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hello in this video we're going to talk
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about kidney stones kidney stones or
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urinary stones have many names including
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Euro Lethe ASIS which is actually
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formation of stones along the urinary
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tract or Neph roli thesis which is
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stones forming specifically in the
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nephron or the kidneys to make things
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even more confusing urinary or kidney
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stones can also be called renal or
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urinary calculi calculi essentially
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means stones
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however these words are used
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interchangeably but essentially mean the
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same thing
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kidney stones in order to understand
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kidney stones we have to revise the
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anatomy here the adrenal glands which
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are endocrine glands sit above the
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kidneys the kidneys form urine urine
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will then travel down the ureter and be
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stored in the bladder the bladder can
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stretch and once full we urinate the
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urine will flow through the urethra and
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then out the ureter has three sites of
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constriction where it contracts the
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smooth muscle and these are important to
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know because these are the sites where
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narrowing can occur and also the site
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where urinary stones can Lodge the sites
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of ureter ik constriction include the
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pelvic ureteric junction the pelvic brim
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and the vesicular ureter ik Junction the
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visco ureter ik Junction is actually the
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connection between the ureter and the
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urinary bladder which is sort of behind
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and under the urinary bladder the kidney
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is organ responsible for filtering the
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blood and disposing of waste it's
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important for regulating blood pressure
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and regulating electrolyte
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balance it is also responsible for
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producing some important hormones such
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as erythropoietin and activation of
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vitamin D here is the adrenal glands
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which are again the endocrine glands
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that sit above our kidneys here is the
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ureter looking inside the kidney it
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consists of pyramids called the medulla
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pyramids surrounding the medulla
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pyramids is the cortex the medulla
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pyramids joins the tip of the medulla
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pyramids joins and forms the calyx the
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calyx then joined together and form and
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drain into the renal pelvis the renal
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pelvis has a renal artery and renal vein
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entering and exiting it residing around
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and within the medullary pyramids are
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the functional units of the kidneys
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called nephrons nephrons are structures
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which filter our blood they secrete
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wastes and allow reabsorption of things
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into the bloodstream thus it has a main
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role in regulating electrolyte and fluid
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balance in our body the head of the
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nephron is the Bowman's capsule where
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the afferent arteriole brings blood in
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forming the glomerulus and then we have
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the efferent arteriole leaving the
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glomerulus once filtering has occurred
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within the Bowman's capsule the filtrate
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will travel along the tube you'll of the
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nephron firstly it will pass the
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proximal convoluted tubules then it will
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go down towards the loop of Henle the
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distal convoluted tubules and then
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finally the collecting duct looking more
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closely at the tube you'll the cells
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that line the nephron tubules are
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predominantly cuboidal epithelial cells
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within the tube you'll of the nephrons
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crystal like structures can fall the
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crystal like structures are essentially
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precipitance of some electrolytes that
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have accumulated there this crystal is
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actually a urinary stone if the crystal
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is small it will just pass in the urine
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but if it remains in the kidneys in the
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nephron it can grow bigger and become a
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kidney stone
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a kidney stone again is basically a big
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crystal the kidney stone can lead to an
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obstruction the obstruction within the
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tube you'll can create a buildup of
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pressure in the tube you'll
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this pressure can cause irritation and
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this irritation is read by the brain as
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renal colic
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there is also an inflammatory process
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going on
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due to the obstruction and this also
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leads to the renal colic the pain we
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feel when there is urinary stones in the
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body alternatively the urinary stone can
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lodge or get stuck within the ureter
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remember the sites of constriction of
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the ureter
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well the stones can get stuck there and
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when this happens irritation and pain
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can occur due to stretching of the
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fibers that are there that which are
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caused again by the increase in pressure
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within the ureter with this increase in
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pressure proximally to the site of
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obstruction and with the irritation
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going on edema can occur and the ureter
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will contract more vigorously trying to
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push the stone out this is called hyper
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peristalsis and so with this in mind the
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clinical presentation of kidney stones
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can include acute flank pain which can
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radiate to the back or towards the groin
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and the flanks there can be associated
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fever because of the inflammation and
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nausea and vomiting
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there can be also urinary frequency and
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urgency hematuria the person may present
