临床见习课程：Urolithiasis.pptVIP

Urolithiasis Question It is common for ureter stone complicated with hydronephrosis. And where is the most common place for ureter stone obstruction? Critical size 5 mm~ 90% 5 mm and located in the lower ureter pass spontaneously 15% pass if between 5 and 8 mm 95% 8 mm become impacted generally requiring lithotripsy or surgical removal 75% of stones are located in the distal third of the ureter Obstruction leads to: Rapid redistribution of renal blood flow?, ↓ glomerular filtration rate ? renal excretion shifts to unaffected kidney Causes rapid decrease in ureteral peristaltic activity Complete obstruction may lead to loss of renal function Increased occurrence of irreversible damage after 1 to 2 weeks of obstruction Partial obstruction lower likelihood of renal injury, may still result in irreversible damage. Question Why impared renal funcion presented in the unilateral hydronephrosis? Question Why impared renal funcion presented in the unilateral hydronephrosis? Question Are there any other imaging methods to detect kidney stones or hydronephrosis? Question Are any other imaging method to detect kidney stones or hydronephrosis? Question Example: Question Any other test to evaluate the renal function except renal pane? Question Any other test to evaluate the renal function except renal pane? Question Treatment Option Question * * * * * * * An otherwise healthy 59yo female was admitted because of bilateral flank pain, which occurred 1 months ago. Case #1 (3-4-52) On Admission PE: vital sign stable, no other abnormality except percussion tenderness over bilateral kidney region Lab Data: CBC, Liver Panel all within normal range Renal Panel: Cr 234umol/L BUN 11.85mmol/L Urine Test: RBC(+++), WBC(+), Pro(+) Imaging MRU showing right hydronephrosis Imaging CT Scan showing right hydronephrosis with right renal and ureter stone Places for obstruction Question Question Question Left renal atrophy BUS KUB IVP RGP Staghorn Calculus IVP showing obstructed, dila