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Soca Review Genitourinary System Case 1-Urinary Stone

Soca Review Genitourinary System Case 1-Urinary Stone

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Published by: Imania Salim Ahmad Bawazier on Jul 14, 2012
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11/09/2013

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SOCA REVIEW GENITOURINARY SYSTEMCASE 1: URINARY STONE
BASIC SCIENCE
1.
ANATOMY OF URINARY TRACT (REVIEW)
2.
HISTOLOGY OF URINARY TRACT (REVIEW)
CLINICAL SCIENCE
1.
FLANK PAIN
a.
Definition
i.
An unpleasant sensation associated with actual or potential tissue damage,and mediated by specific nerve fibers to the brain where its consciousappreciation may be modified by various factors and felt in thecostovertebral angle just lateral to the sacrospinalis muscle and just belowthe 12
th
rib
 b.
Classification
i.
Local = felt in or near the involved organ. Felt in the costovertebral angle just lateral to the sacrospinalis muscle and just below the 12
th
rib. (T10-12,L1)
ii.
Referred = originated in a diseased organ but is felt at some distance fromthat organ. Classification:
1.
Upper ureter = severe pain in the ipsilateral testicle (T11-12).
2.
Midportion of ureter, right = Mc Burney’s point, left = (T12, L1).
3.
Bladder = inflammation and edema of the ureteral orifice, symptomof vesical irritability.
c.
Differentiation between dull and colicky pain
i.
Dull pain = typical renal pain and constant ache in the costovertebral angle just lateral to the sacrospinalis muscle and just below the 12
th
rib.
ii.
Colicky pain = stimulated by acute obstruction, severity and colicky natureof this pain are caused by the hyperperistaltis and spasm. This pain radiatedfrom the costovertebral angle down towards lower anterior abdominalquadrant, along the course of ureter.
d.
Cause of flank pain
i.
Distension of the renal capsule
ii.
Sudden edema
iii.
Sudden renal back pressure
2.
HEMATURIA
a.
Definition
i.
Any condition in which the urine contains blood or red blood cells. (as fewas 5 X 10
6
red cells per milliliter / 1 microlitre of blood per mililitre of urine).
 b.
Cause
 
i.
Lesion anywhere within the urinary system including the kidney itself, therenal pelvis, ureter, bladder, and urethra.
ii.
The relationship of the blood to urine:
1.
Bladder or above (uniform discoloration of urine)
2.
Urethra (blood separate / mixed with urine)
iii.
The relationship of the structure:
1.
Renal parenchyma
accompanied by proteinuria and casts,abnormal morphology of red blood cells
2.
Renal tumors / lesions in the renal pelvis or below
isolated or associated with pyuria if there is any infection. Red blood cells have biconcave appearance.
c.
Distinguishing factor from other condition
i.
Certain dye and occasional drug.
ii.
Intravascular hemolysis and rhabdomyolisis.
iii.
Bleeding outside the urinary tract.
d.
Diagnostic method
i.
Plain abdominal X-ray.
ii.
Ultrasonography (provide information about renal size, renal mass lesions,and renal pelvic and ureteric dilatation.
3.
URINARY STONE
a.
Definition
i.
Polycrystalline aggregates composed of varying amounts of crystalloid andorganic matrix.
 b.
Epidemiology
i.
450,000 visits to EDs annually.
ii.
Approximately 12% for men and 7% for women in the United States.
iii.
Male-to-female ratio is approximately 3:1.
c.
Pathogenesis
i.
Supersaturation that depends on: urinary pH, ionic strength, soluteconcentration, and complexation.
ii.
The nucleation theory.
iii.
The crystal inhibitor theory (including magnesium, citrate, pyrophosphate,and a variety of trace metals).
d.
Composition of stone
i.
Stone analysis, based on initial 24-h urine collection for calcium stoneformers.
 
e.
Risk factor 
i.
Crystalluria.
ii.
Socioeconomic factors.
iii.
Diet.
iv.
Occupation.
v.
Climate.
vi.
Family history.
vii.
Medications.
f.
Clinical sign & symptom
i.
Pain.
ii.
Hematuria.
iii.
Infection.
iv.
Associated Fever.
v.
 Nausea and Vomiting.
g.
Diagnostic modality
i.
History.
ii.
Physical Examination.
iii.
Radiologic Investigations.
1.
Computed tomography.
2.
Intravenous pyelography.
3.
Tomography.
4.
KUB films and directed ultrasonography.
5.
Retrograde pyelography.
6.
Magnetic resonance imaging.
7.
 Nuclear scintigraphy.
h.
Differential diagnosis
i.
A full differential diagnosis of the acute abdomen should be made,including acute appendicitis, ectopic and unrecognized pregnancies, ovarian pathologic conditions including twisted ovarian cysts, diverticular disease, bowel obstruction, biliary stones with and without obstruction, peptic ulcer disease, acute renal artery embolism, and abdominal aortic aneurysm
i.
Management

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