urinary calculi Dr.murtadha Almusfar

Question 1

what’re the clinical feature of urinary calculi ?

Answer 1

1- 50% of pt are 30-50 yr

2- pt with uremia presented with

• erthy color face
• aciditoic breathing
• uremic fetor
• half half nail
• secondry infection appear it symptoms first as high grade fever

3- when urination there are 3 features
a-pain in 75%
b- irritative voiding as dysuria ,frequency, anuria
c- heamaturia

4- anuria or oliguria in retail failure in bilateral ureteral and staghorn stone

5-non urinary symptoms
as nausea vomiting and abdomenl distention

Question 2

in which types of renal stones there will be renal failure ?

Answer 2

1- bilateral ureteral stone
2- bilateral staghorn stone
3- stone obstruct single kidney

Question 3

what’re the most important features in the history should be mention in the pt with renal stone ?

Answer 3

• site of the pain because the presence of the pain indicate obstruction ,infection or ureteral spasm
• history of calculi
• family history of calculi
• history of the transplantation
• chemical composition of the renal stone

Question 4

sit and character of the renal pain ?

Answer 4

dull Pain in the right flank

Question 5

whats the renal stone means ?

Answer 5

means poly-crystalline aggregation

Question 6

what’re the causes of the Renal calculi ?

Answer 6

1- diet / high energy diet
and high sodium diet associated via A difference increase the incidence
2- dehydration and decrease urine colloid
3- inadequate urinary drainage and stasis
4- immbolization
5- occupation :work with pet
6- climate : hot weather
7- family history
8- drugs : indinavir , triamterene
9- structural abnormality in the urinary tract

10- decrease the urinary citrate

11- infection with staph , strept & proteus sap
12- hyperthyroidism

Question 7

whats the uric acid stone ?

Answer 7

• its about 5%
• complete radiolucent (Radiolucent – Refers to structures that are less dense and permit the x-ray beam to pass through them that means its the opposite of the bone )

-most of them contains ca

Question 8

what’re the causes of the uric acid stone ?

Answer 8

• hyperureimia
  a) male with gout
  b) rapid weight loss
  c) high purine diet
  d) myloproliferative disease
• urin PH is equal and less than 5.5

Question 9

whats the composition of the saturvate stone?

Answer 9

MAP

• magnesium
• amonium
• phosphate
• may see in the radiographic film

Question 10

how the saturvate stone appear?

Answer 10

• smoth and dirty white

- staghorn

Question 11

whats the cause of the sturvate stone ?

Answer 11

-in alkaline urine in female with recurrent UTI with splitting organism

Question 12

whats the crystine stone ?

Answer 12

its uncommon contain sulfur so its hard and opaque

Question 13

whats the cause of the crystine stone ?

Answer 13

in acidic urine in inborn error metabolism

Question 14

xanthine stone ?

Answer 14

its extremely rare and its secondary to the xanthine oxidase enzyme

Question 15

other rare stones

Answer 15

1- indinavir
2- silicate
3-matrix stone

Question 16

what’re the features appear during the abdomenal examination ?

Answer 16

1- during the ureteral pain there will be abdominal rigidity in the lat abdominal muscle but not the rectus muscle

2- during the precussion there will be stab pain and tenderness during palptation

3- palpable loin swelling is due to hydonephosis

Question 17

what’re the investigation and diagnosis ?

Answer 17

urinalysis

and blood test

Question 18

what’re the imaging studies ?

Answer 18

1-KUB( kidney, ureter, and bladder (KUB) study is an X-ray)
2- IUV (intravenous pyelogram)
3- Abdominal U/S 
4-CT scan 
5-MRI 
6- nuclear scintigraphy

Question 19

When the KUB used for ?

Answer 19

its used for radiopaque stone which 90%

Question 20

what’re the radiolucent stones?

Answer 20

1- uric acid stone
2- pure cystine
3-matrix

Question 21

IUV (intravenous pyelogram)

Answer 21

look for the filling defect

and give an idea about the renal function

Question 22

when the ct scan used?

Answer 22

if pt with stone presented acute ureteric colicky

Question 23

MRI

Answer 23

is poor document for the renal stone

Question 24

what’s the conservative treatment of the renal calculi ?

Answer 24

oral alkalinizing agent na & k bicarbonate

Question 25

what’re the indication of the extra- corporeal shock wave lithotripsy ESWL ?

Answer 25

1- when the conservative treatment fail

2- when the size of the stone is less than 25mm

Question 26

what’re the indication of the percutaneous nephrolithtomy ?

Answer 26

1- if the ESWL is contradicted in pregnancy ,aneurism or bleeding disorder

2- if its large stone more than 25mm

3- lower pole renal stone

4- stone in the calcuail diverticulum

5- if there is detail obstruction not by the stone but by PUj

Question 27

RIRS

Answer 27

retrograde infrarenal surgery

Question 28

ECIRS

Answer 28

endoscopic combined infrarenal surgery

Question 29

whats the differential diagnosis of the upper renal stone ?

Answer 29

upper renal stone in the flank and the lumber area
RT ; choleocyctitis ,choliolithiasis

LT ; gastritis , peptic ulcer disease & acute pancreatitis

Question 30

whats the differential diagnosis of the middle ureteric pain ?

Answer 30

RT; appendcitiis

LT ; diverticulitis

Question 31

whats the differential diagnosis of the lower ureteric pain ?

Answer 31

in male the groin or testicle

anf female labia majora

Question 32

whats the treatment of the ureteric calculi ?

Answer 32

1- spountaous 
2- medical thereby 
Calp Nas كلب ناس 
- ca blocker; nifedipine 
-alpha blocker ; tamsulin 
-phoshodiestrase inhibitor 5; tadalafil

-NSID as diclofenac and indomethacin

3- endoscope
4- ESWL
5- open surgery

Question 33

what’re the management of pt presented with obstructive ureteral calculi with fever and rigor ?

Answer 33

1- IV line and take blood , urine sample for culture

2-IV fluid
3- symptomatic trt as antipyretic and anti analgesic
4-broad spectrum Antibiotic until the culture appear
5- drainage of the urine by DJ stent or nephrostomy