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MS3 - Renal/Urology > Urolithiasis > Flashcards

Urolithiasis Flashcards

1
Q

pathophysiology of urolithiasis

A
  • ↑ concentration of urinary solute
  • ↓ urine volume
  • Urinary stasis
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2
Q

most common sites to find renal stones

A
  • Pelviureteric junction
  • Crossing the iliac vessels at the pelvic brim
  • Under the vas or uterine artery
  • Vesicoureteric junction
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3
Q

renal stone types

A
  1. Calcium oxalate: 75%
    - ↑ risk in Crohn’s
  2. Triple phosphate (struvite): 15%
    - Assoc. with proteus infection
  3. Urate: 5% (radiolucent)
  4. Cystine: 1% (radiofaint)
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4
Q

factors associated with formation of renal stones

A
  • Dehydration
  • Hypercalcaemia: 1O HPT, immobilisation
  • ↑ oxalate excretion: tea, strawberries
  • UTIs
  • Hyperuricaemia: e.g. gout
  • Urinary tract abnormalities: e.g. bladder diverticulae
  • Drugs: frusemide, thiazides
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5
Q

general presentation of renal stones

A
  • ureteric colic
  • bladder or urethral obstruction
  • UTI
  • Haematuria
  • sterile pyuria
  • anuria
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6
Q

features of ureteric colic

A
  • Severe loin pain radiating to the groin
  • Assoc. with n/v
  • Pt. cannot lie still
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7
Q

features of bladder or urethral obstruction

A
  • Bladder irritability: frequency, dysuria, haematuria
  • Strangury: painful urinary tenesmus
  • Suprapubic pain radiating → tip of penis or in labia
  • Pain and haematuria worse at the end of micturition
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8
Q

urine investigations for renal stones

A
  • dip: haematuria

- MC&S

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9
Q

blood investigations for renal stones

A

FBC, U&E, Ca, PO4, urate

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10
Q

imaging for renal stones

A
  • Kidney, Ureter, Bladder (KUB) X-ray
  • Ultrasound
  • spiral non-contrast CT-KUB
  • Intravenous Urogram (IVU)
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11
Q

usefulness of KUB X-ray

A
  • 90% of stones radio-opaque

- Urate stones are radiolucent, cysteine stones are faint

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12
Q

what does ultrasound help to identify?

A

hydronephrosis

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13
Q

usefulness of CT-KUB

A
  • 99% of stones visible

- GOLD standard

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14
Q

features of Intravenous Urogram (IVU)

A
  • 600x radiation dose of KUB
  • IV contrast injected and control, immediate and serial
    films taken until contrast @ level of obstruction
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15
Q

abnormal findings of Intravenous Urogram

A
  • Failure of flow to the bladder
  • Standing column of contrast
  • Clubbing of the calyces: back pressure
  • Delayed, dense nephrogram: no flow from kidney
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16
Q

contraindications to Intravenous Urogram

A
  • Contrast allergy
  • Severe asthma
  • Metformin
  • Pregnancy
17
Q

functional scans for renal stones

A
  • DMSA: dimercaptosuccinic acid
  • DTPA: diethylenetriamene penta-acetic acid
  • MAG-3
18
Q

prevention of renal stones

A
  • Drink plenty
  • Treat UTIs rapidly
  • ↓ oxalate intake: chocolate, tea, strawberries
19
Q

initial treatment of renal stones

A
  1. Analgesia
    - Diclofenac 75mg PO/IM or 100mg PR
    - Opioids if NSAIDs CI: e.g. pethidine
  2. Fluids: IV if unable to tolerate PO
  3. Abx if infection: e.g cefuroxime 1.5mg IV TDS
20
Q

conservative management of renal stones

A
  • 90-95% pass spontaneously
  • Can discharge pt. c¯ analgesia
  • Sieve urine to collect stone for out-patient analysis
21
Q

indications for medical expulsive therapy (MET)

A
  • stone 5-10mm

- stone expected to pass

22
Q

drugs used in medical expulsive therapy

A
  • Nifedipine or tamsulosin
  • ± prednisolone
  • Most pass w/i 48h, 80% w/i 30d
23
Q

indications for active stone removal

A
  • Low likelihood of spontaneous passage: e.g. >10mm
  • Persistent obstruction
  • Renal insufficiency
  • Infection
24
Q

methods of active stone removal

A
  • Extracorporeal Shockwave Lithotripsy (SWL)
  • Ureterorenoscopy (URS) + Dormier Basket Removal
  • Percutaneous Nephrolithotomy (PNL)
  • laparoscopic or open surgery (rare)
25
Q

indication for Extracorporeal Shockwave Lithotripsy (SWL)

A

Stones <20mm in kidney or proximal ureter

26
Q

side effects of Extracorporeal Shockwave Lithotripsy (SWL)

A

renal injury may → ↑BP

27
Q

contraindications to Extracorporeal Shockwave Lithotripsy (SWL)

A

pregnancy, AAA, bleeding diathesis

28
Q

indications for Ureterorenoscopy (URS) + Dormier Basket Removal

A
  • Stone >10mm in distal ureter or if SWL failed

- Stone >20mm in renal pelvis

29
Q

indications for Percutaneous Nephrolithotomy (PNL)

A
  • Stone >20mm in renal pelvis

- E.g. staghorn calculi: do DMSA first

30
Q

treatment of patient who is febrile with renal obstruction

A
  • Surgical emergency
  • Percutaneous nephrostomy or ureteric stent
  • IV Abx: e.g. cefuroxime 1.5g IV TDS
31
Q

treatment summary for renal stones

A
  • Conservative: stone <5mm in distal ureter
  • MET: stone 5-10mm and expected to pass
  • Active: stones >10mm, persistent pain, renal insufficiency
32
Q

1st line treatment for stone in renal pelvis

A
  • > 20mm = PNL or URS

- <20mm = SWL

33
Q

2nd line treatment for stone in renal pelvis

A
  • > 20mm = SWL

- <20mm = PNL or URS

34
Q

1st line treatment for stone in proximal ureter

A
  • > 10mm = URS or SWL

- <10mm = SWL

35
Q

2nd line treatment for stone in proximal ureter

A

<10mm = URS

36
Q

1st line treatment for stone in distal ureter

A
  • > 10mm = URS

- <10mm = URS or SWL

37
Q

2nd line treatment for stone in distal ureter

A
  • > 10mm = SWL

MS3 - Renal/Urology (13 decks)

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