Urinary stones, also known as kidney stones, form when minerals in urine crystallize and accumulate. Approximately 1 in 20 people will develop a kidney stone at some point. Men are more likely to develop stones than women, and risk increases from age 40-70. Stones can cause severe pain and block the urinary tract. Diagnosis involves imaging tests like ultrasound or CT scans. Treatment depends on the stone size and location, ranging from increased fluid intake to shockwave lithotripsy or surgery. Prevention focuses on dietary changes and medications to reduce stone-forming substances in urine.
Urolithiasis is a common disease that is estimated to
produce medical costs of $2.1 billion per year in the United States alone.
Renal colic affects approximately 1.2 million people
each year in USA and accounts for approximately 1% of
all hospital admissions.
Most active emergency departments (EDs) manage
patients with acute renal colic every day.
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.
Please find the power point on Renal and bladder stones. I tried present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Urolithiasis is a common disease that is estimated to
produce medical costs of $2.1 billion per year in the United States alone.
Renal colic affects approximately 1.2 million people
each year in USA and accounts for approximately 1% of
all hospital admissions.
Most active emergency departments (EDs) manage
patients with acute renal colic every day.
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.
Please find the power point on Renal and bladder stones. I tried present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
SSurocare as the best choice for kidney stone treatment in Bangalore. Also we provide kidney stone removal at affordable cost Bangalore, Visit for advanced treatment of kidney stone surgery.
CHOLELITHIASIS, NEPHROLITHIASIS SECONDARY HYPERTENSION, DM TYPE 2, HYDRONEPH...Jack Frost
CHOLELITHIASIS, NEPHROLITHIASIS
SECONDARY HYPERTENSION, DM TYPE 2, HYDRONEPHROSIS
This presentation contains real names of persons involve of this particular study. This names should not be copied or rewritten. Used the data of this study as basis only. All rights reserved 2009.
This is a presentation i did for a class on basics on renal colic as my professor asked me to do.Here i collected just the basic things about renal colic including renal anatomy,aeitology,cause,clinical feature and management.Hope it will help you.All the information source are verified.Thank You.
studies: the effects of dark chocolate and cocoa on variables associated with neuropsychological functioning and cardiovascular health, Cerebral blood flow response to flavanol-rich cocoa in healthy elderly humans
The Use Of Antibiotic In Food Producing Animals ,Dina m.
what is antibiotic, Why are antibiotics used in food-producing animals?, Which antibiotics used in food-producing animals are related to antibiotics used in humans?
The Health Benefit of ACV, with the newest studies, nice & attractive breaks time. ACV for DM, wt. loss, Hypertension, Hypercholestrolemia, Strenghth Bone, Heart burn, & arthritis.
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
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
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
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
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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Evaluation of antidepressant activity of clitoris ternatea in animals
Urinary Stones
1. Urinary Stone
Urinary stone:
One in every 20 people develop a kidney stone at some point in their life. A kidney
stones(renal calculi) are solid concretions (crystal aggregations) of dissolved minerals in
urine; calculi typically form inside the kidneys or ureters. The terms (nephrolithiasis)
and (urolithiasis) refer to the presence of calculi in the kidneys and urinary tract,
respectively.
Renal calculi can vary in size from as small as grains of sand to as large as grapefruit.
Kidney stones typically leave the body by passage in the urine stream, and many stones
are formed and passed without causing symptoms. If stones grow to sufficient size
before passage--on the order of at least 2-3 millimeters--they can cause obstruction of
the ureter.
Incidence:
Men are especially likely to develop kidney stones, and whites get them more often
than African American. The prevalence of kidney stones begins to rise when men
reach their 40s and continues to climb into their 70s. People who have already had
more than one kidney stone are prone to develop more stones.
Causes:
Kidney stones form when there is :
a decrease in urine volume or an excess of stone-forming substances in the urine.
The most common type of kidney stone contains calcium in combination with either
oxalate or phosphate. Other chemical compounds that can form stones in the urinary
tract include uric acid and the amino acid cystine.
-A number of different conditions can lead to kidney stones:
Dehydration through reduced fluid intake or strenuous exercise without
adequate fluid replacement increases the risk of kidney stones. Obstruction to the
flow of urine can also lead to stone formation. Kidney stones associated with
infection in the urinary tract are known as struvite or infection stones.
Gout results in an increased amount of uric acid in the urine and can lead to the
formation of uric acid stones.
Hypercalciuria (high calcium in the urine), another inherited condition, causes
stones in more than half of cases. In this condition, too much calcium is absorbed
from food and excreted into the urine, where it may form calcium phosphate or
calcium oxalate stones.
I
2. kidney diseases such as renal tubular acidosis (hyperparathyroidism)
associated with an increased risk of kidney stones
Some medications also raise the risk of kidney stones. These medications
include some diuretics, calcium-containing antacids, and the protease inhibitor
Crixivan (indinavir), a drug used to treat HIV infection.
