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7 Cards in this Set
- Front
- Back
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 |
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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) |
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What is an emergency in urolithiasis? |
Obstructive uropathy + UTI --> refer to urology for urgent decompression, and start on antibiotics (ceftriaxone 2g, q24h) |
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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? |
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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) |
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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. |
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How to rate the size of stones? |
small = <5mm medium = 5-8mm large = >8mm |