Urolithiasis Powerpoint

7/27/2019 Urolithiasis Powerpoint

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STUDY:

UROLITHIASI

S


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CHAPTER 1

INTRODUCTION


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Urolithiasis the process of forming stones in thekidney, bladder, and or urethra (urinary tract).

Kidney stones are common cause of blood in the urine

and the pain in the abdomen. Flank, or groin. Kidneystones occur in 1 in 20 people at some time in theirlife.

The pain in kidney stones is usually of sudden onset,

very severe and colicky (intermittent), not improved bychanges in positions, radiating from the back, downthe flank, into the groin.

The development of the stone is related to decreased

urine volume or increased excretion of stone formingcomponents such as calcium, oxalate, urate, cystein,xanthiene, and phosphate.

The stones form in the urine collecting area (the

pelvis) of the kidney and may range in size from tiny tostaghorn stones the size of the renal pelvis itself.


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Nature of the Disease

Urinary Calculi (urolithiasis) are classified in the

urinary system. Commonly called stones, calculi fromprimarily in the kidney (nephrolithiasis), but they canform or migrate to the lower urinary system. They aretypically asymptomatic until they pass into the lower

urinary tract. Stones are usually managed by anurologist. Primarily bladder calculi are rare andusually develop from a history urinary stasis fromobstruction or chronic infection.

The two primarily causative factors are (1) urinarystasis and (2) supersaturation of the urine with poorlysoluble crystalloids. Increased solute concentrationoccurs because of fluids depletion or an increasedsolute load. This increased concentration leads to the

precipitation of crystals, such as calcium, uric acid,


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Factors in Urinary Stone FormationFactors Comment

Climate a hot climate may contribute to excessive sweating causing the urinary

constituents become concentrated and precipitate.

Occupation Workers exposed to very high temperature like boiler men and miners

may sweat excessively and may have a situation similar to the above.

Dietary Factors Some dietary factors like low fluid intake, nutrient deficiency, or an

excess intake certain nutrients like calcium and vit. D have been

implicated in the formation of renal calculi but the evidences are notconclusive.

Prolonged Immobilization A rapid withdrawal of calcium result when an individual is immobilized

and this cases excretion of calcium in the urine.

Certain biochemical abnormalities If the tubules fails to absorb the amino acids like cystine and lysine,

large amounts of these amino acids will appear in the urine, will

precipitate and forms stones.

Excessive excretion of uric acid This occurs if there is derangement in the intermediary metabolism of

purines, as in gout.

Infections Some organisms responsible for urinary infections are irea splitting,

liberating NH3 which alkanizines urine. Any chronic infections of the

urinary tract gives rise to some cells: pus cells, dead bacteria, andepithelial cells and may give to stone formation.


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Types of Calculi

Calcium- most common substance and it is in up

to 90% of stones. Calcium stones are usuallycomposed of calcium phosphate or calcium

oxalate.

Oxalate- second major cause, most common inareas where cereals are major dietary

components and low dairy farming regions.

Struvite- triple phosphate composed of

carbonate and magnesium ammonium

phosphate. These are caused by bacteria,

usually proteus which contain enzyme urease.


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Physiology of the Organ The Urinary system which also called the excretory

system or the genitourinary system is the organ systemthat produces, stores, and eliminates urine. In humans,it includes two kidneys, two ureters, the bladder, andthe urethra.

The kidneys are bean shaped organs, which lie in the

abdomen, nump or retroperitoneal to the organs ofdigestion, around or just below the ribcage and theclose to the lumbar spine.

The organ is about the size of a human fist and is

surrounded by what is called peri- nephric fat, andsituated on the superior pole of each kidney is anadrenal gland.

The kidneys receive their blood supply of 1.25 L/min(25% of the cardiac output) from the renal arteries

which are fed by abdominal aorta.


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This is important because the kidneys main role is tofilter water soluble waste product from the blood. Theouter attachment of the kidneys are their functional

endpoints the ureters, which lies more medical andruns down to the trigone of the bladder.

Functionally the kidney performs a number of tasks.In its role in the urinary system it concentrate urine,

plays a crucial role in the regulating electrolytes, andmaintains acid-base homeostasis.

The kidney excretes and re- absorbs electrolytesunder the influence of local and systemic hormones.

