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7 Cards in this Set

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What are the clinical features of urolithiasis?

1. Pain:


- usually starts at night or early in morning


- severe loin to groin colic due to referred pain, on a background of dull ache due to renal pelvis/ureteric dilation


- patient may roll around and not keep still




2. Fever is absent (suspect infection if feverish)




3. suspect struvite stones in recurrent UTI, gross hematuria, vague abdominal pain, or urosepsis


*** struvite stones tend to be insidious

What type of stones are there?

1. Calcium oxalate (hyperparathyroidism, inflammatory bowel disease)




2. struvite stones, found in staghorn calculi (recurrent UTI) <-- pH >7.6 (alkaline)




3. Uric acid stones (Gout) <-- only stones that are radiolucent




4. cysteine stones (cystinuria has AR inheritance)

What is an emergency in urolithiasis?

Obstructive uropathy + UTI --> refer to urology for urgent decompression, and start on antibiotics (ceftriaxone 2g, q24h)

What are the caveats for flank/ loin to groin pain?

suspect AAA in an elderly patient presenting with first time flank/loin groin pain!




suspect ectopic pregnancy in women complaining of flank/loin groin pain?

What investigations to do?

1. urine dipstick


2. FBC, RP (not routine, unless patient is unstable or suspect infection)


3. X-ray KUB


4. renal US (hydronephrosis, hyrdoureter)


5. CT-KUB (gold standard, looks for other pathologies which are incidental)


6. IV urography (less commonly done)

Treatment for urolithiasis?

1. dietary modifications:


- drink >2L water


- keep salt intake low (for calcium and cystine stones)


- avoid oxalate rich food (nuts, choc, tea, dark roughage--> fiber rich green veg), and limit vit C supplements to <500 mg/day (for calcium oxalate stones)




2. dietary modifications


- analgesia (panadol, tramadol)


- allopurinol 300mg per day if patient have gout and uric acid stones




3. Admit to urology if:


- a/w infection of urinary tract


- a/w persistent pain


- a/w size of stone >8mm on KUB


- patient only has one functional kidney




4. surgical management


- Shockwave lithotripsy (SWL) is a popular choice for the management of small- to medium-sized kidney stones


- Ureteroscopy and laser lithotripsy for the management of small- to medium-sized kidney stones


- For exceptionally large or complex kidney stones, or for a large number of small stones in one kidney, the recommended method of treatment is percutaneous nephrolithotomy.

How to rate the size of stones?

small = <5mm


medium = 5-8mm


large = >8mm