Urology: Urinary Stones/Renal Colic Flashcards
1
Q
what is urolithiasis?
A
the formation of stony things within the urinary tract
2
Q
metabolic cause of urolithiasis
A
- hyperparathyroidism
- idiopathic hypercalcuria
- disseminated malignancy
- hypervitaminosis D
- sarcoidosis
- hyperthyroidism
- cystinuria
- hyperoxaluria
- xanthinuria
- hyperuricuria
- renal tubular acidosis
- primary kidney disease
- drugs
3
Q
what type of calculous disease is common in developed countries?
A
upper urinary tract calculi
4
Q
aetiology of calculous disease
A
- secondary to dehydration
- infection
- anatomical malformations
- metabolic disorders
5
Q
types of calculi
A
- calcium oxalate
- phosphate
- urate
- cystine
- xanthine and pruvate
6
Q
why are calcium oxalate stones important?
A
- they are the most common type of stone
- they have sharp projections
- cause bleeding and they themselves are black due to altered blood on their surface
7
Q
which type of stone causes staghorn stones?
A
phosphate/struvite stones
8
Q
signs and symptoms of renal stones
A
- continuous loin pain
- colic (if the stone becomes lodged at the PUJ)
- microscopic haematuria
- might have associated infection
9
Q
signs and symptoms of ureteric stones
A
- colicky pain radiating from loin to groin
- sweatiness
- restlessness
- naseous
- vomiting
- microscopic haematuria
- might have associated infection
10
Q
investigations for calculous disease
A
- urine dipstick: microscopic haematuria and possible infection
- MSSU for C&S
- U&E
- FBC
- CRP
- CTKUB w/o contrast
- KUB radiograph
- USS (hydronephrosis)
- IVU
- serum Ca, phosphate, uric acid
- 24h urine for Ca, phosphate, oxalate, urate, cystine and xanthine
11
Q
treatment of an acute episode of renal calculi
A
- analgesia (may require opiates)
- antiemetic
- increased fluids
- collect and sieve out calculi for analysis
- IV antibiotics, if infection
- decompression if obstruction is present - done by percutaneous nephrostomy or ureteral stent
12
Q
how can you remove a stone?
A
- it can be passed through urine if the stone is <4mm, maybe if <6mm
- > 6mm have to be removed
- medical explusive therapy: nifedipine or beta-blockers
- ureteroscopy and fragmentation done by lase, ultraspound or electro-hydraulic intracorporeal lithotripsy
13
Q
how to prevent recurrent renal/bladder calculi?
A
- good fluid intake: 2-3L/day
- reduced Ca intake
- treat UTI promptly
- using Na2CO3 to alkalinise the urine in case of cystine and urate stone
- if there is uric stone: allopurinol
- oxalate stone: reduce oxalate intake
14
Q
where are bladder calculi common?
A
developing countries
15
Q
symptoms of bladder calculi
A
- dull suprapubic discomfort
- dysuria
- difficulty initiating urination
- strangury
