Urolithiasis..........................pptx

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1. Urolithiasis Prep. By Dr Misganaw

2. Outline Background Epidemiology Chemical composition Pathophysiology Risk factor Clinical presentation Location & characteristics of pain Physical examination Diagnosis Management

3. Background Urolithiasis from Greek ( ouron - urine , lithos – stone) Can occur or formed any where in the urinary apparatus Common Costs about $ 2.1 million in USA / yr Renal colic affect around 1.2million people / year in USA around 1% hosp ital admission

4. Epidemiology The lower the economic status, the lower likelihood of developing renal stone Most at 20 to 49 year Peak incidence in between 35 to 45 3:1 male to female ratio

5. Chemical composition

6. Chem. Composition cont.

7. Chem. Composition cont.

8. Pathophysiology The formation renal calculi pass complex process, interaction of factors *Amount of Urine passage ( rate of urine passage) *Imbalance b/n promotor & inhibitors for crystallization *Urinary PH *High concentration of urinary stone forming ions *Anatomical abnormalities can affect urinary drainage

9. Pathophio . Cont.

10. Risk factor Age Sex Race ( Caucasian> black > Asians) Strong family history Diets : Obesity - High animals protein ( High Ca 2 , uric & oxalate, low PH & citric) - High salt ( hyper calciuria ) - High ca 2 intake is protective - Vit D ( increase intestinal absorption of Ca 2 ) - Vit C ( Causes hyperoxaluria) Occupation : sedentary life style Gout Low fluid intake (low urine out put <1 liter per 24 hour)

11. Risk . Cont.

12. Clinical presentation The presentation is variable Patients with renal stone may report A. Symptomatic - Pain - Infection - Hematuria B. Asymptomatic Classic renal colic - Acute onset of sever flank pain radiates to the groin, scrotum or labia - Gross or microscopic hematuria - Nausea & vomiting not associated with acute abdomen in 50% Acute renal colic probably the most excruciatingly painful event a person can endure

13. Clinical. Cont. Staghorn calculi are often relatively asymptomatic Branched kidney stone occupying the renal pelvic and at least occupy one calyceal system Manifest as infection & hematuria Sever colic Flank pain radiates to the genetalia Nausea & vomiting Microhematuria Can be little or no pain Chronic stone distends to be associated large or multiple stones May have impaired RF, anemia, weight loss etc Concomitant infection more likely

14. Location & characteristics of pain Depends on level of obstruction & its degree - Uretro pelvic junction - Pelvic brim - uretro vesical junction Ureteric Stone *Cause sever colicky pain in the flank & ipsilateral lower abdomen = With radiation to the testicle or vulva = Intense Nausea with or without Vomiting usually is present

15. Ureter 1. Upper ureter Tends to radiates to the flank & lumbar area 2. Mid ureter Cause Pain that radiates anteriorly & caudally Can easily mimic acute appendicitis on the right Diverticulitis on the left

16. C.F. 3. Distal & VUJ stone Cause pain that Tends to radiate in to the groin & testicle or labia majora in female At the uretro -vesical junction cause irritative symptoms mimicking cystitis such as frequency, dysuria etc 4. Bladder stone Usually asymptomatic & are passed relatively easily during urination Rarely: May claimed to have position dependent retention (obstruction precipitated during standing & relieved recumbent position)

17. C.F.

18. C.F. Phases of pain attack Entire process typically lasts 3 to18 hours Acute phase: typically in most patient with in 2 hours (30’ to 6 hours) Constant phase: 1 up to 4 hours maximum 12hours Relief phase: 1.5 to 3 hours

19. Physical examination Tachycardia Hypertension Dramatic costovertebral angle tenderness Unremarkable abdominal finding Tender testicle but normal appendage Constant body positioning movement ( eg writhing, pacing)

20. Diagnosis

21. Diagnosis 1. Symptomatic 2. Asymptomatic – incidental Presenting symptoms includes pain & hematuria ( microscopic or Macroscopic) Staghorn calculi (struvite) classically present with recurrent UTI, malaise, weakness & loss of appetite can also occur Lab. The recommended based on EUA recommendation UA – sediments / deep stick RBC 24 hr examination RFT CBC U/A (24hour urine ) Metabolic disorder work up Serum Ca 2 PTH

22. Diag. II. Imaging Ultrasonography: its sensitivity 95% detecting stone in calyces, pelvic, pelvi -ureteric junction& vesico ureteric junction, upper urinary tract dilatation KUB radiography Intravenous radiography Intravenous pyelography (IVP) IVU CT scan

23. Diag.

24. Emergency Renal Colic IV access to allow: - Analgesics Paracetamol Opioids NSAID Fluids Anti emetics Incase of infection - Antibiotics Based on – Urine culture - Blood culture - Stone culture

25. None Emergency management of Urolithiasis Medical URS PCNL Laparoscopy Open Prevention

26. Thank you!!!