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Imoudu 2

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Imoudu 2

  1. 1. AETIOPATHOGENESIS,DIAGNOSIS AND MANAGEMENT OF UROLITHIASIS IN CHILDREN BY IMOUDU I A MODERATOR PROF AIKHIONBARE H A
  2. 2. OUTLINE • INTRODUCTION • EPIDEMIOLOGY • AETIOPATHOGENESIS • CLINICAL PRESENTATION • DIAGNOSIS • MANAGEMENT • PROGNOSIS • CONCLUSION
  3. 3. INTRODUCTION • THE EXISTENCE OF CALCULI IN THE URINARY TRACT HAS BEEN RECORDED SINCE THE BEGINNING OF CIVILIZATION • LITHOTOMY FOR THE REMOVAL OF STONES IS ONE OF THE EARLIEST KNOWN SURGICAL PROCEDURES • A PELVIC STONE DATING BACK TO 4800BCE WAS DISCOVERED IN AN EGYPTIAN MUMMY IN 1901
  4. 4. INTRODUCTION • MEDICAL TEXTS FROM ANCIENT MESOPOTAMIA, INDIA,CHINA,PERSIA,GREECE & ROME ALL MENTIONED CALCULOUS DISEASE • PART OF THE HIPPOCRATIC OATH CONTAINS AN ADMONITION ABOUT THE DANGERS OF OPERATING ON THE BLADDER FOR STONES
  5. 5. EPIDEMIOLOGY • GLOBAL DISEASE • COMMONER IN EASTERN EUROPE,SOUTHEAST ASIA,INDIA & THE MIDDLE EAST • IN RSA IT IS COMMONER IN WHITES • IN USA IT IS COMMONER IN WHITES THAN BLACKS,ASIAN & LATIN AMERICANS
  6. 6. EPIDEMIOLOGY • AFFECTS ALL AGE GROUPS • RARE IN CHILDREN - 7% OF ALL CASES • COMMONER IN BOYS 3:2 • ADULTS,M/F 4:1
  7. 7. AETIOPATHOGENESIS • THERE IS CONTINUOUS INTERACTION B/W FACTORS THAT PROMOTE & THOSE THAT INHIBIT CRYSTALLIZATION IN THE FLUIDS OF THE URINARY TRACT • STONES FORM AROUND A NUCLEUS OR NIDUS
  8. 8. AETIOPATHOGENESIS CRYSTALS EVOLVE IN THE PRESENCE OF SUBSTANCES LIKE • Ca-OXALATE • CaCO3 • Mg • NH4 • PO4 • URIC ACID
  9. 9. AETIOPATHOGENESIS STONES IN URINARY TRACT COMMONLY COMPOSE OF • Ca-OXALATE/CaPO4 75-80% • STRUVITE 15% • URIC ACID 7% • CYSTINE 1% • OTHERS <1%
  10. 10. AETIOPATHOGENESIS RISK FACTORS • DEHYDRATION • INFECTION • CHANGES IN URINE pH • OBSTRUCTION OF URINE FLOW • IMMOBILIZATION • DIET • GOUT • FAT MALABSORPTION
  11. 11. AETIOPATHOGENESIS SOME ASSOCIATED METABOLIC CONDITIONS • HYPERVITAMINOSIS D • HYPEROXALURIA • RENAL TUBULAR ACIDOSIS(TYPE 1) • HYPERURICOSURIA • HYPOCITRURIA • CYSTINURIA • SARCOIDOSIS
  12. 12. Kidney stone Classification and external resources
  13. 13. CLINICAL PRESENTATION • COLICKY ABDOMINAL PAIN • HAEMATURIA • DYSURIA • FEVER • DRIBBLING OF URINE • WEIGHT LOSS • PYURIA • OLIGURIA • ANOREXIA • VOMITING
  14. 14. DIAGNOSIS • PLAIN ABDOMINAL X-RAY • CT-SCAN • ABDOMINAL ULTRASOUND SCAN • URINALYSIS • URINE M/C/S • U/E+CREATININE,Ca
  15. 15. DIAGNOSIS • FBC+DIFF • 24HR URINE COLLECTION FOR Mg,Na,Ca,URIC ACID,CITRATE,OXALATE & PO4 • CATCHING OF PASSED STONES FOR ANALYSIS • IVU
  16. 16. MANAGEMENT MEDICAL • TREAT UNDERLYING METABOLIC DISEASE • ADEQUATE HYDRATION • DIETARY MODIFICATION • ALPHA ADRENERGIC BLKERS; TAMSULOSIN,TERAZOSIN,DOXAZOSIN • Ca CHANNEL BLKERS • ALKALIZATION/ACIDIFICATION OF URINE • ANALGESIA
  17. 17. MANAGEMENT SURGICAL INDICATIONS FOR SURGERY; • PERSISTENT & SEVERE PAIN • RENAL INFECTION • RENAL FAILURE • FAILURE OF MEDICAL MANAGEMENT
  18. 18. MANAGEMENT SURGICAL PROCEDURES • LITHOTRIPSY- ESWL • ENDOSCOPIC FRAGMENTATION • PERCUTANEOUS NEPHROLITHOTOMY • LITHOTOMY
  19. 19. PROGNOSIS • USUALLY NOT FATAL • 90% OF STONES 4mm OR LESS IN SIZE PASS SPONTANEOUSLY • DEATH MAY RESULT FROM COMPLICATIONS &/OR UNDERLYING CAUSE
  20. 20. • Emperor of france 1804- 1815
  21. 21. • Nepoleon 111 ruler of france 1850-1870
  22. 22. • Sir isaac newton 1642- 1727
  23. 23. • Lyndon B Johnson president from 1963- 1969
  24. 24. CONCLUSION • THOUGH A VERY RARE CONDITION AMONG CHILDREN IN THIS ENVIRONMENT,THOSE WHO DEVELOP VERY PAINFUL STONES MAY EXPERIENCE SIGNIFICANT MORBIDITY • THERE MAY BE NEED FOR A HIGH INDEX OF SUSPICION,ESPECIALLY IN PRE-SCHOOL AGE CHILDREN WITH RECURRENT ABDOMINAL PAIN
  25. 25. THANK YOU
  26. 26. REFERENCES • Kliegman RM et al; Nelson Textbook of Pediatrics,18th edition 2008;539:1822-26 • Encyclopaedia Britannica 2008 • William W Hay Jr,et al;Current Pediatric Diagnosis and treatment 18th edition 2007;22:728-29 • http//en. Wikipedia.org • http//www.eMedicine.com • Hulton SA.Evaluation of Urinary tract Calculi in children.Arch.Dis.child.2001;84:320-23
  27. 27. REFERENCES • Bushinsky DA.Nephrolithiasis J. Am Soc Nephrol.1998;8:917-24 • Cochat P,Basmaism O.Current approaches to the management of primary hyperoxaluria.Arch Dis child 2000;82:470-73 • Ronnenfarth G,Musselwitz J.Nephrocalcinosis in children:A retrospective survey.Pediatr Nephrol 2000;14:1016-21 • EL-Damanhoury H,Burger R,Hanhefeller R.Surgical aspects of Urolithiasis in children.Pediatr.Nephrol 1991;5:339-47
  28. 28. REFERENCES • Abubakar AM,Mungadi IA,Chinda JY,Ntia IO,Jalo I,Obiano SK.Paediatric Urolithiasis in Northern Nigeria.African Journal of Paediatric Surgery.2004;1:2-5 • Angwafo FF et al.Paediatric Urolithiasis in Subsaharan Africa:A comparative study in two regions of Cameroun.Eur.Urol.2000;37:106-11

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