外科学-各论英文课件：Urolithiasis.ppt

Team Spirit Thank you! * Urolithiasis Location Upper Urinary Tract：Kidney calculi/ Ureteral calculi Lower Urinary Tract ：Bladder calculi/ Urethral calculi Classification Formation Mechanism: Unknown Renal calcification plaque Over saturated crystallization Stone matrix Crystal inhibiting substance Heterogeneous nucleation Mostly associated with Metabolism, Obstruction and Infection. Epidemiology factors Gender and age： Prevalence rate 4-10%；high recurrence 25-40y，Female: 50-65y M:F=3:1；infection stones more commonly in female Child: malformation, infection and malnutrition Lower urinary tract: Aged male, especially with BPH Etiology Epidemiology factors 1. Ethnic： Occupation：work enviroment, drinking, activity amount Geographic and climate：food, temperature, humidity Nutrition：rich protein Drinking Diseases： Obstruction； Metabolic disturbance（hyperparathyroidism, hyperuricuria , hyperoxaluria ）； Hereditary disease（cystinuria） Etiology 2. Urine change More stone formation substance：Ca, oxalate, uric acid Urine PH：alkaline-magnesium ammonium phosphate；acidic-uric acid，cystine Less urine：high concentration Less crystal inhibiting substance： Citric acid Infection improve stone matrix 3. Anatomic abnormality：Obstruction-Infection-Stone Etiology Stone component Upper urinary tract calculi Kidney calculi Ureteral calculi Upper segment Middle segment Lower segment 1. pain： kidney calculi：no symptom, flank pain, severe pain with infection ureteral calculi：acute: renal colic, nausea, vomitting, chronic: back soreness or nothing lower segment UC：bladder irritation hematuria: Microscopic hematuria: mostly Gross hematuria: after exercise, renal colic, infection complications： acute pyelonephritis: pain, fever, still shiver bilateral UC or obstruction of solitary kidney: anuria, ARF severe hydron