This document provides an overview of urolithiasis (urinary stones). It discusses the epidemiology, risk factors, types, pathogenesis, clinical presentation, diagnosis, and management of urinary stones. The main types of stones are calcium oxalate, calcium phosphate, uric acid, infection stones, and cystine stones. Diagnosis involves urinalysis, blood tests, radiography, ultrasound, and CT. Treatment options include medical expulsive therapy, extracorporeal shockwave lithotripsy, ureteroscopy, percutaneous nephrolithotomy, and open surgery. Recurrence risks are reduced through lifestyle changes like increased fluid intake and dietary modifications.
MI is one of the CVS complication leading to mortality whose diagnosis is mainly dependent on clinical presentation and other supportive investigation. clinical laboratory plays crucial role in its diagnosis, prognosis and monitoring therapy.
MI is one of the CVS complication leading to mortality whose diagnosis is mainly dependent on clinical presentation and other supportive investigation. clinical laboratory plays crucial role in its diagnosis, prognosis and monitoring therapy.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
the lecture is about hemolysis during hemodialysis, which is an acute complication arising during hemodialysis session, this lectures will cover the all aspects of hemolysis including prevention , management, investigation, , sign and symptoms arises due to hemolysis. the mechanical shear stress related hemolysis, dialysate related factors, as well as patient related factors induces hemolysis.
It is the review research based topic of presentation on most important body's serum electrolytes "potassium". it is really a very useful effort to collecting the data material from such a many different websites and pages as i gave references in the end of this presentation.
Basic approach to a case of anemia. Investigations to do and to arrive at the diagnosis. (Management not discussed). Peripheral smear findings with pictures are included.
UAEU - CMHS - Hematology-Oncology Course - MMH 302 - HONC 320. Education material for medical students - It cover basic principles of hematology and oncology, including CAR-T and gene editing. It can be used for study and review. It illustrates main principles of hematology and oncology.
a clinical syndrome that results from inadequate tissue perfusion.
Hypovolemic shock - Blood or fluid loss, both leading to a decreased circulating blood volume, diastolic filling pressure, and volume.
Cardiogenic shock - due to cardiac pump failure related to loss of myocardial contractility/functional myocardium or structural/mechanical failure of the cardiac anatomy and characterized by elevations of diastolic filling pressures and volumes
Extra-cardiac/obstructive shock - due to obstruction to flow in the cardiovascular circuit and characterized by either impairment of diastolic filling or excessive afterload
Distributive shock - caused by loss of vasomotor control resulting in arteriolar/venular dilatation leading to a decrease in preload, with decreased, normal, or elevated cardiac output, depending on the presence of myocardial depression.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
the lecture is about hemolysis during hemodialysis, which is an acute complication arising during hemodialysis session, this lectures will cover the all aspects of hemolysis including prevention , management, investigation, , sign and symptoms arises due to hemolysis. the mechanical shear stress related hemolysis, dialysate related factors, as well as patient related factors induces hemolysis.
It is the review research based topic of presentation on most important body's serum electrolytes "potassium". it is really a very useful effort to collecting the data material from such a many different websites and pages as i gave references in the end of this presentation.
Basic approach to a case of anemia. Investigations to do and to arrive at the diagnosis. (Management not discussed). Peripheral smear findings with pictures are included.
UAEU - CMHS - Hematology-Oncology Course - MMH 302 - HONC 320. Education material for medical students - It cover basic principles of hematology and oncology, including CAR-T and gene editing. It can be used for study and review. It illustrates main principles of hematology and oncology.
a clinical syndrome that results from inadequate tissue perfusion.
Hypovolemic shock - Blood or fluid loss, both leading to a decreased circulating blood volume, diastolic filling pressure, and volume.
