Thursday, 8 October 2015

Stones

URINARY BLADDER STONES

🔹Primary Bladder Stones - Develop in absence of any known functional, anatomic or infectious factors & DOES NOT necessarily imply that stones have formed de novo in the bladder. They usually come down from the kidney & get enlarged here. Ammonium acid urate, calcium oxalate, uric acid & calcium phosphate are the most common components of primary bladder calculi.

🔹Secondary Bladder Stones - Develop in concert with bladder outlet obstruction, infection, impaired bladder emptying or a foreign body. It is most common bladder stone encountered throughout the western world. Bladder calculi may arise de novo  within the bladder or may result from the maturation of stone nidi that migrate from the upper tracts & subsequently fail to be spontaneously voided. The frequent absence of calcium oxalate in the nucleus of most bladder stones further suggests AGAINST an upper tract origin.
✏Most bladder calculi are formed de novo within the bladder, but some initially may have formed within the kidney.
✏Most kidney stones that are small enough to pass through the ureters are also small enough to pass through a normally functioning bladder & an unobstructed urethra.
✏In older men with bladder stones composed of URIC ACID, the stone is most likely FORMED IN THE BLADDER.
✏Stones composed of CALCIUM OXALATE  are usually initially formed in the KIDNEY.
✏In adults, MC type of vesical stone (seen in >50% of cases) is composed of URIC ACID. A large percentage of bladder stones are radiolucent (uric acid).✔✔
✏Stone analysis frequently reveals ammonium urate, uric acid, or CALCIUM OXALATE stones.✔✔
✏VESICAL CALCULI maybe single or multiple, especially in the presence of bladder diverticula, and can be small or large enough to occupy the entire bladder. They range from soft to extremely hard, with surfaces ranging from smooth and faceted to jagged & spiculated ('JACK' STONES).
These JACKSTONES are typically either of URIC ACID (if they are formed in the BLADDER) or CALCIUM OXALATE (if they are FORMED IN THE KIDNEY & have descended from there).
📝Note: MC type of kidney stone is of Calcium oxalate & MC type of bladder stone is of Uric acid.

🌰GALL BLADDER STONES🌰
🔹Primary CBD Stone - Formed within the  biliary tract, associated with biliary stasis & infection. The are soft, friable, light-brown stones or sludge in the common bile duct.
🔹Secondary CBD Stone - Formed initially in the GB, they migrate through the cystic duct into CBD & are usually cholesterol stones.
✏Most gallstones pass out of the body unnoticed, some become lodged in the CBD.
✏A frequent site of gallstone impaction is the ampulla of Vater.
✏Blockage of common channel by gallstone can induce acute pancreatitis.
✏MC type of gallstone - Mixed (Overall), Pigment stones (India).
✏MCC of acute cholangitis is CBD stones (choledocholithiasis).

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