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Nephrology and Urology > Urolithiasis > Flashcards

Urolithiasis Flashcards

1
Q

At what locations are kidneys stones most likely to obstruct?

A

Pelvic-ureter jucntion
Crossing the ilium at the pelvic brim
Vesico-ureteric junction

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2
Q

What are the risk factors for urolithiasis?

A 
Male
Age 20-50 years
Comorbidities
<1200ml fluid intake / day
High animal protein/salt, low calcium diet
Sedentary lifestyle
Hot climate
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3
Q

What is the most common type of kidney stone?

A

Calcium oxalate

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4
Q

What is the likely cause of cysteine stones?

A

Genetic

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5
Q

What condition is associated with uric acid stones?

A

Gout

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6
Q

What are struvite stones composed of?

A

Magnesium
Ammonium
Phosphate

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7
Q

What type of kidney stones are associated with infection?

A

Struvite stones

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8
Q

What type of stones are stag horn calculi usually?

A

Struvite stones

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9
Q

What is the cause of xanthine stones?

A

Genetic enzyme deficiency resulting in a build up on xanthine deposits

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10
Q

What is the saturation product?

A

The level at which no more solute will dissolve in solution without a change in pH or temperature

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11
Q

What is the formation product?

A

The level at which spontaneous stone formation occurs

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12
Q

What factors increase the likelihood of kidney stone formation?

A

Low volume, low pH, low citrate, low magnesium, high uric acid, high calcium, high oxalate

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13
Q

How can kidney stones present?

A

Incidental finding
Colicky loin to groin pain, patient cannot settle and can lie still
Visible/non-visible haematuria
Sepsis

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14
Q

What initial investigations into urolithiasis should eb conducted?

A

U&Es, CRP, FBC, urinalysis, CT

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15
Q

What biochemical tests should be conducted for a first kidney stone?

A 
Calcium
Urate
Urine dip
MSS
Sodium nitroprusside
Stone analysis
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16
Q

What biochemical tests should be conducted for recurrent kidney stones?

A

Calcium
Urate
Venous Bicarbonate
24 hour urine analysis

17
Q

What form of imaging is used in urolithiasis?

A

CT

X-ray for monitoring of recurrent stones

18
Q

Medical therapy of kidney stones is with analgesia. Why are NSAIDs preferred in this case?

A

NSAIDs reduce pain by reducting glomerular pressure and ureteric peristalsis

19
Q

What are the surgical options for treatment of urolithiasis?

A 
Ureteroscopy and basket
Ureteroscopy and fragmentation
Flexible ureteroscopy
Extracorporeal schokwave lithotripsy
Percutaneous nephrolithotomy
Emergency stent or nephrostomy
20
Q

Why should patients with kidney stones be admitted?

A 
Uncontollable paain
Fever
Sepsis
Solitary kidney with ureteric stone
Bilateral ureteric stones
Renal failure caused by obstructing stones
21
Q

What are the differentials for an emergency presentation of nephrolithiasis?

A

Ruptured abdominal aortic aneurysm
Testicular/penile pathology
Appendicitis
Gynaecological pathology

22
Q

Npehrostomy is preferred to ureteric stents in nephrolithiasis with sepsis. T/F?

A

False - these both have similar outcomes so whichever is safest and most easily available should be used

23
Q

In a non-emergency settle a patient with a >20mm non lower pole kidney stone can be treated with what surgical options?

A

Percutaneous nephrolithotripsy

Shock wave lithotripsy

24
Q

In a non-emergency settle a patient with a 10-20mm non lower pole kidney stone can be treated with what surgical options?

A

Shock wave lithotripsy

Endourology

25
Q

In a non-emergency settle a patient with a <10mm non lower pole kidney stone can be treated with what surgical options?

A

Percutaneous nephrolithotripsy

Shock wave lithotripsy

26
Q

In a non-emergency settle a patient with a 10-20mm lower pole kidney stone can be treated with what surgical options?

A

Shock wave lithotripsy

Endourology

27
Q

What types of shockwaves can be used in extracorporeal shockwave lithotripsy?

A

Electrohydraulic
Electromagnetic
Piezoelectric

28
Q

How does extracorporeal shockwave lithotripsy act to dissipate renal stones?

A

Shearing and spalling of the stone
Shockwave in a fluid causes a micro bubble, and dissolved gas in fluid around the bubble expands into the bubble and the bubble collapses creating microjets which pit the stone surface

29
Q

What are stag horn calculi?

A

Kidney stones which fill all or part of the renal pelvis and branch into several or all of the calyces.

Nephrology and Urology (13 decks)

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