F3 E1 Shea > Urolithiasis 1 > Flashcards

Urolithiasis 1 Flashcards

(51 cards)

Study These Flashcards
1
Q

Other 5 names for Urolithiasis

A
  • “kidney stones”
  • nephrolithiasis
  • ureterolithiasis
  • cystolithiasis
  • calculus / calculi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the most common type of stone in the US?

A

Calcium oxalate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which stone?

  • Radio-opaque
  • Resistant to dissolution
  • Most commonly caused by dehydration
A

Calcium oxalate

(MC type in US)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which stone?

  • Radiolucent
  • Forms in acidic urine (<6.0)
  • Dissolves in alkalinized urine
A

Uric acid (urate)

  • Malingering pts know this stone does not show up on x-ray. But will show up on CT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which stone?

  • Cause: UTI
  • Radio-opaque
  • Forms in alkaline urine
  • Can be dissolved w/ acidification of urine
  • Composition of most ______
A

Magnesium ammonium phosphate (struvite, triple phosphate, MAP)

  • staghorn calculi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which stone?

  • Genetic defect, autosomal _____
  • Heterozygotes usually _____
  • Homozygotes usually ______
  • Caused by _____
  • Dissolved in ____ environment
A

Cystine

  • recessive
  • hetero –> NOT stone formers
  • Homo –> form stones
  • cystinuria
  • alkaline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which stone?

  • Associated w/ Proteus UTI
  • Radiolucent
A

Matrix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which stone?

  • associated w/ UTI & laxative abuse
  • Radiolucent
A

Ammonium Acid Urate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which stone?

  • Precipitated drug, such as _____
  • Radiolucent
  • Not visible on stone-protocol CT
A

Protease Inhibitor Stone

  • Indinavir
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

A few etiologies of Urolithiasis (8)

A
  • Anatomic
  • Urine characteristics
  • Pt volume status
  • Diet
  • Metabolic
  • Disease states
  • UTI
  • meds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the 2 causes of stones due to anatomy?

A
  • Obstruction
  • Stasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the 2 Crystal Inhibitors?

A
  • Citrate (complexes w/ calcium)
  • Urea (increases solubility of uric acid)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

3 components of volume status of pt w/ Urolithiasis

A
  • Volume depletion
  • Low UOP
  • Supersaturation of solute
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

4 etiologies of metabolic urolithiasis

A
  • Hypercalciuria
  • Hypocitrauria
  • Hyperoxauria
  • Hyperuricosuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

UTIs

  • UTIs can decrease _____
  • Hypo-_____
  • Urea splitting organisms
    • Proteus, Klebsiella, Pseudomonas, Serratia, Staph
    • Urea–> ammonia + bicarb –> ____
    • Proteus –> _____
A
  • ureteral peristalsis
  • citraturia
  • struvite
  • matrix stones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which 7 meds can cause urolithiasis?

A
  • Vit C
  • Vit D
  • Triamterene precipitation
  • Protease inhibitors (Indinavir)
  • Furosemide increases urinary calcium excretion
  • Acetazolamide (CAI) causes RTA state
  • Uricosuric agents (probenecid, salicylates)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

4 sxs of urolithiasis

A
  • Flank pain
  • N/V (from the pain)
  • Hematuria
  • Hyperkinetic** (common). Pt is moving all over and pacing the room
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

3 components of evaluation of urolithiasis

A
  • H&P
  • Labs (creatinine and white count)
  • Imaging (Stone protocol CT WITHOUT contrast)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

3 PE findings of urolithiasis

A
  • Fever
  • Hyperkinetic
  • CVAT (costovertebral angle tenderness)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

3 labs

A
  • UA (pH, specific gravity, hemoglobin, microscopy)
  • CBC (WBC elevation)
  • BMP (creatinine, BUN, electrolytes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

5 imaging studies

Study These Flashcards
A
  • KUB (Kidney, Ureter, Bladder)
  • US abdominal / retroperitoneal / renal & bladder
  • Intravenous Urogram (IVU) (not performed anymore)
  • CT Stone Protocol (abd/pelvis) WITHOUT contrast
  • CT urogram (abd/pelvis) WITH contrast, including delayed phase

(if stone protocol is negative, get the CT urogram)

