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18 Cards in this Set
- Front
- Back
4 type of renal calculi
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calcium oxalate
uric acid cystine struivte |
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two etologies of urinary colculi
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supersaturation /crystalization
inhibitor deficiency |
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describe the supersaturation/crystallization etiology of urinary calculi
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Uric acid and cystine claculi form when urine w/ an acid pH <6.0 becomes oversaturate w/uric ACID or cystine
Struivite (mg ammonium phosphate) form when the Mg ammonium phosphate ions exist in an ALKALINE urine |
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descibe the inhibitor deficiency as an etiology of urinary colculi
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inhibiotrs i.e. high molecular weight glycopr-,citrate, mgph, sinc that exist in urine can retard stone fomrmation. These inhiborts may be lacking wh leads to stones.
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what are the MC stones
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calcium oxalate
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Which stones are radiopaque
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calcium oxlaate
cystine struivte |
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wh stones are readiolucent
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uric acid
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PV ofr cystine claculi
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overhydration
urine alkalinization to pH 7.5 oral cystine-binding drugs i.e. D-penicillamine or a-mercaptoproponylglycine |
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TX of cystine calculi
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percutaneous procedures
extrocorporeal shock-wave lithotripsy (ESWL) dissolution tx (percutaneous). dissolution solutions like N-acetylcysteine or bicarb |
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Name the buts that cause struvite calcui
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urea splitting bacterial wh maintain alkaline urine such as:
proteus providencia pseudomonas klebsiella |
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clinical presentaiton of stones
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MC pain (flank, lower ab, testicular, vulvar)
hematuria (visible or micro) Nausea/vomiting irritative bladder sx (ureterovescular jxn calculus) |
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DX of stones
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PE -->costovertebral angel tenderness
UA -->hematuria (Uric acid w/ pH >6.5) Noncontrast spiral CT --> gold standard intravenous pyelography --> must ascess renal fxn b/4 this procedure US --> pt w/ incr cr- or allergy to contrast cystourethroscopyt & retrograde pyelography |
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what are the emergency surgery indications for stoens
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fever --> tx w/ cystoscopy & retrograde placemnt of ureteral catheter or sten
renal insuf -->incr cr or ureteral calculi = US |
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what is the criteria for observation for spontaneous stone passage
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adequate pain control (orally)
ability to take liquids by mouth stone that has a favorable chance of passing (size & site i.e. distal ureteral calculi of 5mm or less usually pass) |
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what surgical procedures are evaliable for stones
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extracorcorpreal shock wave lithotripsy (ESWL)
percutaneous nephrostomy ureteroscopic |
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what are the indications for surgery
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severe pain
nonprogression of calculus passage infexn (emergency) prolonged obstruction interference w/ lifestyle |
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what are the complications of ESWL (lithotripsy)
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bleeding
perinephric hematoma steinstrasse (gravel causing ureteral obstruction) steinstrasse (gravel causing ureteral obstruction) hypertension |
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what are the contraindications of lithotripsy
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coagulopathy
antiplatelet meds infxn bilateral tx |