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Z Year3 Urology > Urinary tract calculi > Flashcards

Urinary tract calculi Flashcards

1
Q

What are urinary tract calculi?

A

presence of calculi within the urinary system

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2
Q

Where are 3 common points to find urinary tract calculi?

A
  1. Ureteropelvic junction
  2. Pelvic brim (where ureters cross the iliac vessels)
  3. Ureterovesical junction
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3
Q

What is the most common type of stone?

A
  1. Calcium oxalate
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4
Q

What are the other types of stones?

A
  1. Struvite (magnesium ammonium phosphate)
  2. Urate/uric acid - 5% - not visible on X-ray!
  3. Hydroxyapatite (5%)
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5
Q

What is the patho of urinary tract calculi?

A

Urinary solutes are highly concentrated so supersaturate and precipitate out of solution

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6
Q

What can cause urinary tract calculi?

A

Anything that can cause an increase in:

  1. Calcium
  2. Uric acid
  3. Oxalate
  4. Sodium
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7
Q

What are the metabolic causes for urinary tract calculi?

A
  1. Hypercalcaemia
  2. Hyperuricaemia
  3. Hypercystinuria
  4. Hyperoxaluria
  5. Hypocitraturia
  6. Hyperparathyroidism
  7. Renal tubular acidosis
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8
Q

What are the infective causes for urinary tract calculi?

A
  1. Hyperuricaemia
  2. Recurrent UTIs
  3. Chronic UTI
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9
Q

What drugs can cause urinary tract calculi?

A
  1. Indinavir, atazanavir
  2. Diuretics
  3. Antacids (Ca-containing)
  4. Carbonic anhydrase inhibitors
  5. Na- and Ca-containing medications
  6. Vit C+D
  7. Corticosteroids
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10
Q

What are other causes of obstruction?

A
  1. urinary tract abnormalities

2. foreign bodies (stents, catheters)

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11
Q

What urinary tract abnormailites can use urinary tract calculi?

A

o Pelviureteric junction obstruction
o Hydronephrosis
o Ureteral stricture

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12
Q

What are RF for urinary tract calculi?

A
  1. Dehydration
  2. High protein intake
  3. High salt
  4. Structural abnormalities
  5. PMHx
  6. FHx
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13
Q

What is the common epi for urinary tract calculi?

A
  • 3x more common in MALES
  • Age group: 30-50yrs
  • Higher prevalence in hot, dry countries
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14
Q

What are the initial symptoms of urinary tract calculi?

A

asymptomatic

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15
Q

What are the symptoms of urinary tract calculi as they get stuck?

A
  1. Acute severe loin to groin pain = renal colic
  2. N and V
  3. Unable to lie still/writhing in pain
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16
Q

What are the urinary symptoms?

A
  1. Urgency
  2. Frequency
  3. Haematuria (85% microscopic, occasional macroscopic)
17
Q

What are the bedside investigations for urinary tract calculi?

A

1st line: urine dipstick

NOTE: in all women of child-bearing age do pregnancy test to exclude ectopic pregnancy

18
Q

What bloods are done?

A
  1. FBC
  2. WBC for UTI
  3. U&Eā€™s, Cr, Ca to check renal function
19
Q

What imaging is done?

A

GOLD STANDARD: non- contrast CT-KUB or (USS in pregnant) - kidney stones show up white

20
Q

What is the acute management for urinary tract calculi?

A
  1. Fluids
  2. Analgesia (diclofenac)
  3. Anti-emetics (ondansetron)
  4. Urine collection - collect passed stone
21
Q

What is the management for urinary tract calculi when <5mm?

A

leave to pass spontaneously with increased fluid intake

22
Q

What is the management for urinary tract calculi when <10mm?

A
  1. alpha-blocker (tamsulosin)

2. if not passed after 4-6 weeks: surgery

23
Q

What is the management for urinary tract calculi when >10mm or failed therapy?

A

-surgical removal
1st line: extracorporeal shock wave lithotripsy (ESWL)
2. Percutaeneous nephrostolithotomy ā€“ difficult shape stone e.g. staghorns

24
Q

What is ESWL?

A
  1. A scope is passed into the bladder and up the ureter to visualise the stone
  2. AN electromagnetic wave is then focus onto the calculus to break it up into smaller fragments that can pass spontaneously
25
Q

What is PCNL?

A

key hole surgery

26
Q

What are possible complications of urinary tract calculi?

A
  1. Pyelonephritis
  2. Septicaemia
  3. Obstruction
  4. Urinary retention
  5. Hydronephrosis, AKI
27
Q

What is a rare cause of kidney stones?

A

cystinuria

28
Q

Why do you need to be careful with renal colic?

A
  • Common but several DDx
    1. AAA
    2. Biliary colic
    3. Constipation
    4. Bowel obstruction
    5. Ectopic preggers
  • Dipstick haematuria
  • Must confirm with CT/KUB

Z Year3 Urology (18 decks)

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