Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Urology > Urinary stones > Flashcards

Urinary stones Flashcards

1
Q

3rd MC urinary tract D/O

A

Urinary stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Urinary stones pop?

A

M > F (2.5:1)

30-50s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Urolithiasis def

A

Stone formations anywhere in urinary tract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Nephrolithiasis def

A

Stones in kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Ureterolithiasis

A

Stones in the ureters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Urinary calculi composition

A

Polycrystalline aggregates of crystalloid/organic matrix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Basic pathophysiology of stone formation

A

Result of urinary supersaturation of solutes

-low fluid intake, low UA volume = high solutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Most stones are compsed of?

A

Calcium = radiopaque

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Most important factors of stone development

A

High protein/salt intake
Inadequate hydration
Sedentary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Geographic factors of stone development

A

High humidity

INC temp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Genetic predisposition condition? 3

A

Homozygous Cystinuria
Auto rec D/O
INC cysteine excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Acidic urine contributes to

A

Uric acid or cystine stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Alkaline urine contributes to

A

UTI - urease producing organisms
-proteus / klebsiella
=strucite stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

5 major stone types

A
  1. Calcium oxalate
  2. Calcium phosphate
  3. Cystine
  4. Struvite AKA staghorn calculi
    (-Mg ammonium phosphate)
  5. Uric acid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MC urinary stone

A

Calcium Oxalate Stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Calcium Oxalate pH range

A

5.5-6.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Increased risks of developing Calcium Oxalate

A

High sodium/protein
Dehydrated
Hypercalceuria
Low urine citrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

XR attenuation of Calcium Oxalate?

A

Radiopaque

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Citrate interaction w/ calcium

A
  1. UA citrate binds calcium
  2. Decreases calcium
  3. Prevents calcium phosphate/oxalate stones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Acidic urinary citrate level is?

A

Decreased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Alkalosis urinary citrate level is?

A

Increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Calcium phosphate pH level

A

> 7.5 pH alakaline urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Calcium phosphate Increased RFs?

A

High sodium/protein
Dehydration
Hypercalcuria
Low urine citrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Calcium phosphate XR attenuation?

A

Radiopaque

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Struvite stones are composed of?

A

Mg-ammonium-phosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Struvite stone MC pop?

A

Women w/ recurrent UTIs w/ urease producing bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Types of urease producing bacteria?

A 
Proteus / klebsiella
Pseudomonas
Providencia
Staph
Mycoplasma
28
Q

Struvite stone pH range?

A

> 7.2

29
Q

Struvite stone XR attenuation?

A

Radiopaque/radioense

30
Q

Struvite calculi develops where?

A

Upper urinary tract

W/in Renal pelvis extending into 2 calyces

31
Q

What is the only amino acid insoluble in urine?

A

Cystine

32
Q

Cystine stone pH of UA?

A

<5.5

33
Q

What type of genetic predisposition is cystinuria?

A

Auto rec D/O

34
Q

Cystine stone XR attenuation?

A

Radiolucent

35
Q

Uric acid stone RFs?

A

Hyperuricemia
Myeloproliferative D/O
Malig w/ uric acid forming
Abrupt/dramatic wgt loss

36
Q

Uric acid stone pH range?

A

<5.5

37
Q

Uric acid stone XR attenuation?

A

Radiolucent

38
Q

Obstructing stones S/S

A

Colic pain - radiates anteriorly over ABD
Sudden onset - may wake from sleep
Severe unremitting flank pain
Ass/w n/v
Pt constantly moving looking for position of comfort
Hematuria
CVA TTP

39
Q

As stones pass down ureters may change to?

A

Referred ipsilateral groin pain

40
Q

Stones lodged at ureterovesical jx S/S?

A

Urinary urgency.freq

Males - pain at penis tip

41
Q

Does size of stone correlate w/ S/S severity?

A

No

42
Q

DDx for stones?

