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Adult Ped/Med: 5 > Urolithiasis > Flashcards

Urolithiasis Flashcards

1
Q

How likely are kidney stones to recur if you’ve had them once?

A

very likely

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2
Q

What are some risk factors for stone development?

A

decreased water intake, sedentary lifestyle, living in a hot area, history of stones

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3
Q

What is the clinical presentation of someone with stones?

A

If stone is still in the kidney–> they may appear asymptomatic. However, once it starts passing into the ureter, then extreme pain develops in flank and radiates to lower abdomen. Patients are restless, ambulatory, n/v, hematuria, and may experience mirror pain.

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4
Q

does the size of stone correlate to the amount of pain?

A

no!!!

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5
Q

pain tends to decrease once the stone passes into the…

A

bladder!

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6
Q

What might your ddx be for a kidney stone?

A

pyelonephritis, cystitis, bladder cancer, STD, acute abdomen.

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7
Q

How will the patient appear on physical exam?

A

general: patient ambulatory, unwell
vitals: r/o fever, may have increased bp due to pain
abdomen: pain that radiates there? n/v
GU: check CVA tenderness, can’t pee? painful pee? hematuria, r/o stds by checking for discharge, masses etc. tip of penis may have pain

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8
Q

What is the gold standard for diagnosis of a kidney stone?

A

spiral CT

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9
Q

What are some other imaging techniques that may be used to ID a stone? What should you use if someone is also pregnant?

A

plain abdominal film, IVP, U/S, spiral CT. If pregnant, use an ultrasound

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10
Q

What stones are radio opaque? What stones are radiolucent?

A

RO= calcium stones. RL= uric acid

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11
Q

What will your lab findings show?

A

usually reveals hematuria. YOU MUST EXCLUDE INFECTION (so make sure there is no bacteria).

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12
Q

What does pH tell you about stone type?

A

acidic pH forms uric acid stones. alkaline urine forms calcium stones. both TEMP and pH AFFECT stone formation!! a pH below 5.5 suggests uric or cysteine. a pH greater than 7.2 suggests struvite, and calcium based are typically between 5.5 and 6.8

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13
Q

What additional lab testing might be helpful to R/O other problems or causes?

A

serum BUN, serum creatinine, calcium, phosphorus, uric acid, PTH is hypercalcemic.

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14
Q

Stone Passage:

A

80-90% of stones pass on their own. 4 things to instruct patient:

  1. increase fluid intake
  2. strain urine to catch stone
  3. analgesic
  4. facilitate passage with CCB or alpha blocker (nifedipine/tamsulosin).
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15
Q

How do you know if you need to hospitalize someone for a kidney stone?

A

fever, uti, oral analgesic ineffective, intractable vomiting and dehydration.

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16
Q

If the stone DOES NOT pass on its own, what you are treatment options…

A

start to consider these after a few weeks.

  1. shock wave lithrotripsy
  2. percutaneous nephrostoithotomy
  3. ureterscopy
  4. open stone surgery.
17
Q

When should you refer??

A

evidence of obstruction, anatomic abnormalities, or solitary kidney, uti, fever

18
Q

What diet changes should the patient make?

A

increased fluid (patient should be voiding around 1.5-2L a day), restrict sodium intake, decreased animal protein, get calcium from DIET

19
Q

What is the risk factors for UTI

A

sweating, excessive sun exposure, recurrent UTI (struvite stones), neurogenic bladder (struvite), gout (uric acid), chronic diareaah, family history

20
Q

what medications put you at a higher risk of developing stones?

A

carbonic anhydrase inhibitors, triamterene, sulfadiazine, ascorbic acid, indinavir, topamax, acetazolamide

21
Q

what medication could decrease your risk of stone formation?

A

thiazides, that increase Ca uptake in the BODY instead of putting it into the URINE.

22
Q

What are some dietary measures that decrease calcium stone formation?

A

coffee, tea, beer, wine. (colas made no difference).

23
Q

Describe the medical management of uric acid stones?

A

alakanalize the urine to ph of 6-6.5. give potassium citrate, increase fluid intake, and restrict purines.

24
Q

Name several different types of stones?

A

Calcium based (calcium oxalate/phosphate is most common)
Uric Acid
Struvite
Cystine

25
Q

What is unique about struvite stones?

A

they usually come about due to recurrent UTIs caused by klebsiella or proteus species, and cause the development of ammonia. Usually develop into stag horn caliculi.

26
Q

what does the calcium oxalate stones look like?

A

colorless, 8 sided envelope

27
Q

what does the uric acid stones look like?

A

yellow or reddish brown, diamond shaped or six sided

28
Q

what does the cystine crystals stones look like?

A

colorless hexagon shaped

29
Q

This condition can cause repeat nephrolithiasis, specifically if stones are found to be calcium based. Lab studies show increased PTH.

A

primary hyperparathyroidism

Adult Ped/Med: 5 (7 decks)

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