1. 1. CALCULI FORMATION Bonifacio | Bueno | Burton | Busa | Cariaga FEU NRMF Medicine 1-C
2. 2. CALCULI An abnormal or pathologic concretion or mass of mineral salts that occur in the body Precipitation or crystallization of minerals in organs such as the kidneys or the gall bladder CALCULI
3. 3. FORMATION CALCULI FORMATION
4. 4. GALLSTONE FORMATION
5. 5. FORMATION GALLSTONE FORMATION
6. 6. CALCULI GALLSTONES Cholesterol stones Most common Form when amount of cholesterol exceeds or supersaturates capacity of bile Pigment stones From crystallization of calcium bilirubinate May indicate infection Black or brown TYPES OF CALCULI
7. 7. CALCULI RENAL STONES Calcium stones Most common renal stones Contain Ca, PO4, oxalate Caused by excessive Ca in the body Hyperparathyroidism TYPES OF CALCULI
8. 8. CALCULI Uric acid Formed due to Low urine output High protein diet Increased alcohol intake Struvite Affect more women than men May accompany renal infections TYPES OF CALCULI RENAL STONES
9. 9. CALCULI RENAL STONES Cystine Rare Typically occur in individuals with family history of cystinuria TYPES OF CALCULI
10. 10. CALCULI GALLSTONES: Cholesterol Supersaturation of bile with cholesterol Intestinal hypomotility Excess in pro-nucleation factors, deficiency of anti-nucleation factors Hypersecretion of mucus in the gall bladder PROMOTING FACTORS
11. 11. CALCULI GALLSTONES: Pigment Elevated levels of unconjugated bilirubin in the blood Hemolytic diseases Severe ileal dysfunction Intestinal hypomotility Infection of the biliary tree Bacteria (E. coli) Parasite (Ascaris lumbricoides) Fungi (Ophiocordyceps sinensi) PROMOTING FACTORS
12. 12. CALCULI RENAL STONES Slow urine flow Damaged urinary tract lining Absence of inhibitory proteins (nephrocalcin, Tamm-Horsfall protein, uropontin) Intake of medication Dehydration PROMOTING FACTORS
13. 13. CALCULI RENAL STONES Urine pH Acidic pH: favour precipitation and formation of uric acid stones and cystine stones Alkaline pH: CaPO4 stones and struvite stones PROMOTING FACTORS
14. 14. CALCULI RENAL STONES Sufficient consumption of water Decreased protein intake Reduced sodium consumption Frequent drinking of water PREVENTIVE FACTORS
15. 15. CALCULI RENAL STONES Normal concentration of urine elements Normal urine parameters (volume, pH, etc) Presence of inhibitory proteins (Tamm- Horsfall protein, nephrocalcin, uropontin) Prevention of urine stasis (timely and sufficient voiding) PREVENTIVE FACTORS
16. 16. CALCULI GALLSTONES Normal composition of gall bladder contents Low-fat, low-cholesterol diet High fiber intake Decreased sugar consumption Physical exertion/exercise PREVENTIVE FACTORS
17. 17. CALCULI CHOLELITHIASIS UROLITHIASIS Increasing age Middle aged (35-45) Female gender Male gender Gall bladder stasis Urinary stasis Pregnancy Geography Diet, obesity, physical inactivity Diet, obesity Ethnicity Nationality Cirrhosis History of cystinuria Family history Family history of nephrolithiasis Ileal disease, ileal resection Chronic UTI Medications Dehydration Rapid weight loss RISK FACTORS
18. 18. CALCULI CLDN-14 Polymorphisms occuring at: Calcium-sensing receptor (CSR) Vitamin D receptor (VDR) Osteopontin (OPN) GENETIC BASIS OF PREDISPOSITION
19. 19. CALCULI GALLSTONES Pulsating, propagating pain that disappears shortly after it begins Pain in the upper right portion of the abdomen Pain immediately below the area of the breast Pain in the right shoulder Referred pain CLINICAL MANIFESTATIONS
20. 20. CALCULI RENAL STONES Severe pain in the back and sides of the abdomen, just below the ribs May spread to groin area In the case of an infection, symptoms include nausea or vomiting, fever, and chills CLINICAL MANIFESTATIONS
21. 21. CALCULI RENAL STONES CLINICAL MANIFESTATIONS Painful urination Hematuria or pink, red, or brown urine with a foul odour Changes in the voiding pattern Small amounts of urine may be voided at a time.
22. 22. CALCULI RENAL STONES Severe renal obstruction and the possibility of infection Kidney failure GALLSTONES Gall bladder inflammation Common bile/pancreatic duct blockage Gall bladder cancer COMPLICATIONS
23. 23. CALCULI RENAL STONES Urine examination Hematuria Pyuria BUN, creatinine, and electrolytes Abdominal ultrasound Intravenous pyelogram (IVP) LAB DIAGNOSIS
24. 24. CALCULI GALLSTONES Elevated serum aminotransferase, alkaline phosphatase, bilirubin and amylase Blood test: look for signs of infection, obstruction, pancreatitis, or jaundice. Oral cholecystogram Bile microscopy Cholescintigraphy Physical examination (Murphys technique) MRI, CT scan, ultrasound LAB DIAGNOSIS
25. 25. CALCULI GALLSTONES DIAGNOSIS
26. 26. CALCULI GALLSTONES Administration of Ursodiol Contact distribution therapy Use organic solvent methyl tert-butyl ether (MTBE) Surgical removal TREATMENT
27. 27. CALCULI RENAL STONES Extracorporal shockwave lithotripsy (ESWL) Percutaneous nephrolithotomy Ureteroscopy Open surgery Medication TREATMENT
28. 28. CALCULI RENAL STONES TREATMENT Etiology Intervention Dosage/Recommendation URIC ACID Normal 24-h uric acid levels, but urine pH 7; Chronic infection of genitourinary tract with urease-producing bacteria (Proteus, Pseudomonas, or Kiebsiella spp) or yeast Surgical treatment (preferred) Ureteroscopy, percutaneous nephrolithotomy Urease inhibitors AHA; 250 mg tid-qid (up to 1, 500mg in24 h) Hydroxyurea: 500mg qd Antibitotics (short duration) Ciprofloxacin: 250-500mg bid Levofloxacin: 250-750mg qd Ofloxacin: 200mg bid Urine acidifiers Ammonium chloride: 1, 000mg bid-tid Methionine: 200-500mg qd- tid Betaine: 650mg tid with a meal Cranberry juice: > 16 oz in 24h
29. 31. CALCULI FORMATION THANK YOU!