22
Q

Indications for Acute Intervention

  • Complete or high grade _____
  • Bilateral _____
  • Urinary obstruction w/ ______
  • Urinary obstruction in _____ kidney
  • Urinary obstruction w/ rising ____
  • Inability to ____ due to severe N/V
  • Severe pain uncontrolled by _____
Study These Flashcards
A
  • urinary obstruction
  • urinary obstruction
  • urinary infection
  • solitary
  • creatinine
  • take in POs
  • analgesics
23
Q

Tx of Urolithiasis

  • Abx for infection
  • Acute tx to relieve obstruction:
    • _____
    • ______
    • (to prevent sepsis / renal damage / loss of renal function)
  • Later proceed to definitive stone management under more controlled circumstances
Study These Flashcards
A
  • ureteral stent placement
  • nephrostomy tube placement
24
Q

Tx of lower tract stones (2 locations?)

  • 4 treatments?
Study These Flashcards
A

Bladder & urethra

  • Cystourethroscopy, cystolitholapxy
  • Extracorporeal shock wave lithotripsy (ESWL)
  • Open stone removal (super rare!)
    Dissolution (meds) - common tx
25
Tx of upper tract stones (2 locations?) * 6 tx options
**kidney & ureter** * Trial of passage * Extracorporeal Shock Wave Lithotripsy (ESWL) * Dissolution * Open or laparoscopic surgery * Ureteroscopy w/ stone manipulation * Percutaneous Nephrolithotomy (PCNL) **(TED UOP)**
26
**Candidates for "trial of passage"** * Stones \_\_mm or less (68% pass within __ days) * Taking fluids and analgesics PO * Alpha-blocker (\_\_\_) increase passage percentage, decrease time to passage, decrease pain w/ passage * Filter urine (screen / coffee filter) * Periodic imaging to assess for \_\_\_\_.
* 5 * tamsulosin * hydronephrosis
27
**_Dissolution (chemolysis) of Uric Acid Stones_** * **Alkalinize urine** * pH greater than \_\_\_ * __ and ___ PO * Can take __ months to work * **Irrigate collecting system** * via \_\_\_\_\_ * sodium bicarb * THAM
* 6.5 * Sodium bicarb & Potassium citrate * 3 * nephrostomy tube
28
**_Dissolution (chemolysis) of Cystine Stones_** * **Alkalinize urine** * pH greater than \_\_ * ____ PO * **Irrigation of collecting system** * Sodium bicarb * THAM * N-acetylcysteine
* 7.5 * Potassium citrate
29
**Dissolution (chemolysis) of Struvite, Calcium phosphate stones** * Irrigation w/ _____ (\_\_\_)
* acidic solution (Renacidin)
30
**Extracorporeal Shock Wave Lithotripsy** * 3 good things about ESWL * 1 bad thing about ESWL
* Outpatient * Non-invasive * Sedation * **Bad:** stone fragments not removed
31
5 contraindications of ESWL (extracorporeal shock wave lithotripsy)
* pregnancy * coagulopathy * UTI * Renal Artery Aneurysm * AAA **"U CRAP"**
32
3 "relative contraindications" of ESWL | (extracorporeal shock wave lithotripsy)
* **c**ystine stone , matrix stone * chronic **p**ancreatitis / pancreatic calcification * distal **o**bstruction ## Footnote **"COP"**
33
**ESWL (extracorporeal shock wave lithotripsy)** * Stone size \< __ cm * Visible on \_\_\_\_
* 2 * fluoroscopy
34
**ESWL (extracorporeal shock wave lithotripsy)** * Done under \_\_\_\_ * Done w/ _____ imaging * if radio-opaque, \_\_\_\_ * if radiolucent, \_\_\_\_\_ * Shock wave generator positioned where? * Table manipulated to put stone in \_\_\_\_ * Shocks delivered \_\_\_-\_\_\_/ minute * Gated w/ ___ to avoid inducing dysrhythmia
* sedation/anesthesia * fluoroscopic imaging * easily seen * put up a stent and inject contrast dye * against patient's side * cross-hairs * 60-90 * EKG
35
**ESWL** * If bilateral stone disease, may choose to do what? * If solitary kidney, use what?
* To do each kidney at separate settings * ureteral stent
36
**ESWL** * Decrease ____ function up to 3 weeks * 6 complications?
* renal perfusion 1. renal hematoma / retroperitoneal hematoma 2. Ecchymosis 3. UTI --\> sepsis 4. Steinstrasse 5. Ureteral stricture 6. Pain
