Question

4. The top priority need for Dennis is elimination, can you tell elimination, can you tell me after y your data can you be more specific with the problem? How would the stone in Dennis's bladder contribute to the elimination problem?

Answer 1

Renal calculi /Stone/Nephrolithiasis:

A kidney stone is a hard solid mass of material that forms in the kidney from the substances in the urine.Kidney stones or calculi develop as a result of various metabloic disorders which affect the fate of calcium and other mineral elements in the body.Stones may be formed in the kidney, urinary bladder,ureter and urethra.

A kidney stone, also known as a renal calculus or nephrolith, is a solid piece of material which is formed in the kidneys from minerals in urine

Risk factor:

• Imbalance of pH in urine ◦ Alkalic:-Calcium stone ◦ Acidic:-Uric & cristine stone
• Gout
• Hyperparathyroidism
• taking medications such as triamterene diuretics, antiseizure drugs, and calcium-based antacids
• inflammatory bowel diseases that increase calcium absorption
• a diet with high levels of protein, salt, or glucose
• dehydration
• obesity

Etiology:

There are mainly 5 types:-

• Calcium oxalate stone (Is the most common 80% ):Caused by super -saturation of urine with calcium & oxalate Calcium oxalate stone tend to form in alkaline chemistry ( Avoid food high in oxalate(beer, wheat germ, spinach)
• Calcium phosphate stone:Caused by super -saturation of urine with calcium phasphate. Calcium phosphpate stone tend to form in alkaline chemistry (Avoid food high in calcium (Milk & dairy product)
• Struvite stone (Triple stone) : Caused by urea splitting bacteria (Proteus, Pseudomonas, Klebsiella, Staphylococcus) –more common women then the man because of UTI Struvite stone stone tend to form in alkaline chemistry
• Uric acid stone: Caused by excessive dietary purine or gout Uric acid stone tend to form in Acidic urine (Avoid purine sources eg. Meats, gravies, red wine)
• Cystic stone : Caused by cystine crystal formation Cystic stone stone tend to form in Acidic urine ( cystine source Avoid meat milk ,cheese, Egg)

Urine saturation Supersaturation Crystal nucleation Aggregation Retention and growth

symptoms:

• Severe pain in the side and back, below the ribs
• Pain that spreads to the lower abdomen and groin
• Pain that comes in waves and fluctuates in intensity
• Pain on urination
• Cloudy or foul-smelling urine
• Nausea and vomiting Fever and chills if an infection is present
• Urinating small amounts of urine Clinical manifestation
• blood in urine

investigation:

• Blood
• Urine-analysis
• Cystoscopy
• X-ray
• CT scan, MRI
• Intravenous urogram (IVU) or intravenous pyelogram
• USG
• KUB Diagnostic evaluation

treatment:

• Medical management:
• Analgesic
• Spasmotic eg Buscopan
• NSAIDs eg Steroid
• Maintain I/O charting
• Provide rest Management

Noninvasive Surgical management:-

• Lithotripsy (Extracorporeal Shockwave lithotripsy (ESWL)

Open procedure:-

• Ureterolithotomy
• Pyelolithotomy
• Nephrolithotomy
• Partial or total nephrectomy

here in the case of dennis 52 year old complaint of having pain in his back and abdomen and painful urination with blood.he often drinks coffee and diet soda and use medication for heartburn which suggests possibility of stone formation.he delays urination as long as possible because of pain.small calcium crystals,rbc and bacteria suggest blood on urine and infection.x-ray also reveals a stone size of 1.2 cm.so the treatment consideration of dennis must be an elimination of the stone.