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Urolithiases (Risk Factors (Recurrent UTIs, Hypercalcaemia, Drugs e.g,…
Urolithiases
Risk Factors
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Drugs e.g, diuretics, antacids, corticosteroids, aspirin
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Diet: spinach, tea, chocolate, rhubarb increases oxalate levels
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Signs
Renal Colic
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Excruciating ureteric spasms unilateral loin to groin - nerve supply for pain moves from ureter, loin to groin
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Obstruction
Obstruction of lower ureter: bladder irritability, pain in scrotum, penile tip or labia majora
Obstruction of bladder or urethra: pelvic pain, dysuria, strangury (desire but inability to void)
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Renal Obstruction: felt in loin, between rib 12 and lumbar muscles
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Pyonephrosis: a combination of infection and obstruction. Can lose renal function in 24 hours. Systemic sepsis will lead to septic shock
Treatment
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Stones <5mm in lower ureter: 90% pass spontaneously, increase fluid intake
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Pathophysiology
Uric Acid Stones
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Those with ileostomies are at risk - there is loss of bicarbonate from GI secretions which leads to acid urine, reducing solubility of uric acid
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Calcium Stones
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Hypercalciuria = Increased urinary calcium excretion due to hypercalcaemia e.g. in hyperparathyroidism
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Investigations
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Urine PH and 24 hr urine for calcium, oxalate, urate, sodium, creatinine
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FBC, U&E, calcium, phosphate, bicarbonate, urea
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