The document describes the anatomy and physiology of the urinary tract and kidney, risk factors and types of kidney stones, and methods for diagnosing and treating stones, including increasing fluid intake, altering diet, using medications to change urine composition, and surgically removing stones with procedures like ureteroscopy and lithotripsy. Kidney stones form when substances like calcium, oxalate, and uric acid become supersaturated in the urine and crystallize into solid masses.
Nephrolithiasis refers to stones (calculi) in kidney when urinary concentration of substances such as calcium oxalate, calcium phosphate and uric acid increases, but they can form in or migrate to the lower urinary system. They are typically asymptomatic until they pass into the lower urinary tract.
Nephrolithiasis refers to stones (calculi) in kidney when urinary concentration of substances such as calcium oxalate, calcium phosphate and uric acid increases, but they can form in or migrate to the lower urinary system. They are typically asymptomatic until they pass into the lower urinary tract.
Kidney stones (also called renal calculi, nephrolithiasis or urolithiasis) are hard deposits made of minerals and salts that form inside your kidneys. Diet, excess body weight, some medical conditions, and certain supplements and medications are among the many causes of kidney stones.
Kidney stone disease, also known as urolithiasis, is when a solid piece of material (kidney stone) occurs in the urinary tract. Kidney stones typically form in the kidney and leave the body in the urine stream. A small stone may pass without causing symptoms.
Kidney stones (also called renal calculi, nephrolithiasis or urolithiasis) are hard deposits made of minerals and salts that form inside your kidneys. Diet, excess body weight, some medical conditions, and certain supplements and medications are among the many causes of kidney stones.
Kidney stone disease, also known as urolithiasis, is when a solid piece of material (kidney stone) occurs in the urinary tract. Kidney stones typically form in the kidney and leave the body in the urine stream. A small stone may pass without causing symptoms.
Hydronephrosis is the distension of the renal calyces and pelvis due to accumulation of the
urine as a result of the obstruction to the outflow of the urine mostly distal to renal pelvis.
This presentation comprises of congenital anomalies of kidney and urinary tract made concise and in depth for PG preparation. It contains all important topics of the regarding subject covered in detail.
RENAL STONES & STONES IN PREGNANCY .pptxBipul Thakur
THis presentation discusses about the formation of kidney stones the different theories related to formation of stones, thdifferent types of stones and management of kidney stones in case of pregnant female and various considerations required regarding the fetus and the pregnant female.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The hemodynamic and autonomic determinants of elevated blood pressure in obes...
Renal calculi
1.
2. The urinary tract includes the kidneys,
ureters, bladder and urethra. Within each
kidney, urine flows from the outer cortex to
the inner medulla.
The renal pelvis is the funnel through which
urine exits the kidney and enters the ureter.
3.
4.
5.
6. THE KIDNEY IS COMPOSED OF AN INNER
MEDULLA AND AN OUTER CORTEX
SURROUNDED BY A TOUGH FIBROUS CAPSULE.
7. The kidneys remove wastes, control the body's
fluid balance, and regulate the balance of
electrolytes
The medulla is composed of a series of conical
masses called the renal pyramids.
The apex of these pyramids form a papilla
which projects into the lumen of the minor
calyces.
The cortex extends between these medullary
pyramids as the renal columns
The minor calyces are cup shaped tubes which
surround the renal papilla. These converge to
form the major calyces, which in turn unite to
8. Malignant hypertension caused by
renovascular disease. The renal artery is
narrowed by atherosclerotic plaque
causing an elevation in blood pressure.
The increased pressure damages the walls
of the small arterioles and glomerular
capillaries in the cortex.
The vessels rupture causing hemorrhage
and infarction (scarring). The granular
surface of the kidney indicates atrophy and
fibrosis of the cortex due to the destruction of
the small blood vessels
13. DEFINITION
The stones are solid concretions or calculi
(crystal aggregations) formed in the kidneys
from dissolved urinary minerals
Stones are formed in the urinary tract when
urinary concentrations of substances such as
calcium oxalate, calcium phosphate, and uric
acid increase
14. INCIDENCE
Urinary calculi are more common in men than in
women.
Incidence of urinary calculi peaks between the
3rd and 5th decades of life.
