)
lower urinary tract obstruction
Benign prostatic hyperplasia (enlarged prostate)
Prostate cancer
Ureter or urethra strictures (from scar tissue)
Neurogenic bladder (no neurological signal telling bladder to contract)
urinary obstruction complications
Acute Kidney Injury (postrenal AKI) Eventually chronic kidney disease Infection (from pooling of urine and retrograde infection – bacteria tracking back up urinary tract) Dilated kidney / ureters / bladder Pain
common type of renal tumour is
renal cell carcinoma (clear cell)
pathognomonic signs of renal cell carcinoma metastatic spread
cannonball
presentation of renal cell carcinoma is
Often asymptomatic
Haematuria
Vague loin pain
Non-specific symptoms of cancer (e.g. weight loss, fatigue, anorexia, night sweats)
renal cell carcinoma is children often is
Wilm’s tumour
RF for clear cell carcinoma is
Smoking Obesity Hypertension Long-term dialysis Von Hippel-Lindau Disease
paraneoplastic features of renal cell carcinoma are
Polycythaemia (RCC secretes unregulated erythropoietin)
Hypercalcaemia (RCC secretes a hormone that mimics the action of PTH)
Stauffer Syndrome
Stauffer Syndrome is
abnormal liver function tests demonstrating an obstructive jaundice – without any localised liver or biliary metastasis!)
commonest bladder cancer presentation
transitional
typical presentation of bladder cancer is
dye factory worker with painless haematuria
Dx of bladder cancer is through
cystoscopy and biopsy
associations for bladder cancer
dehydration chronically
carcinogens such as aromatic amines, arsenic, smoking
Schistosomiasis causes
bladder squamous cell carcinoma
bladder cancer not invading muscle Tx
ransurethral Resection of a Bladder Tumour (TURBT)
Chemo into bladder after surgery (use barrier contraception afterwards)
Weekly treatments for 6 weeks with BCG vaccine
bladder cancer muscle invasive Tx
Radical cystectomy with ileal conduit
Radiotherapy (as neoadjuvant, primary treatment or palliative)
IV chemotherapy as neoadjuvant or palliative
benign prostatic hyperplasia symptoms
Hesitancy Urgency Frequency Intermittency Straining to void Terminal dribbling Incomplete emptying
assessment of benign prostatic hyperplasia is with
urine dipstick, PSA prior to rectal examination
meds Tx for benign prostatic hyperplasia
alpha blockers and 5-alpha reductase inhibitors
alpha blocker Tx for benign prostatic hyperplasia
tamsulosin 400 mcg once daily
5-alpha reductase inhibitors Tx for benign prostatic hyperplasia
block testosterone and actually help reduce the size of the prostate; e.g. finasteride
surgical options for benign prostatic hyperplasia
Transurethral resection of the prostate (TURP)
Transurethral electrovaporisation of the prostate (TUVP)
Holmium laser enucleation of the prostate (HoLEP)
Open prostatectomy via abdominal or perineal incision
complications of TURP
F – Failure to resolve symptoms I – Incontinence R – Retrograde ejaculation (semen goes backwards and is not produced from the urethra during ejaculation) E – Erectile dysfunction S – Strictures
RF for prostate cancer
age, family history, being black, being tall and use of anabolic steroids
prostate cancer grading system
gleason grading
Mx options for prostate cancer
brachytherapy and hormonal
Tx hormonal therapy for prostate cancer
Hormonal therapy aims to block androgens and slow or stop prostate cancer growth
SE for hormonal prostate cancer therapy
hot flushes, sexual dysfunction, gynaecomastia, fatigue and osteoporosis
androgen receptor blocker example
Androgen receptor blockers (e.g. bicalutamide)
LHRH agonists example
goserelin
gold standard hormonal treatment for prostate cancer is
Bilateral orchidectomy
causes of epididymo orchitis
E. coli
Chlamydia trachomatis
Neisseria gonorrhea
Mumps
presentation of epididymo orchitis
gradual onset over hours, testicualr pain and heaviness, dragging, urethral discharge, pain on palpitation, swelling and erythema
Mx of epididymo orchitis
cirpofloxacin for 2 weeks and abstain from intercourse
testicular torsion window
6 hours
examination signs for testicular torsion
tender, firm, absent cremasteric reflex and abnormal lie (horizontal, retracted and rotated)
what is the name given to the deformity that predisposes to testicular torsion
bell-clapper deformity (absent of fixation to tunica vaginalis)
testicular cancer presentation
non tender, hard with no fluctuance or transillumination, irregular
hydrocele arise due to fluid within
the tunica vaginalis
hydrocele presentation
soft, fluctuant and large
hydrocele may indicate
underlying cancer
varicocele presentation
soft bag of worms, dragging or sore
varicocele arises from
pampiniform venous plexus
Epididymal cyst presentation
top of testicle soft fluctuant lump
The right testicular vein arises from the
IVC
left testicular vein arises from
left renal vein
left sided varicocele can indicate
an obstruction of the left testicular vein, for example caused by a renal cell carcinoma
testicular tumour markers
Alpha-fetoprotein may be raised in teratomas (not seminomas)
Beta-hCG may be raised in teratomas and seminomas, but more often in teratomas
Lactate dehydrogenase
metastatic spread of testicular cancer is
Lymphatics
Lungs
Liver
Brain
common organisms that cause pyelonephritis
Escherichia coli is the most common cause
Klebsiella
Enterococcus
Pseudomonas
presentation of pyelonephritis
High fever and rigors
Loin to groin pain
Dysuria and urinary frequency
Haematuria
Other non-specific symptoms (e.g. vomiting)
Pain on bimanual palpation of the renal angle (over kidney)
urine dipstick findings for pyelonephritis
blood, protein, leukocyte esterase and nitrites
imaging for pyelonephritis
CT, US and DMSA scans for scarring
antibiotic for pyelonephritis
co-amoxiclav
80% of renal stones are
calcium oxolate
what renal stone isn’t visible on x-ray
uric acid
staghorn calculus is produced by
struvite - magnesium ammonium phosphate
struvite arises from
recurrent infections - bacteria can hydrolyse the urea in urine to ammonia, creating the solid struvite
presentation of renal stones
renal colic, loin to groin pain, haematuria, nausea, vomiting, oliguria
Dx of renal stones
urine dipstick, bloods, AXR, CT KUB
Mx of renal stones
NSAIDS, antiemetics, antibiotics, fluids, tamsulosin
surgical interventions for stones
Extracorporeal Shock Wave Lithotripsy
Ureteroscopy and Laser Lithotripsy
Percutaneous Nephrolithotomy
open surgery
oxalate-rich foods
spinach, nuts, rhubarb, tea
urate- rich foods
kidney, liver, sardines