Cardiogenic shock - due to cardiac pump failure related to loss of myocardial contractility/functional myocardium or structural/mechanical failure of the cardiac anatomy and characterized by elevations of diastolic filling pressures and volumes
Extra-cardiac/obstructive shock - due to obstruction to flow in the cardiovascular circuit and characterized by either impairment of diastolic filling or excessive afterload
Distributive shock - caused by loss of vasomotor control resulting in arteriolar/venular dilatation leading to a decrease in preload, with decreased, normal, or elevated cardiac output, depending on the presence of myocardial depression.
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.
Common disorder with an annual incidence of 0.1% to 0.5%.
The peak age at onset is 20 to 30 years
Men > Women ( until 50s )
Wide geographic variations exist, due to differences in diet and water composition, as well as ambient and sunlight exposure. 5-9% in Europe 20% in Saudi Arabia
List the signs/symptoms and differential diagnoses of an acute stone episode
Describe the imaging studies available to diagnose ureteral calculi.
List the classes of medications effective for treating the pain of renal colic.
Outline the basic treatment options for ureteral stone
Describe the clinical scenarios requiring urgent decompression of a ureteral stone.
List the basic principles of stone preventi
renal stone ppt in a ppt on renal stones , types, classifiv\cation of the stones and the manahgement of the renal stones. the rndoscopic procedures have been described well in detail and even the open surgeries have been explaned , it has nice intra op pics and instrument pics and
Lifestyle recommendation in patient of kidney stones to reduce the riskSiddesh Dhanaraj
A brief recommendation in patients of kidney stones. Management, complications, Methods to prevent kidney stones (Non-medical & Medical),Do's and Dont's in Kidney stone.
CHOLELITHIASIS, NEPHROLITHIASIS SECONDARY HYPERTENSION, DM TYPE 2, HYDRONEPH...Jack Frost
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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.
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3. INTRODUCTION
Urolithiasis is as old as mankind
The first documented cystolithotomy was described by Sushruta,
an ancient Indian surgeon in almost 600 BC.
5. NON-MODIFIABLE FACTORS
Age:
o For men , fourth to sixth decade.
o For women, bimodal peak in third decade and the
postmenopausal period.
Gender:
Male: Female = 2:1
Ethnic origin: More in White people
Family history: Contributes 2.5 times
6. MODIFIABLE FACTORS
Environmental factors:
More in hot and arid regions
Drugs:
Drugs can predispose to stone formation through metabolic effects
(e.g. corticosteroids, chemotherapeutic agents).
8. PATHOGENESIS
1. Concentration of culprit salts (eg-calcium
and oxalate) overwhelm inhibitory factors
(e.g. citrate, potassium, magnesium, Tamm–
Horsfall mucoproteins, pH changes)
2.Stasis of urine
Precipitation of Crystals
Stone Formation
9. Contd
Acidic pH precipitates the formation of uric acid stones
Alkaline pH precipitates the formation of calcium phosphate
stones.
Stasis stones are usually multiple, round and have a smooth
surface. These are called ‘milk of calcium stones
Infection also contribute to stone formation
11. CALCIUM OXALATE STONES
This is the most common type of stone(60–85%)
Hypercalciuria, hypercalcaemia, hyperoxaluria, hyperuricosuria
and hypocitraturia are known metabolic abnormalities
Primary hyperparathyroidism is the most common disease
Hyperuricosuria causes uric acid crystal formation, especially in
association with acidic urine, over which calcium oxalate crystals
aggregate.
13. CALCIUM PHOSPHATE STONE
Pure calcium phosphate stones are rare.
Common forms seen are apatite and brushite stones.
Apatite is seen with infection and brushite stones are usually
seen with distal RTA
15. URIC ACID STONES
Hyperuricosuria promotes the formation of both calcium oxalate
and uric acid stones.
Uric acid precipitates into crystals in acidic urine and remains
soluble in alkaline urine.
Common in gout and myeloproliferative disorders after cytotoxic
treatment.
16. CYSTINE STONES
1% of stones
Cystinuria is an autosomal recessive inherited disease
Cystine stones are very hard stones as a result of disulphide
bonds and do not fragment with SWL.
18. INFECTION STONES
These are struvite and apatite stones.