Ph is regulated by the excretion of bound acids andammonium ions. In addition, they remove urea, anitrogenous waste products from the metabolism ofproteins from amino acids. The endpoint ishyperosmulen solution carrying waste for storage inthe bladder prior to urination.


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Human produce about 1.5 liters of urine over 24

hours, although this amount may vary according

to circumstances. Because the role of filtration atthe kidney is proportional to the glomerular

filtrate rate, which is turn related to the blood

flow through the kidney, changes in fluid status

can affect kidney function.

Hormones exogenous and endogenous to the

kidney alter the amount of the blood flowing

through the glomerulus. In human and other related organisms, the

urinary bladder is a hollow muscular organ

shaped like a balloon, located in the anterior

pelvis.


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The bladder stores urine. The maximum that it

can holds is one (1) L. It swells into a round

shape when it is full and gets smaller whenempty. In the absence of bladder disease, it can

hold up to 300 ml of urine comfortably for two to

five hours. The epitheal tissue associated with

the bladder is called transitional epithelium,

normally the bladder is sterile.

Sphinters (circular muscles) regulate the flow of

urine from the bladder. The bladder itself has amuscular layer (detrusor muscle) that, when

contracted increases pressure on the bladder

and creates urinary flows.


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Urination is a conscious process, generally

initiated by stretch receptors in the bladder wall

which signal to the brain that the bladder is full.This is felt as an urge to urinate. When urination

is limited the sphinter relaxes and the detrusor

muscle contracts, producing urinary flow.

The endpoint of the urinary system is the

urethra. Typically the urethra in humans is

colonized by commensal bacteria below the

external urethral sphincter. The urethra emergesfrom the end of the penis in males and between

the clitoris and the vagina in females.


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Pathophysiology

The exact mechanism of stone formation

has not clearly defined. A primarily factor instone formation is the supersaturation of the

urine with elements such as calcium,

phosphate, and oxalate. Certain factorscontribute to the ease of stone formation.

These factors include the pH of the urine,

the amount of solute in the urine, and the

amount of solution or urine. Problems with

purine metabolism predispose to the

formation of uric acid stones.


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Prolonged immobility leads to urinary

stasis and, because of calciummobilization from the bones, an

increase in serum and urine calcium.

If the fluid is also inadequate, thenthe calcium saturating the urine is

more likely to precipitate out from

stones.


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The pH of the urine also contributes

to stones formation or stone

dissolution. Uric acid and cystine

stones are more likely to precipitate

in acid urine; calcium phosphate andstruvite stones are more common in

alkaline urine. Oxalate stones are not

affected by urine pH.


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Signs and symptoms:

Pain

Nausea and vomiting Fever

Hematuria

Pyuria

Anuria

Possible Complication of the Disease:

Complication of Urolithiasis include abscessformation, pyelonephritis, urinary fistula formation,ureteral scarring, and perforation, urosepsis andloss of kidney secondary to longstanding

obstruction.


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Definition of terms: Calculi- is a stone ( a concretion of material, usually

mineral salts) that forms in an organ or duct of the body.

Bladder- an elastic, muscular sac situated in the interiorpart of the pelvic cavity in which urine collects beforeexcretion.

Urinary tract- the organs of the body that produce, store

and discharge urine. Sphinters- regulate the flow of urine from the bladder.

Oxaluria- the excretion of an excess of oxalic acid or

oxalates, especiallt calcium oxalate in the urine. Proteus- a bacterium (genus proteus) found in the

intestines of the animals and in the soil.

Hematuria- presence of red blood cells in the urine.

Pyuria- resulted from pus formation due to tissue


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Anuria- due to total occlusion of the passage to theureters.

Nephrolithiasis- or Kidney Stones, is a solid massmade up of tiny crystals.

Ureters- are paired muscular ducts with narrowlumina that carry urine from the kidneys to thebladder.

Diuretics- provides a means of forced diuresiswhich elevates the urination.

Supersaturation- To cause a chemical solution to bemore highly concentrated than is normally possibleunder certain conditions of temperature andpressure.

pH- A measure of the acidity or alkalinity of asolution, numerically equal to 7 for neutral solutions,increasing with increasing alkalinity and decreasing

with increasing acidity.


