Urinary tract calculi Flashcards
What 3 points of narrowing do urinary tract calculi usually occur
ureteropelvic junction
pelvic brim
ureterovesical junction
What types of ureteric stones can one get
calcium oxalate - most common
Struvite - magnesium ammonium phosphate
Urate/uric acid - not visible on X-ray
Hydroxyapatite
What are diagnostic factors for urinary tract calculi
initially can be asymptomatic
acute severe loin to groin pain - renal colic
nausea and vomiting
unable to lie still
urinary symptoms- urgency , frequency, haematuria
What are some risk factors for urinary tract calculi
dehydration
high protein intake
high salt intake
structural abnormalities
previous kidney stones
family history of kidney stones
What investigations are required
non-contrast CT KUB or USS in pregnant women
urine dipstick
pregnancy test to exclude ectopic pregnancy
FBC to see WCC
U&E’s , Cr, Ca to check renal function
How do you manage urinary tract calculi
fluids
analgesia - DICLOFENAC
anti-emetic - ONDANSETRON
When can lithotripsy be offered
stone burden of less than 2cm in aggregate
When can ureteroscopy be offered
stone burden of less than 2cm in pregnant females
What management should be offered for complex renal calculi and staghorn calculi
percutaneous nephrolithotomy
How do you manage a patient if they have obstruction alongside an infection
nephrostomy tube and urgent decompression
How can one prevent calcium stones
high fluid intake
low animal protein, low salt diet
Thiazide diuretics - increase calcium reabsorption
How can oxalate stones be prevented
Cholestyramine reduces urinary oxalate secretion
pyridoxine reduces urinary oxalate secretion
How can uric acid stones be prevented
allopurinol
urinary alkalinization - oral bicarbonate
When can alpha blockers be used as management
distal ureteric stones less than 10mm in size
What is management for renal stones if less than 5mm and asymptomatic
watchful waiting
