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18 Cards in this Set

  • Front
  • Back
4 type of renal calculi
calcium oxalate
uric acid
cystine
struivte
two etologies of urinary colculi
supersaturation /crystalization
inhibitor deficiency
describe the supersaturation/crystallization etiology of urinary calculi
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
descibe the inhibitor deficiency as an etiology of urinary colculi
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.
what are the MC stones
calcium oxalate
Which stones are radiopaque
calcium oxlaate
cystine
struivte
wh stones are readiolucent
uric acid
PV ofr cystine claculi
overhydration
urine alkalinization to pH 7.5
oral cystine-binding drugs i.e. D-penicillamine or a-mercaptoproponylglycine
TX of cystine calculi
percutaneous procedures
extrocorporeal shock-wave lithotripsy (ESWL)
dissolution tx (percutaneous).
dissolution solutions like N-acetylcysteine or bicarb
Name the buts that cause struvite calcui
urea splitting bacterial wh maintain alkaline urine such as:
proteus
providencia
pseudomonas
klebsiella
clinical presentaiton of stones
MC pain (flank, lower ab, testicular, vulvar)
hematuria (visible or micro)
Nausea/vomiting
irritative bladder sx (ureterovescular jxn calculus)
DX of stones
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
what are the emergency surgery indications for stoens
fever --> tx w/ cystoscopy & retrograde placemnt of ureteral catheter or sten
renal insuf -->incr cr or ureteral calculi = US
what is the criteria for observation for spontaneous stone passage
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)
what surgical procedures are evaliable for stones
extracorcorpreal shock wave lithotripsy (ESWL)
percutaneous nephrostomy
ureteroscopic
what are the indications for surgery
severe pain
nonprogression of calculus passage
infexn (emergency)
prolonged obstruction
interference w/ lifestyle
what are the complications of ESWL (lithotripsy)
bleeding
perinephric hematoma
steinstrasse (gravel causing ureteral obstruction)
steinstrasse (gravel causing ureteral obstruction)
hypertension
what are the contraindications of lithotripsy
coagulopathy
antiplatelet meds
infxn
bilateral tx