RENAL CALCULI.pptx hatvdhdbdhdbsbdvdhdff

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1. R E N A L C A L C U L I

2. Introduction- •A kidney stone is a hard solid mass of material that forms in the kidney from the substances in the urine . • Stone may be formed in the kidney, urinary bladder, ureter and urethra.

3. Definition - • Renal calculi are stones which is small, harden deposits of mineral and acid salts on the inner surfaces of the kidneys. They originate as microscopic particles and develop into stones over time. The medical term for this condition is nephrolithiasis , or renal stone disease.

4. Related Anatomy and Physiology-

5. Risk factor- Family history of renal calculi. Dehydration. Sedentary life style. Metabolic disturbances. Gout. Imbalance of pH in urine.

6. ETIOLOGY -

7. Type of kidney stones-

8. Pathophysiology - Changes in urinary composition(due to etiological factors) Imbalance in the concentration of promoters & imhibitors Increases oxidative stress leads to cell injury Initiates Heterogeneous nucleation leads to Nidus formation Crystal growth & aggregation Interaction between cell & crystal Adhesion of crystal to the cell wall Stone formation

9. Diagnostic Evaluation- History collection Physical examination Blood test 24 hour urine collection USG CT scan IVP Cystoscopy

10. Medical Management- Analgesic drug. e.g. ibuprofen, acetaminophen. Alpha- blocker drug. e.g. nifedipine with tamsulosin . Spasmodic. e.g. Buscopan . NSAID. e.g. Diclofenac .

11. Non-pharmacological management - • Drink water throughout the day. • Eat fewer oxalate-rich foods. •Drink morre fluids that produce a lot more usine that decreases the amount of cystine in usine to prevent cystine stones. •Avoid excessive meat consumption .

12. Surgical Management- Lithotripsy Percutaneous nephrolithotomy Ureterolithotomy Pyelolithotomy Nephrolithotom

13. Lithotripsy

14. Percutaneous nephrolithotomy

15. Ureterolithotomy

16. Nursing Management- • Acute pain related to irritation and spasm from stone movement in the urinary tract as evidence by complaints of pain, facial grimacing, restlessness. • Impaired urinary elimination related to trauma or blockage of ureters or urethra as evidenced by decreased urinary output and bloody urine. • Hyperthermia related to inflammation as evidenced by increase body temperature above normal range, worm to touch. • Disturbed sleep pattern related to pain as evidenced by restlessness, irritability. • Deficient knowledge related to unfamiliarity with nature and treatment of renal calculi as evidenced by multiple questions. • Risk for infection related to introduction of bacteria growth and obstruction.

17. Complications- • Migration → pain & obstruction. • Obstruction → hydroureter & hydronephrosis or calculus anuria . • Hematuria due to Injury of urinary mucosa. • Infection cystitis → pyelonephritis , pyoureter , pyonephrosis . • Metaplasia ( squamous metaplasia ) squamous cell carcinoma.

18. Conclusion- Urinary calculi is of increasing burden in developing Countries with urbanization. There is limitation in the management, due to limited resources. Most presentation in our environment are infected. Mainstay of treatment in most developing countries still remain surgery.

19. Thank you…