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RENAL STONES Flashcards

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1
Q

⚡⚡ MOST COMMON RENAL STONE
⚡⚡ MOST COMMON BLADDER STONE
⚡⚡ MOST COMMON 1° BLADDER STONE
⚡⚡ MOST COMMON PROSTATE STONE

A

⚡⚡ MOST COMMON RENAL STONE
🎯 Calcium OXALATE Stones

⚡⚡ MOST COMMON BLADDER STONE
🎯 Uric Acid > STRUVITE Stones

⚡⚡ MOST COMMON 1° BLADDER STONE
🎯 Ammonium URATE

⚡⚡ MOST COMMON PROSTATE STONE
🎯 CALCIUM PHOSPHATE STONE

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2
Q

CALCIUM PHOSPHATE STONE is the MOST COMMON STONE in

A
  1. Prostate
  2. Salivary Gland
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3
Q

Stone FORMATION INHIBITING Substances

A
  1. Citrate
  2. Tamm Horsefall Protein
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4
Q

⭐ CONCENTRATION PRODUCT
⭐ SATURATION PRODUCT
⭐ FORMATION PRODUCT

A

⭐ CONCENTRATION PRODUCT
🎯 Amount of Solute in SOLUTION

⭐ SATURATION PRODUCT
🎯 MAXIMUM AMOUNT OF SOLUTE IN SOLUTION

⭐ FORMATION PRODUCT
🎯 MAXIMUM AMOUNT OF SOLUTE IN SOLUTION ➕ Removing effect of STONE INHIBITING FACTORS

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5
Q

Stone formation occurs when

A

Concentration product > Formation Product

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6
Q

Radio-opaque Renal Stones
🧠⚡PCO2 ⚡

A
  1. Phosphate
  2. Cysteine
  3. Oxalate Ca2+
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7
Q

Radio-lucent Renal Stones
🧠⚡Translucent In Ur X-ray! DO! ⚡

A
  1. Triamterene
  2. Indinavir
  3. Uric acid
  4. ammonium Urate.
  5. Xanthine
  6. Dihydroxyadenine
  7. Orotic acid
  8. Drug stones
  9. Cephalosporin
  10. Cysteine
  11. Ephedrine
  12. Guaifenesin
  13. Sulphonamides
  14. Magnesium trisilicate
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8
Q

LARGE SIZED RENAL STONES

A
  1. Staghorn / Triple PHOSPHATE stone
  2. Bladder Stones
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9
Q

MULBERRY STONES

A

Calcium oxalate stones

DUE TO: SPICULATED MARGINS

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10
Q

Shape of STONES

A

Calcium Oxalate stones
✨ Monohydrate ➡️ Dumb bell Shaped
✨ Dihydrate ➡️ Envelope shaped

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11
Q

Etiology of KIDNEY STONES
🧠⚡HIDE ⚡

A
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12
Q

Stones formed in ALKALINE URINE

A
  1. Struvite / Triple phosphate stone
  2. Calcium Phosphate
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13
Q

Stones formed in ACIDIC URINE
🧠💡CCU💡

A
  1. Calcium Oxalate
  2. Cysteine
  3. Uric Acid Stone
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14
Q

Triple Phosphate Stone
Composition
🧠⚡ CAM-P⚡

A

Phosphates of
1. Calcium
2. Ammonium
3. Magnesium

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15
Q

💊💉 MANAGEMENT of Calcium OXALATE STONES

A
  1. Decrease FAT in Diet
  2. ⬆️ Ca2+ in DIET
  3. ⬆️⬆️ Pyridoxine in DIET
  4. Cholestyramine: Binds to Oxalate in GUT
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16
Q

Why ⬆️ Calcium in diet when in MANAGEMENT of Calcium OXALATE stones?

