Types of Kidney Stones

There are many types of kidney stones.

1. Calcium Oxalate Calculi.

•  75%
• Occur in alkaline urine
• Called Mulberry stones
• With sharp projections
• Cause bleeding
• Often black due to altered blood on their surface
• Symptomatic even when small

Calcium Oxalate Calculus Pic 1

Calcium Oxalate Calculus Pic 2

X-Ray KUB Showing Renal Stones

2. Phosphate Calculi.

• 15%
• Occur in strongly alkaline urine
• Commonly occur against a background of chronic urinary infection
• Usually compounds of magnesium, ammonium and calcium phosphate
• Surface is smooth
• Dirty white in colour
• May grow rapidly & fill the calyceal system of kidney taking on their shape ( Staghorn calculi)
• Also called struvite calculi

 Phosphate Calculi

Staghorn Calculus

3. Uric Acid Calculi

• 5%
• Occur in acid urine
• Due to a consequence of high level of uric acid in urine
• Hard in consistency
• Surface is smooth
• Light brown in colour
• Radio logically translucent

4. Cystine Calculi

• 2%
• Relatively rare
• Occur in acid urine
• Usually multiple
• White in colour
• Extremely hard in consistency, so difficult to treat
• Metabolic origin (Decreased reabsorption of cystine from the renal tubules)

5. Xanthine and Pyruvate Calculi

• 1%
• Rare
• Inborn error of metabolism is cause.

Pyelolithotomy

2 comments

Posted at 18:41 |  by surgicaloperation

How will you diagnose Acute Appendicitis ?

It is very simple to diagnose acute appendicitis. First take history from patient.

Appendicitis pain symptoms is migrating in type. Appendix pain starts from epigastrium then shift to umbilical area then finally shift to the right iliac fossa (right lower quadrant of abdomen) or pain occurs in whole abdomen and finally shift to right illiac region. Pain is colicky in nature.

Nausea, vomiting & loss of appetite are also other symptoms which may be present.

Acute appendicitis signs are tenderness at Mc Burney's point, Rebound tenderness, Roving's sign and Cough sign are positive. Fever is also a sign.

Mc Burney's point is a point at between lateral 1/3 and medial 2/3 of an imaginary line drawn from the anterior superior iliac spine to umbilicus.

Rebound tenderness : Patient feels pain at Mc Burney's point after
releasing the pressure.

Roving's sign : Patient feels pain at Mc Burney's point when press at left iliac fossa.

Cough sign : Patient feels  pain at Mc Burney's point when asks to cough.

Investigations 

1.Blood C P (Blood Complete  Picture) : Shows leucocytosis (Increase White Blood Cell count) and neutrophilia (Increase Neutrophil count).

2. Ultrasound of abdomen :  May help in diagnosis.

3. Diagnostic laproscopy. Diagnostic as well as Therapeutic.

4 comments

Posted at 00:19 |  by surgicaloperation

MCQ (Single Best Answer) For Doctors and Medical Students

  MCQ (Single Best Answer)
 Answers are given below.

Renal Calculi

1. All are renal Calculi except

A. Cholesterol

B. Calcium Oxalate

C. Calcium Phosphate

D. Uric Acid

2. The side effeec of anti tuberculous drug Pyrazinamide is
A. Peripheral Neuropathy
B. Joints pain
C. Optic Neuritis
D. Deafness

3. Cause of paralytic ileus is ?
A. Hyponatremia.
B. Hypochloremia
C. Hypokalemia
D. Hypocalcaemia.

4. All are present in Thyrotoxicosis except
A. Tremor
B. Palpitation

Typhoid ileal perforation

C. Increase Serum TSH
D. Weight loss

5. In Prostatic Cancer increase Serum
A. Alpha feto protein
B. Bilirubin
C. Ca 125
D. PSA

6. A patient history of constipation. Complain of painful defecation, pain remains 3 - 4 hours after defecation, stool contains streak of blood. The Diagnosis is
A. Fistula in Ano
B. Pilonidal Sinus
C. Anal Fissure
D. Hemorrhoid

7. Which Vitamin deficiency causes Scurvy?
A. Vitamin K
B. Vitamin D
C. Vitamin C

Typhoid ileal primary closure

D. Vitamin B 12

8. All are Anti-tuberculous drugs Except
A. Ethambutol
B. Streptomycin
C. Isoniazid
D. Nystatin

9. Treatment Option of Typhoid ileal perforation are Except
A. Primary ileal perforation closure.
B. Colostomy.
C. Loop Ileostomy.
D.Resection Anastomosis.

10. The drug Carbimazole is used in the Treatment of
A. Hypothyroidism
B. Hyperthyroidism
C. Cushing's Syndrom
D. Epilepsy

11. Treatment options of Anal Fissure except
A. Injection of 5% phenol in almond oil.

Renal Calculus

B. Local application of 0.2% GTN ointment.
C. Anal dilatation.
D. Lateral internal sphincterotomy.

12. In obstructive Jaundice patient, the colour of stool is
A. Clay
B. Yellow
C. Green
D. Redish

13. Treatment of Renal Calculi are except
A. Lithotripsy
B. PCNL (Per Cutaneous Nephrolithotomy)
C. Pyelolithotomy
D. Cystolithotomy

14. Treatment of Bradycardia during spinal anaesthesia is ?
A. Solucortif
B. Adrenaline

Acute Appendicitis

C. Atropine
D. Aminophyline.

15. CA-125 is a Tumor Marker for
A. Ca Cervix
B. Ca Pancreas
C. Ca Gall Bladder
D. Ovarian Cancer

16. Acute Appendicitis occurs most commonly in
A. Neonate
B. Children under 12 years
C. Teen Age
D. Old Age

Answers
1.A  2.B  3.C  4.C  5.D  6.C  7.C  8.D  9.B  10.B  11.A  12.A  13.D  14.C  15.D  16.C

No comments

Posted at 00:25 |  by surgicaloperation

Pilonidal Sinus

Management of Pilonidal Sinus is possible conservatively by removing the hairs from the sinus, anti septic dressing and antibiotic.

2 comments

Posted at 22:50 |  by surgicaloperation

Anal Fissure

            A longitudinal tear in anal canal is called anal fissure. Cause is constipation. Symptoms are painful defecation and bleeding per rectum. Blood come in a streak along stool. Patient can manage medically. Laxative orally and pain killer. Sitz Bath ( sitting in a tub containing hot water and table spoon of dettol for 10 minutes ) twice a day. 0.2% GTN ointment for local application twice a day.

Anal fissure

          If medical treatment fail, then treatment is surgical. Anal dilation or Lateral interrnal Sphinctertomy under spinal anesthesia.

Anal Fissure

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Posted at 22:25 |  by surgicaloperation

Acute Appendicitis

Acute inflammation of appendix is called acute appendicitis.
Diagnosis
Sign & Symptoms are:
1. Pain in right iliac fossa, migrating in nature.
2. Fever
3. Vomiting
4. Loss of appetite
5. Tenderness at right iliac fossa

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Posted at 19:34 |  by surgicaloperation