FN: Urolithiasis: Ix and Mx Flashcards Preview

Final Notes > FN: Urolithiasis: Ix and Mx > Flashcards

Flashcards in FN: Urolithiasis: Ix and Mx Deck (21):
1

Urine shows

Haematuria
MC+S

2

Blood look at

FBC
U+E
Ca
Po4
urate

3

Imaging

KUB XR
USS
Spiral non-contrast CT-KUB
IVU
Functional scans

4

KUB XR

- 90% of stones radio-opaquw
- Urate stones are radiolucent, cysteine stones are faint

5

USS shows

Hydronephrosis

6

Spiral non-contrast CT-KUB

- 99% of stones visible
- Gold standard

7

IVU

- 600x radiation dose of KUB
- IV contrast injected and control, immediate and serial films taken until contrast @ level of obstruction

8

IVU abnormal findings

- failure of flow to the bladder
- standing column of contrast
- clubbing of the calyces: back pressure
- delayed, dense nephrogram: no flow from kidney

9

IVU CI

- contrast allergy
- Severe asthma
- Metformin
- Pregnancy

10

Functional Scans

DMSA: dimercaptosuccinic acid
DTPA: diethlenetriamene penta-acetic acid
MAG-3

11

Prevention

Drink plenty
Treat UTIs rapidly
Reduced oxalate intake: chocolate, tea, strawberries

12

Initial Rx

Analgesia
- Diclofenac 75mg PO/IM or 100mg PR
- Opiods if NSAIDS CI: e.g. pethidine

Fluids: IV if unable to tolerate PO
Abx: if infection: e.g. cefuroxime 1.5mg IV TDS

13

Conservative Mx

- 90-95% pass spontaneously
- Can discharge pt. with analgesia
- Sieve urine to collect stone for OPD analysis

14

Medical expulsive therapy indications

stone 5-10mm
Stone expected to pass

15

Drugs for expulsion

Nifedipine or tamsulosin
± prednisolone
Most pass with 48h, 80% w.i 30 d

16

Active stone removal indications

- low likelihood of spontenous passage e.g. >10 mm
- persistent obstruction
- renal insufficiency
- infection

17

Extracorporeal shockwave lithotripsy

- stones

18

Ureteroenoscopy (URs) + domier basket removal

- Stone >10mm in distal ureter or if SWL failed
Stone > 20 mm in renal pelvis

19

Percutaneous nephrolithotomy (PNL)

Stone >20mm in renal pelvis
e.g. staghorn calculi do DMSa first

20

Febrile with renal osbtruction

Surgical emergency
Percutaneous nephrostomy or ureteruc stent
IV abx e.g. cefuroxime 1.5g IV TDS

21

Rx summary

Conservative: stone

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