A

Calcium will Bind to OXALATE in GUT
⬇️
Less OXALATE ABSORPTION

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17
Q

💊💉 MANAGEMENT of RECURRENT STRUVITE (OR) TRIPLE PHOSPHATE Stones

A

Acetohydroxamic acid
⬇️
Irreversible ⛔ of Urease enzyme

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18
Q

VERY HARD STONES are:
🧠💡Difficult to break by ESWL💡
🧠💡BHC2💡

A
  1. Calcium OXALATE monohydrate
  2. Cysteine
  3. Brushite
  4. Hydroxyapatite
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19
Q

💊💉 MANAGEMENT of RECURRENT CYSTEINE STONE
🧠⚡CD⚡

A

⭐ Cystine Complexing Agents

D-penicillamine
Alpha-mercaptopropionylglycine (MPG)

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20
Q

Glass shrads like Crystals seen in

A

Uric acid stones

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21
Q

💊💉 MANAGEMENT of RECURRENT URIC ACID STONES

A

Allopurinol

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22
Q

Uric acid stones are seen in

A
  1. TUMOUR lysis Syndrome
  2. Gout
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23
Q

Xanthine stones

A

Brick red

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24
Q

Triamterene stones

A

Anti-HTN medication leading to RADIOLUCENT Stones

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25
Indinavir stones
Protease inhibitor in AIDS leading to Radiolucent calculi
26
Ammonium Urate Stones seen in
1. IBD 2. Laxative Abuse
27
Renal stones ➕ Nitroprusside Cyanide Test ➕
Cysteine Stones
28
Alkalinization of URINE can be done by 🧠⚡ABC ⚡
1. Bicarbonate 2. Citrate (Potassium Citrate)
29
🧑🏻‍⚕️ Clinical Features of RENAL STONES
1. Asymptomatic 2. Hematuria 3. HYDRONEPHROSIS 4. PAIN:⚡⚡ MOST COMMON
30
PAIN in RENAL STONES 🧠⚡3 types⚡
1. Fixed Renal Pain 2. Colicky Abdominal Pain 3. Dietl's Crisis
31
Fixed RENAL PAIN in RENAL STONES IS DUE TO ⭐ Location
Distension of RENAL CAPSULE ⭐ LOCATION: RENAL ANGLE
32
Colicky ABDOMINAL PAIN in RENAL STONES IS DUE TO ⭐ Location
⭐ Stone struck at a Location ⭐ Location depends on the SITE of Stone: 1. Renal Pelvis (OR) Upper Ureter: ✨ Loin to Groin ✨ Along OBTURATOR Nerve: Inner Aspect of THIGH 2. Upper & Mid URETER: ✨ Along ILIO-HYPOGASTRIC NERVE 3. Lower URETER: ✨ Along ILIO-INGUINAL NERVE 4. Intramural part of Bladder: ✨ Strangury
33
STRANGURY Meaning
Intense painful urge to pass Urine ⬇️ When pt tries to urinate ⬇️ Passes only 1-2 drops of BLOODY URINE
34
DIETL'S CRISIS
Stone at Renal Pelvis blocks URINE from draining into ureter ⬇️ Urine accumulation in KIDNEY ➕ Distension of Renal Capsule ⬇️ Excess fluid shifts the STONE ⬇️ Swelling subsides & Patient passes large amount of DILUTE URINE
35
🩺 IOC for RENAL STONE 🩺 IOC for URETERIC STONE 🩺 IOC for BLADDER STONE
NCCT ABDOMEN (OR) NCCT KUB
36
USG KUB cannot Visualise LOWER PART OF URETER Why?
Bowel Gas infront of it
37
NCCT is the 🩺 IOC for 🧠⚡ RuSH⚡
1. Salivary Gland Stone 2. Head Trauma 3. Renal Stones
38
💊💉 MANAGEMENT of ASYMPTOMATIC RENAL STONES WITH SIZE ≤ 5-6MM