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CHAPTER 2

PATIENTSDATA


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Name: Michael LimareAge: 35 years old

Height: 52Gender: Male

Physical activity: Light


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CHAPTER 3

SOCIO-

ECONOMICHISTORY


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Occupation: Bakery Worker

Education: High schoolGraduate

Income: 150 pesos a dayPlace of residence:

Caburihan Drive, Canelar Z.C


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CHAPTER 4

MEDICALHISTORY


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Mr. Limare is experiencing, having

presence of fever, burningurination. The pain that he is

suffering of are described as sharp,

colicky in nature and associatedwith nausea, vomiting, and

malaise. He is also have suffer touti (urinary tract infection).


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CHAPTER 5

DIETARYHISTORY


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Mr.Limare health lifestyle is not quite

good. He loves salty foods. He is also

not taking the proper consumption ofwater. Instead of water he is always

dringking cola beverages, and when he

reach at home most of the day hisviand are usually canned foods such

as sardines, tuna and other canned

foods. He is also eating nuts productswhich has a high salt intake. he does

not have a proper diet.


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CHAPTER 6DIAGNOSIS


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Diagnosis:

Urolithiasis


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CHAPTER 7

MEDICAL ANDNUTRITIONAL

INTERVENTIONS

a e ca an nu r ona


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a. e ca an nu r onaintervetionThiazide Diuretics Atleast 3 medicine. Thiazide

diuretics have been shown touseful in reducing recurrence of

stones in patients with

hypercalciuria.

Binders The use of cholestyramine or

calcium carbonate, which binds

oxalate, in the gut has been

suggested for patients who excrete

large amounts of oxalate.

Citrate Increasingly citrate preparationsare being used for the prevention

of recurrent calcium oxalate

stones.


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b.) Diet Prescription

Low Sodium and Low Protein are

prescribed.

Low Sodium Diet- a diet that limits the intake of

foods. Your body needs small amounts of sodiumto maintain a healthy fluid balance, but too much

sodium can force your heart and kidneys to work

harder and raise your blood pressure. Low protein Diet- A low-protein diet is a diet in

which people reduce their intake ofprotein. A

low-protein diet is often prescribed to people

with kidney orliverdisease.

c e ary anagemen w
http://encyclopedia.thefreedictionary.com/Dietinghttp://encyclopedia.thefreedictionary.com/Proteinhttp://encyclopedia.thefreedictionary.com/Kidneyhttp://encyclopedia.thefreedictionary.com/Liverhttp://encyclopedia.thefreedictionary.com/Liverhttp://encyclopedia.thefreedictionary.com/Kidneyhttp://encyclopedia.thefreedictionary.com/Proteinhttp://encyclopedia.thefreedictionary.com/Dieting


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c. e ary anagemen wRationale

Increased Fluid Intake to assist in stonepassage. Patients with renal stones should

drinks eight to ten glasses of water daily.

For calcium stone; reduced dietary protein

and sodium intake ; liberal fluid intake.

For uric acid stones; low purine diet and

limited protein.

For cysteine stones; low protein diet;

increased fluids.

d ) C t ti


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d.) ComputationWt= 60 kg

Ht= 52

Physical activity: Light (35)

