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© Hairuhusiwi kukopi bila kibali cha ULYCLINIC
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Urolithiasis

Introduction

This is a calculus which has formed in the urinary tract i.e. calyx, renal pelvis, ureters or urinary bladder as a result of urine which is supersaturated with respect to a stoneforming salt.

Risk factors

Signs and Symptoms

Diagnostic criteria

• Sudden onset of acute colic, localized to the flank, causing the patient to move constantly.
• nausea and vomiting
• blood in urine
• referred pain to the scrotum or labium on the same side as the stone moves down the ureter
• Urinalysis with features of infection or microscopic haematuria
• Ultrasound with an acoustic shadow with features of obstructive uropathy eg. Hudroureter or hydronephrosis
• Plain x-ray can pick up to 90% of calculi as they are radio-opaque
• Conventional intravenous urogram or CT urography confirms upper urinary tract lithiasis.

Investigation

Management

  • Pharmacological

    Analgesia for pain, if needed:

    • Ibuprofen (PO) 400mg 8hourly for 3 days
    OR
    • Tramadol inj 100mg stat then continue with PO 50mg 8 hourly For distal ureteric calculi less than 7mm D: Tamsulosin 0.4 mg (PO) once daily for a month may be prescribed for spontaneous stone expulsion.

    Note: Refer patients for surgical interventions in centres where there is expertize and equipment
  • Non-pharmacological

    • Ensure adequate hydration. (Drink water 2.5 to 3 litres per day, diuresis more than 2.5 litres of urine)
    • Nutritional advice for a balanced diet-rich in vegetables and fibre, normal calcium content1-1.2 g/day limited NaCl content (4-5 g/day), limited animal protein content0.8-1.0g/kg/day
    • Surgical intervention is indicated
    • For patient with obstructive uropathy and infection, emergency decompression is indicated by percutenous nephrostomy placement or ureteric DJ Stenting

Prevention

Updated on,

23 Novemba 2020 12:29:46

References

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