People with inflammatory bowel disease or who have had an intestinal
bypass or ostomy surgery are also more likely to develop kidney stones.
Signs & Symptoms:
Kidney stones are usually asymptomatic until they obstruct the flow of urine.
Symptoms can include acute flank pain groin, or abdomen. Changes in body position
do not relieve this pain. (renal colic), nausea and vomiting, If infection is present in
the urinary tract along with the stones, there may be fever and chills. . Kidney stones
also characteristically cause blood in the urine. Some patients show no symptoms until
their urine turns bloody—this may be the first symptom of a kidney stone. The amount
of blood may not be sufficient to be seen, and thus the first warning can be
microscopic hematuria, when red blood cells are found in the microscopic study of a
urine sample, during a routine medical test. However, not every kidney stone patient
demonstrates blood in urine, even microscopically. About 15% of proven kidney stone
patients may not show even microscopic hematuria so this is not considered a
definitive diagnostic sign.
II
3. A Simple Mechanism to Understand Stone Formation:
Imagine a glass of water containing little salt .If you add some more salt, it dissolves.
When you add more and more salt, a stage is reached when the water is no longer able
to dissolve the salt added to it. This is because the solution is supersaturated with the
salt. Above this point, any little amount of salt added to the solution will start
precipitating. This is exactly the mechanism by which stones form except that the
solution is urine and the chemical composition of the salt is different.
- There are 3 main ways by which stones form in the urinary tract:
First a crystal has to form, then it has to grow and then a large number of such grown -
up crystals has to aggregate to each other before it becomes large enough to block the
urinary passage.
It would be comforting to know that nature has it own protective mechanisms to
prevent stone formation. Yes! There are certain substances in urine which interfere
with the growth and aggregation of crystals which are responsible for stone formation.
It is because of the presence of these substances in urine that most of us do not form
stones. The stone forming substances are kept in a dissolved state in our urine.
Diagnosis & Investigation:
Diagnosis is usually made on the basis of the location and severity of the pain.
Radiological imaging is used to confirm the diagnosis and a number of other tests can be
undertaken to help establish both the possible cause and consequences of the stone.
Ultrasound imaging is also useful as it will give details about the presence of
hydronephrosis (swelling of the kidney) suggesting the stone is blocking the outflow of
urine). It can also be used to show the kidneys during pregnancy when standard x-rays are
discouraged (damaging to the fetus).
About 10% of stones do not have enough calcium (very small stones) to be seen on
standard x-rays (radiolucent stones) and may show up on ultrasound although they typically
are seen on CT scans.
III
4. I.V.P. test The relatively dense calcium renders these stones radio-opaque and they can be
detected by a traditional x-ray of the abdomen that includes Kidney, ureters, and bladder,
This may be followed by an IVP (Intravenous Pyelogram) which requires about 50ml of a
special dye to be injected into the bloodstream that is excreted by the kidneys and by its
density helps outline any stone on a repeated X-ray. These can also be detected by similar
"dye" is injected directly into the ureteral opening in the bladder by a surgeon.
Some people might be allergic to this contrast if this the case, then this test cannot be done.
Computed tomography (CT or CAT scan), a specialized X-ray in this setting does not
require the use of intravenous contrast, which carries some risk in certain people (e.g.,
allergy, kidney damage). All stones are detectable by CT except very rare stones composed
of certain drug residues in urine.
The non-contrast "renal colic study" CT scan has become the standard test for the
immediate diagnosis of flank pain typical of a kidney stone. If positive for stones, a single
standard x-ray of the abdomen (KUB) is recommended. This additional x-ray provides the
physicians with a clearer idea of the exact size and shape of the stone as well as its surgical
orientation.
-Investigations typically carried out include:
Microscopic study of urine which may show proteins, red blood cells, pus cells,
cellular casts and crystals.
Culture of a urine sample done to look for the presence of urinary tract infection
(exclude urine infection)
Blood tests: Full blood count for the presence of a raised white cell count
(Neutrophilia) suggestive of infection, a check of renal function and if raised blood
calcium blood levels (hypercalcaemia).
24-hour urine collection to measure total daily urinary volume, magnesium, sodium,
uric acid, calcium, citrate, oxalate and phosphate.
IV
5. Treatment:
1. Conservative Management:
It is usually the treatment of choice for small stones in the kidney and ureter. Most of
such stones pass spontaneously in the urine (4 mm or less) without any need for
intervention. The probability of a stone passing down spontaneously will depend upon
the size of a stone, it’s location, shape etc. Such patients can be treated with anti-biotic
and analgesics to feel symptomatically better. Oral dissolution agents can also be given
for a considerable length of time. The patient is generally instructed to maintain a high
fluid intake ranging from 2 to 3.5 liters/day.
If a patient has severe abdominal pain associated with vomiting and fever, then
admission is usually required and intra-venous fluids may have to be given. this does not
help, then the stone may have to be removed by endoscopy.