37
**Which tx?** * Done in OR under general anesthesia * Transurethral approach * Flexible scope placed up ureter * Energy delivered to calculus * laster lithtripsy * ultrasonic lithotripsy * electrohydraulic lithotripsy (EHL) * Pneumatic impactor "\_\_\_\_\_" * Stone broken up * Fragments basketed out * Possible ____ temporarily
**Ureteroscopy w/ stone manipulation** * "jackhammer" * ureteral stent
38
**9 Complications of Ureteroscopy w/ manipulation (endoscopy)** * Ureteral \_\_\_\_ * Ureteral \_\_\_\_ * Submucosal \_\_\_\_ * Ureteral ____ (1%) * Extrustion of stone outside the lumen of ureter * \_\_\_\_ * \_\_\_\_ * \_\_\_\_\_
* Avulsion * perforation * tunneling * stricture * UTI * Bleeding * Pain
39
**Prevention of Future Stones** * Fluid intake, should result in a urine volume of ___ L * Encourage fluids w/ _____ , Discourage \_\_\_\_. * Low sodium (less urinary Ca, more urinary citrate) * Low ___ protein intake (amino acid effect) * Low oxalate * Moderate Ca intake * Avoid high doses of vit __ and \_\_\_
* 2.5 * citrate / soda * animal * C & D
40
3 contraindications of Percutaneous Nephrolithotomy (PCNL)
* UTI * Coagulopathy * No percutaneous renal access ## Footnote **(CUN)**
41
**Percutaneous Nephrolithotomy (PCNL)** * Access achieved in ____ or \_\_\_\_ * Access through the \_\_\_\_, ____ approach, needle placed under ____ guidance * Needle/catheter advanced to \_\_\_\_\_\_ * Wire, tract dilation * Nephroscopy * Instruments passed under direct \_\_\_ * Energy delivered to \_\_\_\_\_\_ * _____ grasped, removed
* Interventional Radiology or OR * skin / flank / fluoroscopic * renal collecting system * vision * lithotripsy stone * fragments
42
4 complications of PCNL (percutaneous nephrolithotomy)
* bleeding * sepsis * renal pelvis perforation * pneumothorax / hydrothorax
43
**Prevention of Future Stones** * Reduce \_\_\_\_ * High ____ lowers urinary citrate * Animal protein * Limit intake of ____ and \_\_\_\_\_ * ____ and \_\_\_\_\_: low \_\_\_\_\_\_
* PRAL (potential renal acid load) * PRAL * cheese & egg yolks * fruits & veggies
44
6 meds to prevent future stones
* potassium citrate (raises pH & citrate level) * thiazide * allopurinol * pyridoxine (B6) * Cholesyramine * Thiols
45
**Which med for Prevention of Future Stones?** * Corrects acidosis, which increases urinary citrate and decreases urinary calcium * Binds w/ calcium, inhibits calcium crystallization * **SE:** hyperkalemia\*\* & peptic ulcers * **Caution:** Uncontrolled DM, renal insufficiency, delayed gastric emptying, K sparing diuretics * **Dosing:** titrate per urine pH
Potassium Citrate
46
**Which med for Prevention of Future Stones?** * Corrects acidosis * Increases reabsorption of Ca into kidneys, decreasing urine calcium excretion * Can worsen stone disease, if it causes hypokalemia\*\* * May be given w/ potassium\*\* * 2 SE?
**Thiazide** * weakness & fatigue
47
**Which med for Prevention of Future Stones?** * decreases uric acid levels * Only decreases stone incidence if pt had been _hyperuricosuric\*_
Allopurinol
48
**Which med for Prevention of Future Stones?** * Involved in metabolism of oxalate * Deficiency leads to hyperoxaluria
Pyridoxine (B6)
49
**Which med for Prevention of Future Stones?** * Ileal resection --\> decreased bile acid absorption * Bile acids increase colonic wall permeability to oxalate --\> increase oxalate absorption * ___ binds bile acids, decreasing colon wall permeability to oxalate
Cholestyramine
50
**Which med for Prevention of Future Stones?** * Tx for cystinuria * Increases solubility, prevention of cystine stones * Tiopronin * D-Penicillamine
Thiols
51
What 2 things = emergency?!
* Fever * Obstructive stones
F3 E1 Shea
flashcards
Decks in class (14)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions