Urolithiasis

Question 1

Urolithiasis Pathogenesis

Answer 1

When the urine is saturated with salt and minerals

• 60-80% contain calcium
• Randall’s plaques

Question 2

Urolithiasis Epidemiology

Answer 2

• Renal stones present occur in 1/10 of the population, mostly asymptomatic
• Male:Female 3:1
• Peak between 30 and 50

Question 3

Urolithiasis RFs

Answer 3

Anatomical anomalies, FHx, hypertension, gout, hyperparathyroidism…

Question 4

Urolithiasis Presentation

Answer 4

• Many asymptomatic
• Sudden severe pain causes by dilation stretching and spasm or ureter
• Pain starts in loin at costovertebral angle and moves to groin
• Periods of relief unlike intermittent pain of biliary or intestinal colic
• Rigors, fever, dysuria, haematuria, urinary retention, N/V
• Writhing in agony unlike peritonism where they lie still
• Pyrexia suggest infection

Question 5

Urolithiasis Differentials

Answer 5

-Biliary colic, dissection, pyelonephritis (v high temp, pain does not radiate), pancreatitis, appendicitis, perforated peptic ulcer…

Question 6

Urolithiasis Ix

Answer 6

-Sticj testing for red cells (urolithiasis), white cells and nitrites (infection) and pH (pH above 7 suggests urea-splitting organisms while pH below 5 suggests uric acid stones), culture
-Bloods
-Non enhanced CT scanning
AXR

Question 7

Urolithiasis Management

Answer 7

Inpatient or Outpatient

• Outpatient if pain is relieved, patient can drink large volumes of fluid, no complications
• NSAIDS more effective then opioids
• Antiemetics and rehydration therapy if needed
• Majority of stones may pass spontaneously