SEMINAR ON ANALYSIS OF CALCULI

PRESENTED BY ANU PRASHER B.Sc. MLT FINAL YEAR MODERATOR DR. HARJEET KAUR

INTRODUCTION
An abnormal solid conc. of mineral and Salt formed around organic material
Found in cysts and ducts Found in bladder, renal pelvis, kidneys & ureter

Largest stones are found in bladder

 Small stones are found in renal pelvis, Kidney and ureter Can be of varying sizes Requires nucleus on which crystals are deposited. Its presence can obstruct urinary flow and can cause infection and haematuria.

TYPES OF STONES
Uric acid stones Calcium oxalate stones Phosphate stones Calcium carbonate stones

Cystine Stones Xanthene Stones Fibrin Calculi Urostealith

 URIC ACID STONES

Uric Acid stones are round or oval Uric Acid Stones are almost coloured varying shades of brown They may be single or multiple Usually found in patients with gout but also found in patients with bladder outflow obstruction. They are usually fairly hard & often have a smooth surface though sometimes they may be rather tough

 CALCIUM OXALATE STONES

They are found in a majority of calculi usually mixed with a greater or less amount of phosphate Oxalate Stones are among the hardest stones found and So are not easily crushed

The surface of small oxalate stones is often rough and blood stained
Oxalate stones is a primary stones that grows slowly, usually it is of moderate size and is solitary Sometimes it bristles with spines

 PHOSPHATE CALCULI
It may contain either triple phosphate or calcium phosphate Calcium phosphate , mixed with calcium oxalate is a common finding in patients with hypercalciuria Triple Phosphate is deposited when the urine is alkaline and so is usually found when there is infection of urinary tract, when urea is converted into ammonium carbonate

These are among the softest & whitest stones

 CALCIUM CARBONATE STONES

Calculi consisting mainly of calcium carbonate are very rare in man but small amounts of the substance can be detected in the number of calculi Stones containing carbonate tend to be rather hard The salt is deposited as carbonate-apatite from alkaline ,infected,carbonate rich urines

 CYSTINE STONES
These are also rare They are usually fairly small and are smooth and waxy in appearance and to the touch. They are brownish Yellow or Light green in colour and occur in cases of cystinuria. The increased cystine excretion is often the cause of calculus formation as in case of cystinuria

 XANTHINE STONES
They are even rarer than Cystine They are Yellowish brown in colour being rather similar to uric acid calculi They sometimes contains uric acid

They occour in case of xanthinuria

 UROSTEALITH
Urostealith calculi have been reported in bladder
They are soft and contain a large amount of fat They are extremely rare

 FIBRIN CALCULI
Fibrin Calculi may form from blood clots They are rare but may form the nucleus of other stones

Factors causing the formation of Stones

Certain conditions are recognized as being favourable for stone formation but do not explain the presence of some stones It is known that stagnation of urine particularly if there is also infection present may lead to stone formation e.g. in Hydronephrosis Enlarged prostate Bladder Infection Hyperparathyrodism Hypervitaminosis D with excessive mobilization and deposition of calcium are also known to be accompained by formation of calculi

URINARY CALCULI
These may be found in any part of urinary tract like kidney, renal pelvis, ureter. They vary very considerably in size from little more than pin head to the size of an egg The passage of stones down the ureter produces renal colic, which is characterized by serve pain in the back radiating to the groin region Stones may also be passed through the urethera with great pain Hematuria is a common urinary finding when symptoms of stone are present.

KIDNEY STONES

GALL STONES
Substances found in Gall stones are Cholestrol Bile Pigments Calcium Phosphate and Calcium Carbonate

Cholestrol stones are often white or light coloured, mixed stones are usually quiet dark
They may be single multiple,large or small.Those

contaning Ca salts are radio opaque

Their presence ,however ,predisposes to attacks of cholecystitis with formation of debris and impaired emptying of the gall bladder

GALL BLADDER STONES

PANCREATIC CALCULI
They occur rarely They are small in size Rough appearance and mostly composed of organic matter mainly calcium carbonate and calcium phosphate but there may be traces of magnesium salts

Pancreatic calculi usually found in association with chronic pancreatitis

PANCREATIC CALCULI

SALIVARY CALCULI
Salivary Calculi are occasionally submitted for examination
They are most commonly composed of calcium phosphate and calcium carbonate with small amount of organic matter

They are usually submandibular ducts

formed

in

the

parotid

or

SALIVARY CALCULI

FAECAL CONCRETIONS
Enteroliths : It consist mainly of phosphates deposited around a nucleus which is often a foreign body such as fruit stone

Some organic material or faecal pigment are present

Small enteroliths may also be formed by the deposition of phosphate on undigested vegetable material

 Coproliths :-

Are almost entirely organic containing hardened faecal material formed from stationary faecal matter in colon

Drug calculi :Small stones may be formed from drugs which are insoluble or only slightly soluble e.g. Magnesia Barium Sulphate

MONITORING PATIENTS
For the common calcium stones, large amounts of fluids and theazide diuretics are used for treatment Thiazides plus and allopurinol are used for patients with calcium stones who have increased calcium and uric acid in urine Stones resulting from infection contain bacteria and are removed surgically and the appropriate fluids and antibiotics therapy instituted

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