A

Bleeding - clots=temp obstruct
Pyelonephritis - flank pain and fever (not expected unless obstruct w/ infection)
GYN flank pain - ectopic preg, preg, ruptured ovarian cyst, ovarian torsion.
AAA - ruptured or leaking
Mesenteric ischemia - ABD w/out peritonitis S/S initally
Herpes zoster - flank pain +rash/lesion - no hematuria
Drug-seeking - false pain/hematuria

43
Q

Urinary stone labs

A 
UA 
-hematuria 90%
-pH <5.5 - uric acid/cysteine stones
-pH 5.5-6.8 - calcium oxalate stones
-pH >7.2 - struvite stones
-pH >7.5 - calcium phosphate stones
CHEM 17
STONE ANALYSIS - strainer
44
Q

Imaging gold standard for urinary stones?

A

Non-contrast CT

-all stones visible

45
Q

Stones seen on KUB XR

A

Calcium = radiopaque

Cannot exclude stone if NEG

46
Q

Renal U/S is a good alternative image if?

A

Pt is pregnant
Safe, good accuracy.
Not standard of care

47
Q

Acute TXT of asymptomatic pt w/ no infection

A

no TXT

48
Q

Majority of Acute TXT id conducted how? Intervention?

A

Outpatient Conservative-

  1. Hydration
    - INC H2O
    - IVF if needed
  2. Pain
    - NSAID,narcs
  3. Antimetic
    - Ondansetron/promethazine
  4. Alpha-blk agents (pass it)
    - Alfuzosin/tamsulosin
49
Q

What size stone typically pass spontaneosly?

A

<=5-6mm

50
Q

Stone referral indications

A 
Infection
Obstruction 
Intractable pain (admit)
Persistent N/V
>=6mm size
Fails to pass w/in 4wks
Kidney ABNL/single
Pregnant
Immunocompromised
PMHx severe renal Dz
51
Q

Pt w/ obstructed urinary calculi w/ fever and infected urine req?

A

Emergent urologic eval and drainage

-pus under pressure-

52
Q

Extracorporeal shockwave Lithotripsy (ESWL) works best when?

A

Stones are in renal pelvis or upper 2/3 of ureter and size <1.5cm

53
Q

TXT of choice if stones require advanced intervention?

A

TOC = ESWL 75%

54
Q

Before performing a ESWL what is req?

A

D/C NSAIDs 3 days prior (decrease bleed risk0

55
Q

What may be used post ESWL to help facilitate stone passage?

A

Ureteral Stent

56
Q

Ureteroscopic stone extraction attribute?

A

Remove Stones in lower 1/3 of ureter (NL anatomy)

57
Q

Percutaneous nephrolithotomy attributes

A

Remove Stones in renal collecting system or upper 2/3 of ureter w/ size >2cm

58
Q

Open stone surgery is reserved for who?

A

Pts w/ complex anatomy, obstruction, large infected struvite stones

59
Q

Acute pts bottom line management

A 
Push fluids (PO/IV)
Pain control
Confirm stone PRN 
Admit PRN
Refer PRN
60
Q

Recurrent stones lab w/u

A

24hr UA
-volume, pH, composition
Serum PTH and Uric acid
-R/O hyperparathyroidism or gout

61
Q

PVT strategies

Diet

A

DEC salt > INC Ca2+ UA
DEC protein > INC Ca2+ and DEC citrate in UA

Do not restrict Ca2+ intake (low calcium diet > increased risk of stones)

INC bran/water
-fiber > feceses Ca2+ excretion

Avoid soda
-high in phosphate > INC calcium phosphate formation

Avoid VIT-C >2g/day
-ascorbic acid metabolism = INC oxalate

62
Q

Reducing calcium in diet physiology

A 
DEC dietary Ca2+ >
DEC oxalate binding in GI >
INC serum oxalate >
INC urinary oxalate > 
INC urinary calcium oxalate > stones
63
Q

Recommended ca2+ intake

A

RDA 1000-1200 MG/d

64
Q

Txt for recurrent stones

A

High UA calcium = thiazide diuretic (HCTZ, chlorthalidone) > DEC UA Ca2+

Low UA citrate or pH = potassium citrate therapy

  • raises citrate in Ca2+ stone formers
  • raises pH in uric acid/cystine stone formers
65
Q

Very important orevention strategy

A

Hydrate -water

66
Q

How much should a stone forming patient urinate?

A

1.5-2L/d

67
Q

F/U for chronic stone formers?

A

6mo- RPT 24H UA to assess respone to intervention
Q1yr CT to assess new forms
RPT Stone analysis if TXT fail

Urology (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions