urinary calculi Dr.murtadha Almusfar Flashcards
what’re the clinical feature of urinary calculi ?
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
in which types of renal stones there will be renal failure ?
1- bilateral ureteral stone
2- bilateral staghorn stone
3- stone obstruct single kidney
what’re the most important features in the history should be mention in the pt with renal stone ?
- 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
sit and character of the renal pain ?
dull Pain in the right flank
whats the renal stone means ?
means poly-crystalline aggregation
what’re the causes of the Renal calculi ?
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
whats the uric acid stone ?
- 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
what’re the causes of the uric acid stone ?
- 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
whats the composition of the saturvate stone?
MAP
- magnesium
- amonium
- phosphate
- may see in the radiographic film
how the saturvate stone appear?
- smoth and dirty white
- staghorn
whats the cause of the sturvate stone ?
-in alkaline urine in female with recurrent UTI with splitting organism
whats the crystine stone ?
its uncommon contain sulfur so its hard and opaque
whats the cause of the crystine stone ?
in acidic urine in inborn error metabolism
xanthine stone ?
its extremely rare and its secondary to the xanthine oxidase enzyme
other rare stones
1- indinavir
2- silicate
3-matrix stone
what’re the features appear during the abdomenal examination ?
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
what’re the investigation and diagnosis ?
urinalysis
and blood test
what’re the imaging studies ?
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
When the KUB used for ?
its used for radiopaque stone which 90%
what’re the radiolucent stones?
1- uric acid stone
2- pure cystine
3-matrix
IUV (intravenous pyelogram)
look for the filling defect
and give an idea about the renal function
when the ct scan used?
if pt with stone presented acute ureteric colicky
MRI
is poor document for the renal stone
what’s the conservative treatment of the renal calculi ?
oral alkalinizing agent na & k bicarbonate
what’re the indication of the extra- corporeal shock wave lithotripsy ESWL ?
1- when the conservative treatment fail
2- when the size of the stone is less than 25mm
what’re the indication of the percutaneous nephrolithtomy ?
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
RIRS
retrograde infrarenal surgery
ECIRS
endoscopic combined infrarenal surgery
whats the differential diagnosis of the upper renal stone ?
upper renal stone in the flank and the lumber area
RT ; choleocyctitis ,choliolithiasis
LT ; gastritis , peptic ulcer disease & acute pancreatitis
whats the differential diagnosis of the middle ureteric pain ?
RT; appendcitiis
LT ; diverticulitis
whats the differential diagnosis of the lower ureteric pain ?
in male the groin or testicle
anf female labia majora
whats the treatment of the ureteric calculi ?
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
what’re the management of pt presented with obstructive ureteral calculi with fever and rigor ?
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