15. CONTINUED……………..
The incidence of upper urinary tract stones is
greater in industrial countries, such as the
United States and countries of Europe, than in
developing nations.
50% re-occurrence with in 5-10 years
Between 70 and 80 percent of stones are made
up primarily of calcium oxalate crystals; the rest
contain calcium phosphate salts, struvite
(magnesium, ammonium, and phosphate), uric
acid, or cystine (an amino acid)
India-each year 5-7 million cases are diagnosed
1/1000 need hospitalisation
16. CONTINUED………
There is seasonal variation with stone
occurring more often in the summer months
suspecting the role of dehydration in this
process
17. ETIOLOGY AND RISK FACTORS
Metabolic
Abnormalities that result in increased
urine levels of calcium, oxaluric acid, uric
acid or citric acid.
Climate
Warm climates that cause increased
fluid loss. Low urine volume and
increased solute concentration in urine
18. CONTINUED……………..
DIET
Large intake of dietary proteins that increases
uric acid excretion.
Excessive amounts of tea or fruit juices that
elevate urinary oxalate level.
Large intake of calcium and oxalate.
Low fluid intake that increases urinary
concentration
19. CONTINUED……………..
Genetic factors
• Family history of stones formation, cystinuria, gout
or renal acidosis.
Lifestyle
• Sedentary occupation and immobility.
A major pre-disposing factor is the presence of
UTI.
Infection increases the presence of organic matter
around which minerals can precipitate and
increases the alkalinity of the urine by the
production of ammonia. This results in precipitation
of calcium phosphate and magnesium-ammonium
20. CONTINUED……………..
Stasis of urine also permits precipitation of
organic matter and minerals.
Other factors associated with the development
of stones include long-term use of antacids,
vitamin D, large doses of vitamin C and calcium
carbonate.
Any foreign body in the bladder serves as a
nidus for infection and calculi formation
21. Drug-Induced Stones (Indinavir and
Nelfinavir Stones)
These agents are excreted as urinary
crystals that may result in crystal deposition
or stone formation
22. PATHOPHYSIOLOGY
Many theories have been proposed to explain the
formation of stones in the urinary tract. No single
theory can account for stone formation in all
cases.
Crystallization appears to be the primary factor in
calculus development from:
1. Supersaturation of urine with increased solutes
2. Matrix formation caused when mucoproteins bind
to the mass of the stone
3. Lack of inhibitors caused by increased or absent
protectors against stone formation
23. TYPES OF CALCULI
Calcium
Calcium is the most common substance and is
found in up to 90% of stones.
Calcium stones are usually composed of calcium
phosphate or calcium oxalate. They may range
from very small particles, often called "sand" or
"gravel," to giant staghorn calculi, which may fill
the entire renal pelvis and extend up into the
calyces.
About 35% of all clients with calcium stones do not
have high serum levels of calcium and
24. There are two variants of hypercalciuria
The primary abnormality is increased intestinal
absorption of calcium or increased bone
reabsorption.
The resulting higher serum calcium level triggers
increased renal filtration of calcium and parathyroid
hormone (PTH) suppression. This in turn decreases
tubular reabsorption, thereby increasing the
concen-tration of calcium in the urine.
"Renal leak" of calcium, the other abnormality, is
caused by a tubular defect. The resulting
hypocalcemia stimulates PTH production, which
increases intestinal absorption of calcium. Clients
25. 2.OXALATE
The second most frequent stone is oxalate,
which is relatively insoluble in urine. Its
solubility is affected only slightly by changes in
urinary pH.
The mechanism of oxalate availability is
unclear but may be closely related to diet. The
disease is most common in areas where
cereals are a major dietary component and
least common in dairy-farming regions.
26. An increased incidence of oxalate stones
may be related to:
Hyperabsorption of oxalate, seen with
inflammatory bowel disease
Postileal resection or small-bowel bypass
surgery
Overdose of ascorbic acid (vitamin C), which
metabo-lizes to oxalate
Familial oxaluria (oxalate in the urine)
Concurrent fat malabsorption, which may
cause calcium binding, thus freeing oxalate
for absorption
27. 3.STRUVITE
Struvite stones, also called triple phosphate, are
composed of carbonate apatite and magnesium
ammonium phosphate.