OBSERVATION
39
💊💉 MANAGEMENT of SYMPTOMATIC RENAL STONES WITH SIZE > 5-6MM 🧠⚡E-UP-PAN ⚡
ESWL ➕ DJ stent placement ⬇️ if C/I A. URS (OR) RIRS B. PCNL ⬇️ ⬇️ if FAILS PYELOLITHOTOMY (OR) NEPHROLITHOTOMY ⬇️ ANATROPHIC NEPHROLITHOTOMY
40
Identify
DJ Stent
41
DORNIER'S APPARATUS used for
ESWL (Extracorporeal Shock Wave Lithotripsy)
42
⚡⚡ MOST COMMON COMPLICATION OF ESWL
Pain Others 1. Hematuria 2. Stone street: Steinstrasse
43
STEINSTRASSE
Multiple stone fragments are generated that CLOGS the ureter
44
🚫 CONTRAINDICATION of ESWL
1. Pregnancy 2. Children 3. Obese 4. STONE > 1.5cm 5. Cardiac Pacemaker implanted 6. Very Hard stones (Ca-oxalate & Cysteine) 7. Obstructed system 8. Uncontrolled Bleeding disorder 9. LOWER CALYX STONE
45
PCNL is preferred for (Percutaneous Nephro-Lithotomy)
Stone removal in OBSTRUCTED System
46
COMPLICATIONS of PCNL
1. Bruising 2. Hematuria 3. Colonic Injury 4. Pleural Injury 5. Pneumothorax 6. Splenic Injury
47
Identify
PCNL
48
Identify
URS URETEROSCOPIC REMOVAL of STONES
49
Identify
RIRS Retrograde INTRARENAL Surgery
50
Which LASER can be used to shatter RENAL STPNES
Holmium:YAG laser
51
DORMIA BASKET is used for
Collecting Broken Fragments of RENAL STONE
52
🚦DIFFERENTIAL DIAGNOSIS🚦 of URETERIC STONES
1. Foreign Body 2. Calcified 12th RIB 3. GB Stones 4. ingested PILLS
53
How to DISTINGUISH BETWEEN GB Stones & URETERIC Stones
1. LATERAL X-RAY: ✨ GB STONE: Anteriorly placed ✨ URETERIC STONE: Posteriorly placed 2. RADIO-OPAQUE ✨ Only 10% of GB STONES are RADIO-OPAQUE ✨ 90% of RENAL STONES are RADIO-OPAQUE
54
✨ Only 10% of GB STONES are RADIO-OPAQUE ✨ 90% of RENAL STONES are RADIO-OPAQUE
55
💊💉 MANAGEMENT of URETERIC STONE ⭐ Size < 5-6mm ⭐ Size ≥ 5-6mm ➕ SYMPTOMATIC
⭐ Size < 5-6mm 🎯 Observation ⭐ Size ≥ 5-6mm ➕ SYMPTOMATIC 🎯 URS: Ureteroscopic Removal of Stone ⬇️ ⬇️ if fails URETEROLITHOTOMY
56
Identify
Ureterolithotomy
57
RULE: While giving INCISION to Ureter, always give LONGITUDINAL INCISION
Transverse incision, heals with STRICTURES
58
Which Suture Material is used for URETEROLITHOTOMY
Absorbable ✨ Vicryl ✨ PDS
59
Bladder STONE: TYPES
60
JACK STONES
Calcium OXALATE stones in BLADDER with SPICULATED MARGINS
61
🧑🏻‍⚕️ Clinical Features of BLADDER STONES
1. Pain 2. Hematuria 3. ⬆️ ⬆️ Size stone
62
Identify
Suprapubic Cystolithotomy
63
🚫 CONTRAINDICATION of PERURETHRAL CYSTOLITHOTOMY
1. Urethral Stricture 2. Stone in BLADDER Diverticula 3. Failed PERURETHRAL CYSTOLITHOTOMY
64
🩺 IOC for BLADDER STONES
CECT
65
Calcium Phosphate stone: Crystal Shape
Amorphous Flat shaped plates (OR) Wedge-shaped Prisms
66
Indications for CONSERVATIVE MANAGEMEMT OF URETERIC STONE
⭐ 4 to 6 wks 🎯 Single stone ≤ 5mm 🎯 Undilated Ureter 🎯 Stone in Lowe ⅓rd of URETER 🎯 EVIDENCE of Downward motion of stone
67
PCNL is done from Posterior side through Posterior Calyx? Why?
If in Renal Pelvis is selected ⬇️ Avoid DAMAGE to Posterior Branch of Renal Artety

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