URINARY CALCULI Flashcards by Iseoluwa Ojo

Urolithiasis

-The 3rd most common affliction after ______ and _________ diseases.
-Life time risk 5 – 15% of population

UTI

Prostatic

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EPIDEMIOLOGY: Intrinsic Factors
-Heredity/Genetics
-______________ (2-3x Risk)
- Race (__________)
- __________ – autosomal defect in
the transport of amino acids

-________________ (RTA)
- _________________ (MSK)

Family History; caucasians

Cystinuria

Renal tubular acidosis

Primary Renal Disease

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Renal tubular acidosis (RTA)
(inherited & acquired-production of a persistently ____________________ and reduced urinary ____________ ; associated nephrocalcinosis).

alkaline urine

citrate

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Primary Renal Disease (MSK)

congenital condition with __________ of collecting ducts with associated __________ and ____________

dilatation

stasis ; calcification

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Risk factors

Age, Sex; BMI
- ____:___ = Male: Female
- 30 – 50 age group (Peak 20-30 yrs)
- Increased BMI
(increased stone formation especially in ________ ).

3:1

women

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Risk Factors

Diet• High ________ intake,
excess _________, _______ urine
volume.

protein

sodium

low

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Risk Factors

Urinary pH• Urinary tract infection
caused by ___________ organism promotes _________ urine and ________ stone formation

urease-splitting; alkaline

struvite

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Risk Factors

Acid urine favors formation of _________ and ________ stones

uric acid

cystine

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Risk Factors: Medication

• Acetazolamide increases ________ and ____________
• Triamterene crystalizes in urine and forms a nidus for stone formation.
•_________ in megadoses.
• _________ and ___________
• Theophyline
• Protease inhibitor in HIV
( __________ stones)

urine pH and calcium excretion

Vitamin C; Calcium

vitamin D; Indianvir

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Risk Factors: Systemic disorders
• Primary hyperparathyroidism,
•________ disease
• ___________
• Gout, __________ , metastatic Ca,
• Prolonged ______________ ,
Hyperthyroidism

Crohn’s ; Sarcoidosis

Multiple myeloma

immobilization

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Stone with the highest incidence rate is??

Stone with the least incidence rate is??

Calcium oxalate stones

Cystine

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Calcium Oxalate (30 – 70%)
- Usually due to combine factors
(supersaturation, inhibitors, stasis).
- Hard, Radioopaque, irregularly
shaped with color yellow to dark
red.
- Mostly formed in _________ urine

acidic

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Calcium Phosphate 30%
- Usually formed in _________ urine

Consists of Ca magnesium ammonium phosphate (triple phosphate).
struvite stone.

alkaline

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Urea splitting organisms

List 3

Proteus, Pseudomonas, Klebsiella,

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____________ stones are Associated with infection–Urea splitting organisms

Calcium phosphate /struvite

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Uric acid/Urate 5–10%
- Hard, usually multiple
- Non-radioopaque (radiolucent)
- Urine commonly __________
- May have hyperuricemia (______ ,
_________ disease)
- High recurrence rate

acidic PH < 6

gout; neoplastic

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Cystine Stone (1 – 3%)
- Inborn error of metabolism
- Autosomal recessive trait (Cystinuria)
- Multiple, soft usually radioopaque
(hexagonal crystals in urine).
- Sometimes aggregate to form Staghorn

Okay

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PRESENTATION- Usual Adult Male

Asymptomatic – Routine X-rays,
microscopic/mild ________________

Symptomatic
-_____ – (commonest, colicky/intermittent, sharp or dull)
- Nausea, Vomiting
- Fever/Malaise (Infection)
- _________________ or a palpable kidney
- Others – __________ , LUTS + ARU

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haematuria

Pain; Renal angle tenderness

Strangury

Strangury (or _______________ ) is a medical symptom characterized by a slow, agonizingly painful, and ____________________________ , often producing only ___________ of urine despite a desperate, frequent need.

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vesical tenesmus

spasmodic urge to urinate

a few drops

Example of a radiolucent stone?

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Uric acid stone

Diagnosis
Identify the number, size, shape and location of stones :
• Radiopaque stones can be seen on a _________________ of the kidneys,
ureters and bladder – KUB
• Radiolucent stones can be detected by ultrasound, computerized tomography or
intravenous pyelography

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plain abdominal radiograph

Metabolic investigations
• Urinalysis, urine pH and urine culture
• 24-hour urine collection for volume,pH, calcium, phosphorus, sodium, uric acid, oxalate, citrate, cystine and creatinine (collect at least ______ specimens to account
for variability).

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two

Struvite stone

AKA??

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Magnesium ammonium phosphate

Indications for further treatment
- Intractable pain
- Obstruction (+ ______)
- Big stone/Stone growth
-____________ Calculi
- Infection
- Social/Occupational/Patient
preference

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Fever; Staghorn

TREATMENT : Acute Stone Event - Admit - Analgesics - Antiemetics - Fluids(_____litres/day) - Antibiotics (+) - Correction of : Metabolic disorders, dietary extremes - Medical therapies

2-2.5

Surgical Management Location and size of stone Management Kidney < 0.5 cm, asymptomatic =_________ 0.5-2 cm = Consider ________ > 2 cm or lower pole and > 1 cm = __________ or ___________ or ________

Observe ESWL Percutaneous approach ESWL Open surgery.

ESWL stands for _______________________ . It is a common, non-invasive medical procedure used to break up stones in the kidney and ureter (the tube connecting the kidney to the bladder).

Extracorporeal Shock Wave Lithotripsy

Bladder Stones: - Usually manifesting an underlying pathology: (mostly related to _________________ ).

bladder outlet obstruction

Bladder stones Occurs later in life and no relationship to social class. T/F

Bladder Stones Usually seen in (men or women?) and frequently solitary but sometimes multiple. - Comprised of ___________, ___________ or __________ stone.

Men Ammonium urate uric acid ; calcium oxalate

Bladder stones Majority are Radio_________ (_________ )

lucent; uric acid

Bladder Stones Investigation : _________,___________ Treatment: _________,____________

X-Ray, Ultrasound Cystolitholapaxy Cystotomy

PROSTATIC & SEMINAL VESICLE STONES - Found within the prostate gland - Represents calcified _______________ - Usually small, numerous and tannish-gray in color

corpora amylacea

PROSTATIC & SEMINAL VESICLE STONES Composed of __________________ - Asymptomatic/Chronic ___________ / ___________

Calcium phosphate Prostatitis Haematospermia

Investigations for Prostatic calculi ________ + ________ for diagnosis - Usually located at the surgical resected adenoma hence ________ for management.

X-ray ; TRUS TURP

Seminal vesicles stone – smooth, hard but rare. Associated with _______________.

haematospermia

URETHRAL STONES - Usually originate from the ___________ secondary to stasis, urethral diverticulum, urethral stricture, site of previous surgery. - Solitary, hard, usually found in ________/__________ region.

bladder prostatic ; bulbar

Urethral Stones Presents with intermittency, ___________ haematuria & infection: +dribbling +ARU

terminal

Urethral Stones Diagnosis by _______________ , _____________ or X-ray study. - Management: _______________________ (impacted)

palpation ; Urethroscopy Endoscopy Urethrotomy

Kidney stones are common and are most often associated with _________________

hypercalciuria

Stones may require surgical intervention, and recurrence after surgery is (common or uncommon?)

Common

_________ intake and a ______ and ________ diet are the mainstays of management

High fluid low-salt ; low-oxalate

Low-calcium diets should be ???

avoided

URINARY CALCULI Flashcards

(43 cards)