Their cause is certain bacteria, usually Proteus,
which contain the enzyme urease. This enzyme
splits urea into two ammonia molecules, which
raises the urine pH. Phosphate precipitates in
alkaline urine.
Stones formed in this manner are staghorn calculi
.Abscess formation is common.
Struvite stones are difficult to eliminate because the
hard stone forms around a nucleus of bacteria,
protecting them from antibiotic therapy.
Any small fragment left after surgical removal of the
stone begins the cycle again.
28. 4. URIC ACID STONE
Uric acid stones are caused by increased
urate excretion, fluid depletion, and a low
urinary pH.
Hyperuricuria is the result of either increased
uric acid production or the administration of
uricosuric agents.
Approximately 25% of people with primary
gout and about 50% of persons with
secondary gout develop uric acid stones.
29. A high dietary intake of food rich in purine (a
protein) may predispose clients to uric acid
stone formation. Also, treating neoplastic
disease with agents that cause rapid cell
destruction may increase the urinary uric acid
concentration.
It is hypothesized that uric acid crystals absorb
some of the crystal inhibitors normally found in
urine.
30. 5.CYSTINE
Cystinuria is the result of a congenital metabolic
error inherited as an autosomal recessive
disorder.
Cystine stones typically appear during childhood
and adolescence;
development in adults is very rare
32. most characteristic manifestation of renal or
ureteral calculi
caused by movement of the calculus and
consequent irritation
Renal colic originates deep in the lumbar
region and radiates around the side and
down toward the testicle in the male and the
bladder in the female
Ureteral colic radiates toward the genitalia
and thigh
33. CONTINUED……..
When the pain is severe, the client usually has
nausea, vomiting, pallor, grunting respirations,
elevated blood pressure and pulse,
diaphoresis, and anxiety
34. Urinary tract infection
Other manifestations of calculi include
infection with an elevated temperature and
white blood cell (WBC) count and urine
obstruction that causes hydroureter,
hy-dronephrosis, or both
Haematuria
Pain resulting from the passage of a calculus
down the ureter is intense and collicky. The
patient may be in mild shock with cool, moist
skin
36. 1.HISTORY
Prior stone formation
Renal or bladder colic type pain without
objective evidence of calculi formation
Risk factors
Location, character, and duration of current
pain
Current and previous radiation patterns
(indicates possible location and movement of
calculus through the urinary system)
37. 2. PHYSICAL EXAMINATION
Vital signs include increased pulse,
respirations, and blood pressure associated
with colicky pain;
fever indicates serious infection.
Hyperactive bowel sounds occur with nausea
and vomiting; hypoactive or absent bowel
sounds occur with ileus.
38. 2.DIAGNOSTIC STUDIES
Urinalysis, urine culture, and sensitivity testing
determine the presence of urinary tract infection,
hematuria, or urine crystals.
Radiographic studies
Ninety percent of calculi are visible on
radio-graphic images.
Calcium phosphate stones are brightest on
radio-graph; uric stones are least visible
(radiolucent).
KUB using plain abdominal film detects larger,
radiopaque stones.
39. Intravenous urography (IVU) locates radiopaque
stones, allowing evaluation of associated
obstructive uropathy and crude eval-uation of
renal function (i.e., the ability to concen-trate
and excrete contrast material).
it is a standard method for examining the urinary
tract for obstruction in cases of renal colic
Tomograms locate stones in the pericaliceal
sys-tem. They are performed in combination
with IVP.
Renal and bladder ultrasound locates stone,
creates hypoechogenic "shadow”and gives
some indication of associated obstructive
40. Computed tomography scan locates
radiopaque stones.
Radionuclide study is an alternative technique
tor locating calculi among patients allergic to
contrast materials or in a nonfunctioning
kidney
Among endoscopic procedures, cystoscopy is
performed for bladder stone, ureteroscopy for
ureteral calculus, and nephroscopy for stone in
the pericaliceal system.
41. D. LABORATORY STUDIES
Serum chemistry tests identify calcium,
phosphate, oxalate, cystine metabolism, and
renal function (creatinine, BUN)
abnormalities.