2. Extracorporeal Shock Wave Lithotripsy (ESWL):
Shock waves are used to break up a large stone (greater than 6 mm) into smaller pieces
that can pass through the urinary system. It is a non – operative technique with no
necessity for anesthesia and involves minimal pain. Unlike the earlier open operation
treatment, ESWL does not involve any cutting of tissues and no scars are left after the
procedure.
The ESWL procedure usually lasts for about 40 minutes. But depending on the size
and number of stones, more than one session may be required for proper breaking of
the stones. Patients may be required to remain in the hospital for a day for observation.
After the procedure, the patient is advice to drink more plenty of fluids. This helps in
the passage of stone fragments in the urine.
3. Ureteroscopic Stone Removal:
It is ideally suited for stones in the lower portion of the ureter. It involves the passage
of an instrument namely ureteroscope through your urinary passage. The instrument is
as thick as a pen and is about 40 cm long. You may have to be admitted in the hospital
V
6. for a few days (2-3 days) for this procedure and it has to be done under anesthesia.
A variety of other instruments can be passed in through the scope which can be used to
break the stones and remove them. Very rarely it may so happen that the stone cannot
be removed by this method in which case open surgery may be needed.
4. Percutaneous Nephrolithotripsy:
This procedure is ideally suited for very large calculi within the kidney and the upper
ureter. In this procedure, a puncture is directly made on to the kidney, the stone is seen
with a telescope, broken into fragments and the fragments removed.
In some cases, it may not be possible to remove the entire stone. So a combination of
other procedures likes ESWL
5. Open Surgery:
In some cases, it might be required. The type of open surgery will depend upon the
site and size of the stone within the urinary tract.
Complication:
In 4 patients with cutaneous urinary diversion who underwent percutaneous ureteral
stone removal, similar ureteral complications developed as a result of severe ureteritis
at the site of the stone. Ureteral narrowing occurred within days of percutaneous
ureteral stone removal, progressing to complete occlusion in 2 cases. These
complications led to prolonged hospitalization and additional procedures for each
patient. One patient with an occluded ureter was lost to follow up. Two patients
responded satisfactorily to repeated ureteral dilations and prolonged stinting. One
patient underwent excision of the affected ureteral segment. The average interval
between tube placement and removal of tubes and stints was 15 weeks in 4 patients.
The average inpatient period was 24 days.
Prevention:
Preventive strategies include dietary modifications and sometimes also taking drugs
with the goal of reducing excretory load on the kidneys.
Drinking enough water to make 2 to 2.5 liters of urine per day.
A diet low in protein, nitrogen and sodium intake.
Restriction of oxalate-rich foods and maintaining an adequate intake of
dietary calcium is recommended. There is equivocal evidence that calcium
VI
7. supplements increase the risk of stone formation, though calcium citrate
appears to carry the lowest, if any, risk.
Taking drugs such as thiazides, potassium citrate, magnesium citrate and
allopurinol depending on the cause of stone formation.
Depending on the stone formation disease, vitamin B-6 and orthophosphate
supplements may be helpful, although these treatments are generally reserved
for those with Hyperoxaluria. Cellulose supplements have also shown
potential for reducing kidney stones caused by hypercalciuria (excessive
urinary calcium) although today other means are generally used as cellulose
therapy is associated with significant side effects.
thiazides
A class of drugs usually thought of as diuretic. These drugs prevent stones through an
effect independent of their diuretic properties: they reduce urinary calcium excretion.
Thiazides are the medical therapy of choice for most cases of hypercalciuria (excessive
urinary calcium) but may not be suitable for all calcium stone formers; just those with
high urinary calcium levels.
Allopurinol
Is another drug with proven benefits in some calcium kidney stone formers. Allopurinol
interferes with the liver's production of uric acid.
Hyperuricosuria, too much uric acid in the urine, is a risk factor for calcium stones.
Allopurinol reduces calcium stone formation in such patients. The drug is also used in
patients with gout or hyperuricemia, but hyperuricosuria is not the critical feature of uric
acid stones. Uric acid stones are more often caused by low urine pH. Even relatively
high uric acid excretion will not be associated with uric acid stone formation if the urine
pH is alkaline. Therefore, prevention of uric acid stones relies on alkalinization of the
urine with citrate.
Potassium citrate
Is also used in kidney stone prevention. This is available as both a tablet and liquid
preparation. The medication will increase the urinary pH making it more alkaline as well
as increasing the urinary citrate level, which helps reduce calcium oxalate crystal
aggregation.
Certain foods may increase the risk of stones
spinach, rhubarb, chocolate, peanuts, cocoa, tomato juice, grapefruit juice, apple juice,
soda (acidic and contains phosphorus), and berries (high levels of oxalate). In the United
States, the South has the highest incidence of kidney stones, a region where sweet tea
consumption is very common.
Other drinks are associated with decreased risk of stones, including wine, lemonade and
orange juice, the latter two of which are rich in citrate, a stone inhibitor.
Done by: Dina
VII