Calculus (medicine)

Types

• Calculi in the urinary system are called urinary calculi and include kidney stones and bladder stones. They can have any of several compositions, including mixed. Principal compositions include oxalate and urate.
• Calculi of the gallbladder and bile ducts are called gallstones and are primarily developed from bile salts and cholesterol derivatives.
• Calculi in the nasal passages are rare.
• Calculi in the gastrointestinal tract can be enormous. Individual enteroliths weighing many pounds have been reported in horses.
• Calculi in the stomach are called gastric calculi.
• Calculi in the salivary glands are called salivary calculi.
• Calculi in the tonsils are called tonsillar calculi.
• Calculi in the veins are called venous calculi.
• Calculi in the skin, such as in sweat glands, are not common but occasionally occur.

Cause

• From an underlying abnormal excess of the mineral, e.g., with elevated levels of calcium that may cause kidney stones, dietary factors for gallstones.
• Local conditions at the site in question that promote their formation, e.g., local bacteria action or slower fluid flow rates, a possible explanation of the majority of salivary duct calculus occurring in the submandibular salivary gland.
• Enteroliths are a type of calculus found in the intestines of animals and humans, and may be composed of inorganic or organic constituents.
• Bezoars are lumps of indigestible material in the stomach and/or intestines; most commonly, they consist of hair. A bezoar may form the nidus of an enterolith.

Pathophysiology and symptoms

• Irritation of nearby tissues, causing pain, swelling, and inflammation
• Obstruction of an opening or duct, interfering with normal flow and disrupting the function of the organ in question
• Predisposition to infection

• Nephrolithiasis
• *Can cause hydronephrosis and kidney failure
• *Can predispose to pyelonephritis
• *Can progress to urolithiasis
• Urolithiasis
• *Can progress to bladder outlet obstruction
• Cholelithiasis
• *Can predispose to cholecystitis and ascending cholangitis
• *Can progress to choledocholithiasis and gallstone pancreatitis
• Gastric calculi can cause colic, obstruction, torsion, and necrosis.

  Diagnosis

• Clinical history and physical examination
• Imaging studies
• *Some stone types can be detected on X-ray and CT scan
• *Many stone types can be detected by ultrasound
• Factors contributing to stone formation are often tested:
• *Laboratory testing can give levels of relevant substances in blood or urine
• *Some stones can be directly recovered and sent to a laboratory for analysis of content

  Treatment

• Healthy diet & exercise
• Drinking fluids
• Surgery
• Medication / Antibiotics
• Extracorporeal shock wave lithotripsy for removal of calculi

  History

• There was a high probability of intraoperative and postoperative surgical complication like infection or bleeding
• The physicians would not perform surgery as in ancient cultures they were two different professions