Complete blood count detects systemic
infection
Twenty-four-hour urine collection measures
ex-cretion of phosphorous, calcium, uric acid,
and creatinine levels.
Stone analysis determines the composition
of the calculus and assists in designing a
preventive pro-gram.
42. COMPLICATIONS
Obstructive uropathy compromises the
function of the affected kidney.
Microscopic or gross hematuria is rarely
associated with significant hemorrhage.
Urosepsis is infection that may cause shock
or death without prompt intervention.
Ileus may occur
44. CALCIUM OXALATE:
Increase hydration.
Reduce dietary oxalate.
Give thiazide diuretics.
Give cellulose phosphate to cholate calcium and
pre-vent GI absorption.
Give potassium citrate to maintain alkaline
urine.
Give cholestyramine to bind oxalate.
Give calcium lactate to precipitate oxalate in GI
tract.
45. CALCIUM PHOSPHATE
Treat underlying causes and other stones
Administer antimicrobial agents,
acetohydroxamic acid and antibiotics.
Use surgical intervention to remove stone.
Take measure to acidify urine
46. URIC ACID STONES
Reduce urinary concentration of uric acid.
Alkalinize urine with potassium citrate.
Administer allopurinol.
Reduce dietary purines.
47. CYSTINE
Increase hydration.
Give alpha-penicillamine and tiopronin to
prevent cystin crystallization.
Give potassium citrate to maintain alkaline
urine
48. STRUVITE STONES
Complete removal of the stone with
subsequent sterilization of the urinary tract is
the treatment of choice for patients who can
tolerate the procedures.
Percutaneous nephrolithotomy is the preferred
surgical approach for most patients.
At times, extracorporeal lithotripsy may be
used in combination with a percutaneous
approach. Open surgery is rarely required.
49. CONTINUED……….
Irrigation of the renal pelvis and calyces with
hemiacidrin, a solution that dissolves struvite,
can reduce recurrence after surgery. Stone-free
rates of 50–90% have been reported after
surgical intervention.
Antimicrobial treatment is best reserved for
dealing with acute infection and for maintenance
of a sterile urine after surgery.
50. CONTINUED…………….
Urine cultures and culture of stone fragments
removed at surgery should guide the choice
of antibiotic.
For patients who are not candidates for
surgical removal of stone, acetohydroxamic
acid, an inhibitor of urease, can be used.
side effects-headache, tremor,and
thrombophlebitis, that limit its use
52. 1. URETEROSCOPY-
involves first visualizing the stone and then
destroying it.
Access to the stone is accomplished by
inserting a ureteroscope into the ureter and then
inserting a laser, electrohydraulic lithotriptor, or
ultrasound device through the ureteroscope to
fragment and remove the stones.
A stent may be inserted and left in place for 48
hours or more after the procedure to keep the
ureter patent.
Hospital stays are generally brief, and some
patients can be treated as outpatients.
53. LITHOTRIPSY
LASER LITHOTRIPSY. A newer treatment for
calculi is laser lithotripsy. Lasers are used
together with a uretero-scope to remove
or loosen impacted stones. Constant
wa-ter irrigation of the ureter is required
to dissipate the heat
54. EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY
(ESWL)
ESWL is a noninvasive procedure used to
break up stones in the calyx of the kidney.
In ESWL, a high-energy amplitude of pressure,
or shock wave, is generated by the abrupt
release of energy and transmitted through
water and soft tissues. When the shock wave
encounters a substance of different intensity (a
renal stone), a compression wave causes the
surface of the stone to fragment. Repeated
shock waves focused on the stone eventually
reduce it to many small pieces.
55. CONTINUED………….
These small pieces are excreted inthe urine,
usually without difficulty.the fragments may
be passed upto 3 months after the procedure
Stone size should be 1.5-2 cm
56. PERCUTANEOUS LITHOTRIPSY
Percutaneous litho-tripsy involves the insertion
of a guide percutaneously (through the skin)
under fluoroscopy near the area of the stone.
An ultrasonic wave is aimed at the stone to
break it into fragments.
stone size should be >2.5 cm
57.
