Aortic Dissection
play_arrow Aortic Dissection Dr Swapnil Pawar Aortic Dissection Stanford Classification Type A – Involves the ascending aorta, regardless of the origin of the primary tear Type B – All other […]
Remifentanyl Vs Fentanyl Dr Swapnil Pawar
Analgesics Dr Swapnil Pawar
Effects of the sudden and sustained increase in LV Afterload Dr Swapnil Pawar
Renal Calculus
Dr Swapnil Pawar
Management of Renal Calculi
Reasons for admission:
– Inability to tolerate oral intake due to nausea and vomiting
– Uncontrollable pain
– Fever
For all renal calculi:
Regular analgesia, often requiring NSAID’s and opiates
Anti-emetics if nauseous and vomiting
Advised patient to strain when voiding to encourage the passing of the stone
If <5mm – appropriate for outpatient management
If 5-10mm – appropriate for outpatient management. Tamsulosin can be commenced to encourage spontaneous passage of stone
If >10mm – Unlikely to pass spontaneously, and hence, urological referral for surgical intervention is advised
If stones <10mm do not pass spontaneously within 4 weeks, then urological input is also advised. Potential options for surgical input include:
– Shock Wave Lithotripsy
– Ureteroscopy with lithotripsy
– Percutaneous nephrolithotomy
In rare cases – laparoscopic stone removal may be indicated
At any point in time, if the patient spikes fevers or becomes septic, then urgent urology referral is warranted for a stent or nephrostomy for decompression
Prevention of Renal Calculi
For all stones, recommended measures include:
– Increased fluid intake to decrease the concentration of urine and hence, risk of precipitation
– Weight loss
– Decreased sodium intake
– Increased fruit and vegetable intake
Additional measures can be considered depending on the composition of the stone:
Calcium oxalate/phosphate
– Maintaining adequate calcium in diet (hypocalcemia worsens risk)
– Reduce animal protein intake
– Limit sucrose and fructose intake
Uric Acid
– Alkalinisation of urine
– Uric acid-lowering therapy (i.e. xanthine oxidase inhibitor)
Cystine
– Alkalinisation of urine
– Thiol containing drugs (i.e. tiopronin, D-penicillamine)
Struvite
– Antimicrobial therapy
– Urease inhibitors
References:
Curhan, G.C., Aronson, M.D., Preminger, G.M. (2021) Kidney stones in adults: Diagnosis and acute management of suspected nephrolithiasis. UpToDate. Retrieved 28th August 2021 from https://www.uptodate.com.acs.hcn.com.au/contents/kidney-stones-in-adults-diagnosis-and-acute-management-of-suspected-nephrolithiasis
Curhan, G.C. (2021) Kidney stones in adults: Prevention of recurrent kidney stones. UpToDate. Retrieved 28th August 2021 from https://www.uptodate.com.acs.hcn.com.au/contents/kidney-stones-in-adults-prevention-of-recurrent-kidney-stones
Dr Swapnil Pawar August 25, 2021
play_arrow Aortic Dissection Dr Swapnil Pawar Aortic Dissection Stanford Classification Type A – Involves the ascending aorta, regardless of the origin of the primary tear Type B – All other […]
Dr Swapnil Pawar September 13, 2024
Dr Swapnil Pawar August 1, 2024
©Allrights reserved. Get Your Web Site Designed By St.George Web Design. Get a quote on your web design.