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Flashcards in stones Deck (31):
1

what are 2 main diet risks

1. low fluid
2. high salt and protein

2

what is epi

most common in middle aged men

3

**3 main stone types, how common and how they show on ultrasound

1. calcium oxalate (80%) - radio-opaque
2. uric acid (10%) - lucent
3. struvite (10) - opaque

4

*3 other types of stone

1. cystine - opaque
2. matrix - lucent
3. medications stones (inudivir - old HIV med) - faintly opaque

5

behavioral and env. risks for stones

- low fluid
- live in hot places or work hot
- high protein, high salt

6

what are 2 main factors in stone dev.

1. excessive stone promoters
2. insuff. stone inhibs

7

4 stone promoters

1. fluid low
2. high urine Ca, oxalate
3. urine stasis
4. infection

8

4 stone inhibitors

1. citrate
2. magnesium
3. pyrophasphae
4. glycoprotein

9

2 main types of Ca stone

1. oxalate - most common
2. phosphate - rare

10

3 factors that increase Ca

1. renal Ca leak
2. increased GI absorbtion
3. leach Ca from bone

11

what is hyperoxaluria

5% of Ca stone formers
- IBD and short bowel syndrome
- increase in bile salts and fatty acids in coon- more oxalete absrobed

12

diet methods to prevent Ca oxalte stones

1. fuids
2. low animal proteins
3. low Na
4. low oxalate foods
DO NOT reduce Ca

13

2 meds for Ca oxalte

1. hydrochlorothiazide
2. K citrate

14

what causes struvate stones

- infection with urea splititng bugs
- proteus, klebsiella, pseudomonas
- NOT E. coli
- get alkaline urine

15

features of struvite stones

staghorns
- opaque

16

features of uric acid stones

- lucent on x-ray
- assoc. with gout and acidic urine
- can be disolved with alkaline urine
- K citrate

17

what are cystine stones

- autosomal recc. defect intubular transport
- aggressive- in childhood

18

*** what are causes of cystine stones

decreased reabsorption of COLA
Cystine
Ornitihine
Lysine
Arginine

19

how define stone type

patient strains out a stone and sent for testing

20

3 tests for anyone who passes a stone

1. serum Cr, Ca, uric acid
2. urine R+M
3. urine C+S

21

what to do for recurrent formers

full metabolic workup
- 2x 24 hour urine

22

4 presentations of stone

1. renal colic
2. N/V
3. urinary freq/urg
4. hematuria

23

DDx for renal colic

- acute uteric obst.
- pyelo
- acute abdo crisis
- ruptured AAA
- gyne
- radiculitis

24

4 investigations for someone with renal colic

1. urinalysis
2. blood tests
3. non- contract CT
- most sens and spec
4. KUB x-ray

25

what is medical mgmt of actue renal colic

1. anagesia
2. gravol
3. NSAID
4. ABx if UTI
5. IV fluids
6. medical expulsive therapy (a-blockers)

26

*** red flags that need urgent admission (5)

1. pain not controlled
2. fever and UTI with obst. stone
3. refractory vomiting
4. solitary kidney with obst.
5. severe hematuria

27

4 steps to ureteric stone

1.

28

2 options for those that don't pass

1. shockwave - most - 70% success
2. uretoscopy - 99%
- failed shockwave

29

4 options for renal stones

1. 2.5 cm , staghorn, struvite

30

**** 5 things to prevent stones

1. metabolic eval. to ID abnormality
2. incr. fluid
3. less salt
4. minimize oxalte
5. minimize protein
DO NOT reduce Ca intake

31

4 main locations for stones to stick

1. uretovesicular jct
2. calyx of kidney
3. uretopelvic jct
4. ureter over the iliacs

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