58. POST OPERATIVE COMPLICATIONS
IMMEDIATE
Pain
Urinary infection
Obstructive uropathy
Haematuria
Urinoma-URINOMA HAPPENS AS A RESULT OF
URETERAL TEAR WHICH ALLOWS THE ENTRY OF
FREE FLUID INTO THE RETROPERITONEUM
Renal and perirenal haematoma
Surrounding organ injury
61. OPEN SURGICAL PROCEDURES
If the stone is too large or if endourologic and
lithotripsy procedures fail to remove it, an open
surgical procedure is performed
ureterolithotomy is the surgical removal of a
stone from the ureter through a flank incision
for higher stones or an abdominal incision for
lower ones. A Penrose drain and ureteral
catheter are usually placed postoperatively for
healing and drainage of urine
62. CONTINUED…………….
Cystolithotomy, removal of bladder calculi
through a suprapubic incision, is used only
when stones cannot be crushed and
removed transurethrally. Stricture (abnormal
narrowing) is the most common
postoperative complica-tion.
A stone is removed from the renal pelvis by
pyelo-lithotomy and from the renal calyx by
a nephrolithotomy
63. MEDICATIONS
Lortab (500) mg one tab by mouth every 6
hours as needed for pain
Percocet (325) mg one tab by mouth every 6
hours as needed for pain
Pyridium (100, 200) mg one tab per mouth
every 8 hours for dysuria (burning)
Cipro (250, 500) mg one tab per mouth
twice a day
64. PROGNOSIS
Despite advances in the treatment of urinary
calculi, it is often impossible to remove all stone
fragments com-pletely. From 5 to 30 percent of
patients have residual stone burden requiring
ongoing treatment.
Recurrence rate is approximately 30 percent
within years.
Extracorporeal shock wave lithotripsy and
endoscopic stone removal techniques have
significantly improved long term prognosis of rena
function after calculus removal.
65. NURSING INTERVENTION
adequate hydration, dietary sodium
restrictions, dietary agrees, and the use of
above-stated medication minimise stone
formation
High fluid intake at least 3000 ml per day is
recommended.
Dietary intervention may be important in the
management of formation urolithiasis.
nutritional management should include
limiting oxalate- foods and thereby reducing
oxalate excretion. Foods high in , calcium or
oxalate contents are as follows:
66. RICH SOURCES OF CALCIUM
Cereals such as ragi, whole bengal,
gram(chana), moth beans(matki),Rajmah,
soyabeans, horsegram
All green leafy vegetables
Oilseeds such as dry coconut, gingelly seeds
(til), mustard seeds
Figs and all dry fruits such as cashewnuts,
almonds, dried figs
All kinds of fish.
Snail, mutton muscle
67. RICH SOURCES OF PHOSPHORUS
Cereals such as bajra, barley, millet, jowar,
dry maize, ragi, oatmeal
Soya bean. Moderate sources of phosphorus
are bengal gram (chana),Cowpea (chawli),
rajmah
Dry fishes
Milk powder, milk
68. RICH SOURCES OF OXALIC ACID
Horsegram (kuleeth), kesari dalAlmonds,
cashewnuts, gingelly seeds, ripe chillies,
amla, woodapple.
Cocoa, coffee, tea
Green leafy vegetables such as amaranth,
curry leaves, drumstick leaves, mustard
leaves, neem leaves,
69. FOODS CONTAINING PURINE
Foods with high Purine content.Organ
meats such as kidney, liver, pancreas, brain.
Sweet breads. Sardines. Meat extracts.
Foods with moderate amounts of Purine
Meat, Fish, Shell fish, Alcohol ,Chickoo,
apple
Foods with small amounts of Purine
Asparagus, Mushrooms, Cauliflower,
Spinach, Peas, Dry beans ,Pulses, Coffee,
Tea
70. NURSING DIAGNOSIS
ACUTE PAIN R/T OBSTRUCTING URINARY
CALCULUS
ALTERED URINARY ELIMINATION RELATED
TO PRESENCE OF URINARY CALCULI
RISK TOR INFECTION R/T OBSTRUCTING
URINARY CALCULUS
ALTERED RENAL PERIPHERAL TISSUE
PERFUSION R/T POSTRENAL
OBSTRUCTION