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MRCS med school > 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%
  2. Triple phosphate (struvite): 15%
  3. Urate: 5%
  4. Cystine: 1%
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4
Q

Calcium Oxalate stones ass with?

A

crohns

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5
Q

What are struvate stones ass with?

A

proteus infection

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6
Q

X ray appearance of Urate and cystine stones

A

Urate radiolucent

Cystine radiofaint

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7
Q

factors associated with formation of renal stones

A
  • Dehydration
  • Hypercalcaemia: 1O HPT, immobilisation
  • ↑ oxalate excretion
  • UTIs
  • Hyperuricaemia: e.g. gout
  • Urinary tract abnormalities: e.g. bladder diverticulae
  • Drugs
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8
Q

Drugs leading to stones formation

A

furosemide

thiasides

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9
Q

Food with high amounts of oxalates

A

strawberries

tea

chocolate

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10
Q

General presentation of renal stones

A
  • bladder or urethral obstruction
  • UTI
  • Haematuria
  • sterile pyuria
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11
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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12
Q

Features of bladder or urethral obstruction

A

Storage/voiding sx

Suprapubic pain radiating → tip of penis or in labia

Pain and haematuria worse at the end of micturition

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13
Q

Blood investigations for renal stones

A

Ca

PO4

Urate

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14
Q

Imaging for renal stones

A
  • Kidney, Ureter, Bladder (KUB) X-ray/CT
  • Ultrasound
  • Intravenous Urogram (IVU)
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15
Q

usefulness of KUB X-ray

A
  • 90% of stones radio-opaque
  • Urate stones are radiolucent, cysteine stones are faint
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16
Q

what does ultrasound help to identify?

A

hydronephrosis

17
Q

usefulness of CT-KUB

A
  • 99% of stones visible- GOLD standard
18
Q

features of Intravenous Urogram (IVU)

A
  • 600x radiation dose of KUB- IV contrast injected and control, immediate and serialfilms taken until contrast @ level of obstruction
19
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
20
Q

contraindications to Intravenous Urogram

A
  • Contrast allergy
  • Severe asthma
  • Metformin
  • Pregnancy
21
Q

functional scans for renal stones

A
  • DMSA: dimercaptosuccinic acid

(DTPA: diethylenetriamene penta-acetic acid

or MAG-3)

22
Q

prevention of renal stones

A
  • Drink plenty
  • Treat UTIs rapidly
  • ↓ oxalate intake: chocolate, tea, strawberries
23
Q

Initial treatment of renal stones

A
  1. Analgesia
  2. Fluids
  3. Abx if infection: e.g cefuroxime 1.5mg IV TDS
24
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

25
indications for medical expulsive therapy (MET)
- stone 5-10mm - stone expected to pass NOT USED ANYMORE
26
drugs used in medical expulsive therapy
- Nifedipine or tamsulosin- ± prednisolone - Most pass w/i 48h, 80% w/i 30d
27
Indications for active stone removal
- Low likelihood of spontaneous passage: e.g. \>10mm - Persistent obstruction - Renal insufficiency - Infection
28
methods of active stone removal
- Extracorporeal Shockwave Lithotripsy (SWL) - Ureterorenoscopy (URS) + Dormier Basket Removal - Percutaneous Nephrolithotomy (PNL) - laparoscopic or open surgery (rare)
29
Side effects of Extracorporeal Shockwave Lithotripsy (SWL)
renal injury may → ↑BP
30
Contraindications to Extracorporeal Shockwave Lithotripsy (SWL)
pregnancy AAA Bleeding diathesis
31
Treatment of patient who is febrile with renal obstruction
- Surgical emergency - Percutaneous nephrostomy or ureteric stent - IV Abx: e.g. cefuroxime 1.5g IV TDS
32
Treatment for stone in renal pelvis
- \>20mm = PNL or URS - \<20mm = SWL
33
Treatment for stone in proximal ureter
- \>10mm = URS or SWL - \<10mm = SWL
34
Treatment for stone in distal ureter
- \>10mm = URS - \<10mm = URS or SWL

MRCS med school (44 decks)

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