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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/Dieting7/27/2019 Urolithiasis Powerpoint
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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.