FN: Urolithiasis: Pathophysiology and PResentation Flashcards Preview

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Flashcards in FN: Urolithiasis: Pathophysiology and PResentation Deck (13):
1

Epi

ifetime incidence: 155
Young men
- peak age: 20-40 yrs
Sex: M>F=3:1

2

Pathophysiology

Increased concentration of urinary solute
Reduced urinary volume
urinary stasis

3

Common anatomical sites

- pelviureteric junction
- Crossing the iliac vessels and the pelvic brim
- Inder the vas or uterine artery
- Vesicoureteric junction

4

Stone types

Calcium oxalate
Triple phosphate
Urate
cystine

5

Calcium oxalate

75%
Raised risk in crohns

6

Triple phosphate (struvite)

15%
- Ca Mg NH4 - phosphate
- May from staghorn calculi
- Association with proteus infection

7

Urate:% (radiolucent)

Double if confirmed gout

8

Cystine

1% (faint)
Association with Fanconi Syn

9

Associated factors

- dehydration
- Hypercalcaemia: primary HPT, immobilisatoin
- Raised Oxalate excretion: tea, strawberries
- UTIs
- Hyperuricaemia e.g. gout
- Urinary tract abnormalities e.g. bladder diverticulae
- Drugs: frusemide, thiazides

10

Presentation ureteric colic

- Severe loin pain radiating to the groin
- Association with n/v
- Pt. cannot lie still

11

Bladder or Urethral obstruction

- Bladder irritability: frequency, dysuria, haematuria
- Strangury: painful urinary tenesmus
- Suprapubic pain radiating - tip of penis or in labia
- pain and haematuria worse at the end of micturition

12

Other possible features

UTI
Haematuria
Sterile pyuria
Anuria

13

Examination

Usually no loin tenderness
Haematuria

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