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to be obese
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the risk factors for developing a kidney
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stone include a high-protein diet high
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salt diet
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male Caucasian obesity dehydration
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medications including antacids and
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carbonic anhydrase inhibitors sodium and
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calcium containing medications also
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increases the risk of developing kidney
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stones crystal urea is also risk factor
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as well as having a family history these
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risk factors will lead to a number of
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things first some of these risk factors
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will increase urinary solute
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concentration including concentration of
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calcium uric acid and calcium oxalate
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and sodium some of these risk factors
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will also decrease the stone forming
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inhibitors which include citrate and
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magnesium the increase in urinary
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solutes and the decrease in urinary
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stone inhibitors causes urine
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supersaturation leading to urinary
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crystal formation or urinary stone
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formation a decrease in urinary volume
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such as in dehydration and an excessive
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increase or decrease in urinary pH also
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contributes to urine supersaturation
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so in summary urine supersaturation with
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stone forming salts results in crystal
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formation urine Neri stone formation and
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as I mentioned there are a lot of types
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of urinary forming salts such as calcium
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uric acid and oxalate and because of
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this there are many types of stones
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kidney stones the stone pathology can be
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broadly divided into five different
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types these include calcium oxalate
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stones which make up the majority 75%
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there is also the calcium phosphate as
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well Stu vite is common in chronic
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urinary tract infections there's also
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uric acid stones and cysteine stone
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investigations for suspected renal
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calculi renal stones include a full
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blood count CRP magnesium calcium
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phosphate levels urinalysis which may
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show hematuria a 24-hour urine calcium
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level phosphate level oxalate urate
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cysteine and xanthine levels and this
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can show us what type of kidney stone he
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might be x-ray can be performed to
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detect a kidney stone
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an ultrasound can also detect a kidney
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stone kidney stone an ultrasound may
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show a to stick shadowing
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ultrasound may also reveal
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hydronephrosis if the obstruction is
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within the ureter causing backflow of
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urine which will dilate the ureter
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approximately finally a CT scan can also
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be used which can show kidney stones
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let's look at an algorithm again the
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clinical presentation of kidney stones
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include fever nausea vomiting acute
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flank pain radiating to the groin or the
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back the pain is often described as
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stabbing and severe there is tachycardia
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with or without hematuria the triad for
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urinary or kidney stones some say is
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fever vomiting and acute flank pain so
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in an acute setting analgesia is given
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with or without an antiemetic to prevent
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vomiting IV fluids are administered
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carefully
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most urinary stones if small less than
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half a centimeter will pass
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spontaneously without any intervention
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however if intervention is required it
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is either done electively or as soon as
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possible by intervention I mean surgical
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management and surgical management will
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depend on how big the kidney stone is as
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well as where the kidney stone is if it
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is within the ureter or within the
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actual kidney percutaneous 'no Frasca me
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allows placement of a small flexible
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rubber tube a catheter through the skin
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and into the kidney and this is in order
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to drain urine out if there is signs of
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obstruction this is more of a
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symptomatic relief in terms of removal
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of the kidney stone
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there is your tarik stent insertion here
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is the ureter and let us say the stone
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is lodged within the ureter well a stent
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a rod can be fed up through the urethra
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through the bladder and up the ureter to
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the side of obstruction and the stent
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can be placed there the stent will allow
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drainage of the urine essentially
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bypassing the blockage the urine can
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then just drain straight into the
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bladder
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if the urinary stone is within the
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kidney a procedure called a percutaneous
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nephrology Atum ii can be performed in
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this procedure the aim is to remove the
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stone from the kidney by a small
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puncture wound through the skin it is
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most suitable for removal of stones that
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are more than let's say 2 centimeters in
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size and which are present around the
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pelvic region of the kidney another
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surgical procedure that can be done for
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urinary stones within the ureter or
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within the kidneys is a simple
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endoscopic procedure that will break
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down the stone within the kidneys or the
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ureter alternatively there is open
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surgery to remove and break the stone
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finally there is the extra corporeal
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shock wave lithotripsy which uses shock
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waves to break up stones that form in
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the kidneys to enable easy passage of
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these fragments out of the body within
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urine
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you
