Calculus (medicine)

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An 8-mm kidney stone

A calculus (plural calculi) is a stone (a concretion of material, usually mineral salts) that forms in an organ or duct of the body. Formation of calculi is known as lithiasis. Stones can cause a number of medical conditions.

Some common principles (below) apply to stones at any location, but for specifics see the particular stone type in question.

Calculi are not to be confused with gastroliths.

Types of lithiasis

  • Calculi in the renal system (kidneys, ureters, urinary bladder, urethra) can be of any one of several compositions, including mixed. Principal compositions include oxalate and urate.
  • Calculi of gall bladder/ bile-duct are primarily developed from bile-salts and cholesterole derivatives.
  • Calculi in the nasal passages (rhinoliths) are rare.
  • Calculi in the gastrointestinal tract (enteroliths) can be enormous. Individual enteroliths weighing many pounds have been reported in horses.
  • Salivary duct calculus
  • Tonsillolith

Calculi usually are asymptomatic, and large calculi may have required many years to grow to their large size.

Etiology

In kidney stones, calcium oxalate is the most common mineral type (see Nephrolithiasis). Uric acid is the second most common mineral type, but an in vitro study showed uric acid stones and crystals can promote the formation of calcium oxalate stones.[1]

Pathophysiology and symptoms

Stones can cause disease by several mechanisms:

  • 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 (often due to disruption of normal flow)

A number of important medical conditions are caused by stones:

Diagnosis

Diagnostic workup varies by the stone type, but in general:

  • Clinical history and physical examination
  • Imaging studies
    • Some stone types (mainly those with substantial calcium content) can be detected on X-ray and CT scan
    • Many stone types can be detected by ultrasound
  • Factors contributing to stone formation (as in #Etiology) are often tested:
    • Laboratory testing can give levels of relevant substances in blood or urine
    • Some stones can be directly recovered (at surgery, or when they leave the body spontaneously) and sent to a laboratory for analysis of content

Treatment

Modification of predisposing factors can sometimes slow or reverse stone formation. Treatment varies by stone type, but, in general:

History

The earliest operation for curing stones is also given in the Sushruta Samhita (6th century BCE).[2]The operation involved exposure and going up through the floor of the bladder.[2]

The care of this disease was forbidden to the physicians that had taken the Hippocratic Oath because

  • 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

See also

References

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  1. 2.0 2.1 Lock, Stephen etc. (2001). The Oxford Illustrated Companion to Medicine. USA: Oxford University Press. 836. ISBN 0-19-262950-6.

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