LITHESIS Presentation: Definition, causes and locations

To understand the formation of stones in various organs

1. NAME: KAMARA SRIE MININ SCHOOL OF CLINICAL SCIENCES –MAKENI TOPIC; LITHIESIS LITHIESIS

2. CONTENT INTRODUCTION TYPE OF STONE FORMATI0N SIGNS OR SYMPTOMS CAUSES RISK FACTORS  DIAGNOSTIC EVALUATION:- SURGICAL MANAGEMENT

3. INTRODUCTION LITHIESIS T he formation of stony concentrations (calculi) in the body, most often in the gall bladder or urinary system . T he formation is refers to as gallstones, kidney stone, bladder stone etc. Stones, or calculi, are formed in the urinary tract from the kidney to bladder by the crystallization of substances excreted in the urine.

4. TYPE OF STONE FORMATI0N Gallstones kidney stone bladder stone etc.

5. Gallstones Gallstones are hardened deposits of digestive fluid that can form in your gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. The gallbladder holds a digestive fluid called bile that's released into your small intestine. Bile is a digestive fluid produced in your liver and stored in your gallbladder. When you eat, your gallbladder contracts and empties bile into your small intestine (duodenum).

6. Gallstones range in size from as small as a grain of sand to as large as a golf ball. Some people develop just one gallstone, while others develop many gallstones at the same time.

7. SIGNS OR SYMPTOMS OF GALLSTONES Gallstones may cause no signs or symptoms. If a gallstone lodges in a duct and causes a blockage, the resulting signs and symptoms may include : Sudden and rapidly intensifying pain in the upper right portion of your abdomen Sudden and rapidly intensifying pain in the center of your abdomen, just below your breastbone Back pain between your shoulder blades   Pain in your right shoulder   Nausea or vomiting

8. causes Your bile contains too much cholesterol. Normally, your bile contains enough chemicals to dissolve the cholesterol excreted by your liver. But if your liver excretes more cholesterol than your bile can dissolve, the excess cholesterol may form into crystals and eventually into stones.   Your bile contains too much bilirubin. Bilirubin is a chemical that's produced when your body breaks down red blood cells. Certain conditions cause your liver to make too much bilirubin, including liver cirrhosis, biliary tract infections and certain blood disorders. The excess bilirubin contributes to gallstone formation . Your gallbladder doesn't empty correctly. If your gallbladder doesn't empty completely or often enough, bile may become very concentrated, contributing to the formation of gallstones.  

9. Types of gallstones   Types of gallstones that can form in the gallbladder include : Cholesterol gallstones . The most common type of gallstone, called a cholesterol gallstone, often appears yellow in color. These gallstones are composed mainly of undissolved cholesterol, but may contain other components .   Pigment gallstones . These dark brown or black stones form when your bile contains too much bilirubin.  

10. Risk factors  Factors that may increase your risk of gallstones include :   Being female( ostrogen )   Being age 40 or older   Being overweight or obese   Being sedentary   Being pregnant   Eating a high-fat diet   Eating a high-cholesterol diet   Eating a low-fiber diet   Having a family history of gallstones   Having diabetes   Having certain blood disorders, such as sickle cell anemia or leukemia   Losing weight very quickly   Taking medications that contain estrogen, such as oral contraceptives or hormone therapy drugs   Having liver disease  

11. COMPLICATIONS OF GALLSTONES   Complications of gallstones may include :   Inflammation of the gallbladder.  ( cholecystitis ) Blockage of the common bile duct.  Blockage of the pancreatic duct.  Gallbladder cancer. 

12. RENAL CALCULI STONE/NEPHROLITHIASIS

13. Renal calculi /Stone/Nephrolithiasis A kidney stone, also known as a renal calculus or nephrolith , is a hard solid mass of material that forms in the kidney from the substances in the urine. Kidney stones or calculi develop as a result of various metabolic disorders which affect the fate of calcium and other mineral elements in the body. Stones may be formed in the Kidney urinary bladder ureter and urethra Introduction

14. Causes and predisposing   Etiology factors of kidney stones: Diet high in purines and abnormal purine metabolism ( hyperuricemia and gout) Immobility Fluid intake , Chronic dehydration Excessive intake of vitamin D, milk, and alkali Hypercalcemia and hypercalciuria

