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#Phase 2.1: Peri Op > Urinary Tract Calculi > Flashcards

Urinary Tract Calculi Flashcards

1
Q

What are urinary tract calculi? (2 things)

A
  1. Stones formed anywhere in UT
  2. Caused by precipitations of solutes in urine
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2
Q

What are some general risk factors for urinary tract calculi? (3 things)

A
  1. Male
  2. FHx
  3. Dehydration (increases concentration of urine solutes)
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3
Q

What medical conditions increase the risk of urinary tract calculi? (5 things)

A
  1. UTI
  2. Gout (high uric acid)
  3. Hyperparathyroidism (high Ca)
    4 HTN
  4. DM
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4
Q

What features of a diet increase the risk of urinary tract calculi? (3 things)

A
  1. High Na = reduces Na + Ca reabs @ PCT = hypercalciuria
  2. High Ca
  3. High oxalate
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5
Q

What medications increase the risk of urinary tract calculi?

A

Loop diuretics = X Ca reabs @ DCT

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6
Q

What foods increase oxalate? (5 things)

A
  1. Chocolate
  2. Tea
  3. Rhubarbs
  4. Strawberries
  5. Nuts
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7
Q

What causes Calcium oxalate stones?

A

Metabolic / idiopathic

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8
Q

What causes Calcium phosphate stones?

A

Metabolic / idiopathic

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9
Q

What causes Magnesium Ammonium Phosphate stones?

A

UTI

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10
Q

What causes Urate stones?

A

Hyperuricaemia

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11
Q

What causes Cystine phosphate stones?

A

Renal tubular defects

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12
Q

What are the most common sites for stones to lodge? (3 things)

A
  1. Pelviureteric junction (renal pelvis + ureter)
  2. Pelvic brim (ureteral crossing of iliac vessels)
  3. Vesicoureteric junction (urinary bladder + ureter)
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13
Q

When can urinary tract calculi be asymptomatic? (2 things)

A
  1. Small stones
  2. Stones @ renal pelvis / bladder
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14
Q

What are the clinical features of urinary tract calculi? (6 things)

A
  1. Fever (inf / pyelonephritis)
  2. N+V
  3. Abd pain (colicky, unilateral) (bc ureteric obst)
  4. Costophrenic Angle Tenderness
  5. Haematuria
  6. Inability to lie still (differentiates from peritonitis)
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15
Q

What is Costovertebral Angle tenderness?

A
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16
Q

Where does the Abd pain in Urinary Tract Calculi radiate to? (2 things)

A
  1. Groin
  2. Testes / labia majora
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17
Q

What are other differentials that present similarly to urinary tract calculi? (4 things)

A
  1. Acute appendicitis
  2. Biliary colic
  3. Diverticulitis
  4. Testicular torsion
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18
Q

How do you differentiate Acute Appendicitis from Urinary Tract Calculi?

A

UTC = causes FLANK pain

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19
Q

How do you differentiate Biliary Colic from Urinary Tract Calculi?

A

UTC pain NOT related to eating

20
Q

How do you differentiate Diverticulitis from Urinary Tract Calculi?

A

UTC NO bloody stools

21
Q

How do you differentiate Testicular Torsion from Urinary Tract Calculi?

A

UTC = causes FLANK pain

22
Q

What lab tests should be done for Urinary Tract Calculi? (5 things)

A
  1. Urine dip (haematuria / infection)
  2. FBC (raised WCC in infection)
  3. CRP (raised in infection)
  4. U&Es
    - renal function
    - urate + calcium levels (to find stone type)
    - stone in urine –> retrieve + analyse to find type
  5. Urine culture (if infection present)
23
Q

What is the Gold standard imaging for Urinary Tract Calculi?

A

Non-contrast CT of KUB (kidneys ureters and bladder)

24
Q

Why is non-contrast CT of KUB the Gold standard imaging for UTC? (2 things)

A
  1. 99% stones visible
  2. Excludes acute abdomen differentials (e.g ruptured AAA)
25
Q

What are the disadvantages of AXR for UTC?

A

Not all stones are radio-opaque

26
Q

When can a US be done for UTC?

A

To assess for hydronephrosis (kidney swelling)

27
Q

What is the disadvantage of US for UTC?

A

Detects renal stones but NOT ureteric stones

28
Q

How should all patients with UTC be managed initially? (3 things)

A
  1. IV fluid resus
  2. Analgesia
  3. Abx if infection (piperacillin / tazobactam / gentamicin)
29
Q

After initial management of a UTC patient what does the next management depend on?

A

Size of stones

30
Q

How should a patient with a stone smaller than 5mm be managed?

A

Just observe (stone will pass by itself)

31
Q

How should a patient with a 5-10mm stone be managed?

A
  1. alpha-blockers (tamsulosin)
  2. Calcium channel blockers (nifedipine)
32
Q

How do alpha-blockers and Calcium channel blockers help patients with UTC? (2 things)

How?

A
  1. Promote stone expulsion
  2. Reduce analgesia req

By dilating + relaxing ureters

33
Q

How should a patient with a 10-20mm stone be managed? (2 things)

A
  1. ESWL (extracorporal shock wave lithotripsy)
  2. Ureteroscopy
34
Q

How does ESWL help a patient with UTC?

A

US shock waves shatter stone

35
Q

What are the contraindications for ESWL in UTC patients?

A

Obese patients because poor penetration of US waves

36
Q

What are the side fx of ESWL used in UTC? (3 things)

A
  1. Renal injury
  2. Increased BP
  3. DM
37
Q

How should a patient with a 20+ mm stone be managed? (2 things)

A

Percutaneous nephrolithotomy (key whole surgery to remove stone)

38
Q

How should a patient with a Calcium stone be managed? (3 things)

A
  1. Low sodium diet = increases Na + Ca reabs @ PCT
  2. Thiazide diuretics = increases Ca reabs @ DCT
  3. Citrate (dissolves Calcium oxalate crystals)
39
Q

How should a patient with a Magnesium Ammonium Phosphate stone be managed?

A

Abx (bc caused by UTI)

40
Q

How should a patient with a Urate stone be managed? (2 things)

A
  1. Potassium citrate = alkalises urine = dissolves crystals
  2. Allopurinol = reduces uric acid prod
41
Q

How should a patient with a Cystine stone be managed?

A

Tiopronin / Penicillamine = chelates crystals

42
Q

What are the complications of UTC? (3 things)

A
  1. Hydronephrosis (swollen kidney)
  2. Acute Pyelonephritis
  3. Post-renal AKI
43
Q

What is Acute Pyelonephritis? (2 things)

A
  1. Bac overgrowth caused by stone obstructing UT
  2. Renal pelvis inflamm

(complication of UTC)

44
Q

How does Acute Pyelonephritis present? (4 things)

A
  1. Fever
  2. Frequency
  3. Urgency
  4. Dysuria
45
Q

What is hydronephrosis? (2 things)

A
  1. Proximal accum of urine caused by stone obstructing UT
  2. Renal pelvis + calyx dilation (visible in US)

(complication of UTC)

#Phase 2.1: Peri Op (24 decks)

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