Urease-producing bacterial (Proteus, Klebsiella, Serratia or
Enterobacter )
Staghorn calculi are infection stones that grow in a branching
pattern, taking the form of the pelvicalyceal system.
20. CLINICAL PRESENTATION
The presenting symptoms depend on the location, size and type
of stone:
May be asymptomatic
Haematuria
Ureteric colic radiating to groin, scrotum or labia
High grade fever with chills
Calculuria
Urgency and frequency.
Malaise and weight loss
22. INVESTIGATIONS
Urinary examination (Urine RE and CS)
Blood examination
A radiograph of the kidneys, ureters and bladder are good first-
line tests
USG
Non-contrast CT (NCCT) is the investigation of choice for the
diagnosis of stones
Other required tests to roll out the causes or effects
25. METABOLIC EVALUATION
Depends on the risk associated with the recurrence of stone
formation, in child patients and bilateral stone cases.
Urinary examination is done to look at crystals and pH
Serum levels of calcium, phosphorus and uric acid
PTH
26. NON-SURGICAL MANAGEMENT OF STONE
1. Watchful waiting (<5 mm, non-obstructive, asymptomatic, lower
pole renal calculi)
2. Medical expulsive therapy (by Tamsulosin, an α1-adrenergic
adreno-receptor blocker)
3. Extracorporeal shockwave lithotripsy (ESWL)- Acoustic pulse
waves are generated and focused on the stone
28. SURGICAL MANAGEMENT
Indications for surgical intervention:
1. Failure of medical management
2. Impaired renal function
3. Chronic infection – staghorn calculi, matrix calculi
4. High-risk occupation or geographical location – pilots, long-
distance locomotive drivers, sailors.
5. Patient’s preference
29. SURGICAL OPTIONS
Endourology
1. Ureterorenoscopy
2. Retrograde intra renal surgery
3. Percutaneous nephrolithotomy
Non-endourological surgical management
1. Open surgery such as pyelolithotomy and
2. Anatrophic nephrolithotomy
31. Contd
Ureterorenoscopy
long thin scopes
They have working channels that allow for the introduction of
energy sources, graspers and baskets.
A semi rigid URS is usually used with a pneumatic lithotripter or
laser energy device.
32. Retrograde intra renal surgery
A slimmer and more fexible URS
This procedure avoids the morbidity associated with
percutaneous nephrolithotomy (PCNL).
Laser is used as an energy source for stone fragmentation.
Indications for retrograde intrarenal surgery (RIRS),Renal stones
<2 cm, Lower pole calculi,Obesity,Musculoskeletal deformities
(e.g. kyphoscoliosis) and renal anomalies (HSK or pelvic
kidney),Bleeding diathesis.
33. Percutaneous nephrolithotomy
PCNL involves removal of renal stones by creating a track
between the skin and the pelvicalyceal system.
Fluoroscopy or US is used for localisation.
The posterolateral calyx is commonly chosen for entry
US in conjunction with pneumatic and laser lithotripsy
34. PREVENTION OF RECURRENT STONE
DISEASE
General measures advised to all patients include:
fluid intake of more than 2.5 litres per day
Dietary calcium should not be restricted
Supplemental calcium, if necessary, should be taken at meal
times
Reduce intake of animal protein and salt
35. COPMPLICATIONS IF UNTREATED
Urinary tract obstruction
Infectious complications
loss of renal function
Bilateral obstructing ureteric stones in a solitary kidney can
present with anuria
pyelonephritis, pyonephrosis, renal abscess or septicaemia.
Pyelo-enteric or cutaneous fistulae in neglected cases
Nephron loss can occur as a result of recurrent episodes of
infection and obstruction, causing chronic renal failure.
36. CONCLUSION
Although the incidence of urinary stones has declined
progressively owing to the alleviation of poverty and the
improvement in basic nutrition, the modern world is witnessing a
steady increase in the incidence of renal calculi.
Timely intervention can eliminate the suffering of the patients.