15. Genetic predisposing Contd …   Living in mountainous, desert, or tropical areas Excessive oxalate absorption in inflammatory bowel disease and bowel resection or ileostomy Chronic obstruction with stasis of urine, foreign bodies within the urinary tract Chronic urinary tract infection ( Struvite stone) ( cystinuria ) Dietary factors: excessive intake of oxalate-containing foods such as spinach excessive vitamin D supplementation, a high-salt diet, high intake of animal protein, inadequate fluid intake predisposes to dehydration Medication antacids Protease inhibitors: Indinavir sulfate Steroids :

16. Medical conditions leading   Those who have undergone intestinal bypass or ostomy surgery Inflammatory bowel disease Chronic diseases such as diabetes and hypertension. kidney diseases such as renal tubular acidosis  Hyperparathyroidism Gout (uric acid stones)

17. Pathophysiology Urine saturation Super saturation Crystal nucleation Aggregation Retention and growth

18. Pathophysiology Inhibitors of stone formation :   Stones can form when there is a deficiency of substances that normally prevent crystallization in the urine, such as Citrate, magnesium, nephrocalcin , and uropontin . (that inhibit the nucleation, growth, and aggregation of calcium-containing crystals) SUPERSATURATION OF URINE:   When the urine becomes supersaturated with one or more calculogenic (crystal-forming) substances, a seed crystal may form through the process of nucleation.

19. TYPE OF NEPHROLITHIASIS There are mainly 5 types:- Calcium oxalate stone (Is the most common 80% ) Calcium phosphate stone Struvite stone (Triple stone) Uric acid stone Cystic stone

20. CALCIUM OXALATE STONE  Calcium oxalate stone (Is the most common 80% )- Caused by super -saturation of urine with calcium & oxalate They may range from very small particles, often called SAND or GRAVEL to giant staghorn calculi. The peak onset is during a person’s 20. They are more common in men between age 20 - 30. Calcium oxalate stone tend to form in alkaline chemistry ( Avoid food high in oxalate(beer, wheat germ, spinach)  

21. Cont Causes of hypercalciuria   Increase calcium reabsorption in gut as in milk-alkali syndrome, A high rate of bone reabsorption E.g Paget’s disease, hyperparathyroidism, cushing’s syndrome, immobility etc & Impaired renal tubular absorption of filtered calcium as in renal tubular acidosis. excessive intake of vitamin D. Oxalate: It is the second most common stone, which is relatively insoluble in urine Diseases of the small intestine increase risk of these stones. Oxalate is present in certain foods such as spinach. It's also found in vitamin C supplements.

22. CALCIUM PHOSPHATE STONE Calcium phosphate stone (5-10%):- Caused by super -saturation of urine with calcium phasphate . Calcium phosphpate stone tend to form in alkaline chemistry (Avoid food high in calcium (Milk & dairy product)

23. STRUVITE STONE Struvite stone (Triple phosphate stone) Caused by urea splitting bacteria (Proteus, Pseudomonas, Klebsiella , Staphylococcus) more common women then the man because of UTI Struvite stone tend to form in alkaline chemistry

24. Cystic stone Cystic stone (10-15%):- Caused by cystine crystal formation Cystic stone tend to form in Acidic urine ( cystine source Avoid meat milk ,cheese, Egg ) .

25. URIC ACID STONE Uric acid stone (5-10%) Caused by excessive dietary purine or gout Uric acid stone tend to form in Acidic urine (Avoid purine sources eg . Meats, gravies, red wine)

26. Renal colic   Bladder stones produce symptoms similar to cystitis. Large ureteral stones produce symptoms of obstruction as they pass down the ureter (ureteral colic). Pain relief is immediate after stone passage

27. CLINICAL MANIFESTATION:- Severe pain in the side and back, below the ribs Pain that spreads to the lower abdomen and groin Pain that comes in waves and fluctuates in intensity Pain on urination Cloudy or foul-smelling urine Nausea and vomiting Fever and chills if an infection is present Urinating small amounts of urine Heamaturia , palonephrosis,hydronepharosis

28. Diagnostic evaluation:- Blood Urine-analysis Cystoscopy X-ray CT scan, MRI Intravenous urogram (IVU) or intravenous pyelogram USG KUB

29. Medical management Analgesic   Spasmotic eg Buscopan NSAIDs eg Steroid Maintain I/O charting Provide rest  

30. SURGICAL MANAGEMENT Close procedure :   Lithotripsy (Extracorporeal Shockwave lithotripsy (ESWL)- Noninvasive Open procedure Ureterolithotomy Pyelolithotomy Nephrolithotomy Partial or total nephrectomy

31. Summary Stones, or calculi, are formed in the urinary tract from the kidney to bladder by the crystallization of substances excreted in the urine.