A. DBW= 112 lbs8 lbs= 120 lbs

120 lbs 2.2= 55kg

B. BMI= act. wt ht(m) 5 12= 60+2= 62 inches= 60 kg (1.57m) 62 inches 2.54cm= 157.48

= 60 2.46

BMI = 24.39 NORMAL 157.48100= 1.57m

C. TER= DBWPA

5535= 1,925

TER= 1,925 kcal


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D. NPC method

NPC= DBWProtein reqt=55 .6= 33gram

=334cal= 132

=1,925-132= 1793 kcal

CHO=1,793.70= 1,255 4= 313.78 or315 gram

FAT=1,793.30= 537.9/538 9= 59.77 or60

gram


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Food

grp

#ex HM CHO

315g

P

33g

FAT

60g

KCAL

1,925

BF Am

snack

L Pm

snack

S Mid.S

Veg.A 2 1cup 3 1 - 16 2

B 1 1/2cu

p

3 1 - 16 1

Fruit 5 varies 50 - - 200 1 1 1 1 1

Milk - - - - - -

Sugar 3 1tsp. 15 - - 20 1 1 1

Rice 11 varies 253 22 - 1100 2 2 2 2 2 1

Meat

Meduim fat

1 varies - 8 6 86 1

Fat 11 1tsp - - 55 495 1

TOTAL 314g 329 61g 1933kca

l


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Sample MenuBreakfast

1slice papaya

2pcs. White bread with butter 3pcs. Skyflakes

1 cup coffee, 1 tsp. Sugar

*water

AM Snack 2 slice jelly roll

1 glass lemon juice, 1 tsp sugar

Lunch

Ginataang Langka

2 cups steamed rice

1 pc. Banana

*water

PM Snack

2 pcs. Puto (puti)

1 glass pineapple juice, i tsp sugar

Supper

Soup from tinola

Chicken tinola (wings)

Green papaya 1 cup Sili leaves 1cup

2 cups steamed rice

1 pc banana

1 small slice mango float

Midnight Snack

3pcs. Crackers

*water


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CHAPTER 8

PROGRESS ANDPROGNOSIS


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Urine(24hour) uric acid, calcium, phosphate,

oxalate, or cysteine may be elevated.

KUB rray shows presence of calculi and oranatomical changes in the area of the kidneys or

along the course of the ureter.

IVP provides rapid confirmation of urolithiasis as acause of abdominal or flank pain. Shows

abnormalities in anatomical structures and outline

of calculi.

Chemical Analysis is performed to determine

stone formation.


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CHAPTER 9

DIETARYINSTRUCTION

Foods allowed Foods not allowed


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Foods allowed

Drinks Coffee, juices and nectars made from fruits and

vegetables

recommended in this table, fruit punch

Fruits Apples, apricots (fresh or canned), avocado, bananas,

cherries

(sweet), cranberries, grapefruit, red or green grapes, lemon

and

lime juice, melons, nectarines, papayas, peaches, pears,

pineapples, oranges, strawberries (fresh), tangerines

Vegetables Artichokes, asparagus stalks, bamboo shoots,

broccoli, brussels

sprouts, cabbage, cauliflower, chayote squash, chicory, corn,cucumbers, endive, kale, lettuce, lima beans, mushrooms,

onions,

peas, peppers, potatoes, radishes, rutabagas, zucchini

Breads, cereals,

and grains

Egg noodles, rye bread, cooked and dry cereals without nuts

or

bran, crackers with unsalted tops, white or wild rice

Meat/meat

replacements,

fish, poultry

Meat, fish, fresh or frozen poultry (such as chicken or

turkey),eggs, egg whites, egg replacements

Foods not allowed

Beans (wax, dried), beets and beet

greens, chives, collard greens,

eggplant, escarole, dark greens of

all kinds, kale, leeks, okra,

parsley, rutabagas, spinach, Swiss

chard, tomato paste,

watercress

Nuts (peanuts, almonds, pecans,

cashews, hazelnuts), nut butters,

sesame seeds, tahini (paste made

of sesame seeds)

Salt, salt seasonings, andmonosodium glutamate (a

seasoning salt added to foods)

Soy sauce

Salted crackers and snack foods

Vegetables prepared in brine

(such as pickles, sauerkraut)

Cured and processed meats

(such as cold cuts, smoked fish)

Condensed or canned soups that

are made by adding water


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CHAPTER 10

CONCLUSION AND

RECOMMENDATION

Th ib d di t t i t th ti f f d


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The prescribed diets restricts the consumption of foodsand beverages that make the kidneys work harder. Whenthe kidneys function normally, they work with other organsto remove waste from the blood and maintain a proper

balance of fluid in the circulatory system. When kidneydisease damages the kidneys, the organs do not maintainthese normal functions. The diet aims to reduce thecomplications associated with kidney disease.

Normal kidneys maintain normal levels of phosphorus,sodium and potassium in the blood. When the kidneysfunction properly, they also remove the by products ofprotein metabolism from the blood. Damaged kidneys donot carry out these functions, so the diet limits daily intakeof protein, sodium, potassium and phosphorus. The

National Kidney and Urologic Diseases InformationClearinghouse explains that reducing the intake of thesesubstances prevents them from building up in the bloodand improves the health of people who have kidneydisease.

Urolithiasis Powerpoint

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