The Treatment of Modern Western - Biblio.nhat-nam.ru

79UROLITHIASISUrolithiasis refers to stones within the urinary tract. Theseare also called urinary calculi and nephrolithiasis.Approximately one in 1,000 adults are hospitalized in theU.S. per year due to urinary calculi, and urinary tract stonescan be found in one percent of all autopsies. These calculimay range in size from microscopic crystalline foci to stoneswhich are several centimeters in diameter. Eighty percent ofcalculi in the U.S. are composed of calcium. The remainderare formed from magnesium ammonium phosphate. Stoneswithin the urinary tract form because of supersaturation ofthe urine with calculus-forming salts. Causes of such supersaturationinclude over-excretion of salt, urine acidity, andlow urine volume. Magnesium ammonium phosphate stonesindicate the presence of a urinary tract infection caused byurea-splitting bacteria. This type of stone mostly occurs inwomen. Unfortunately, studies have shown that patientspassing a first CA calculus are likely of forming a secondstone at a rate of 15% within the first year, 40% within fiveyears, and 50% within 10 years.Although many renal calculi are asymptomatic, they commonlycause pain, hematuria, urinary obstruction, and secondaryinfection. The pain associated with urolithiasis tendsto be excruciating and intermittent. It typically originates inthe flank or kidney area and radiates across the abdomenalong the course of the ureter. Calculi in the bladder maycause suprapubic pain. GI symptoms commonly includenausea, vomiting, and abdominal distention and mayobscure the urinary origin of this condition. Chills and feverare also common.The Western medical diagnosis of urolithiasis mostlydepends on its clinical symptoms. Differential diagnosisincludes appendicitis, cholecystitis, peptic ulcer, prancreatitis,ectopic pregnancy, and dissecting aneurysm. A currenthistory of a high protein diet and supplemental intake ofvitamins C and D may help clarify the picture. Urine may benormal. However, macroscopic or microscopic hematuria arecommon, and pyuria with or without bacteria may also beseen. Crystalline substances may be identified in the sediment,and most urinary calculi are demonstrable on x-ray.Renal ultrasonography may be helpful, and noncontrast spiralCT scan is useful in emergency room evaluation of acuteflank or abdominal pain.According to Western medicine, small, solitary calculi uncomplicatedby infection or obstruction require no specific therapy.The Western medical treatment of symptomatic calculiconsists of antibiotic treatment of bacteria causing urinarytract infection and/or narcotics, such as morphine or meperidine,for the relief of pain. Shock wave lithotripsy is the usualtherapy for symptomatic calculi which are located in the renalpelvis or the ureter and are less than two centimeters in diameter.Percutaneous nephrolithotomy may be used to removelarger renal calculi and ureteroscopy may be used for largerurethral calculi. Occasionally, uric acid calculi in the upper orlower urinary tract may be dissolved by prolonged alkalinizationof the urine. In order to prevent recurrence of calculi, thiazidediuretics are prescribed for patients with hypercalciuria.For patients with hypocitruria, oral alkali, such as potassiumcitrate, are prescribed. Prophylaxis for those with hyperoxaluriavaries. Patients with small intestine disease can be treatedwith a combination of low oxalate, low fat diet, calciumloading, and cholestryamine. In hyperuricosuria, intake ofmeat, fish, and poultry should be reduced and allopurinol maybe prescribed. In general, patients with a history of urolithiasisshould increase their water consumption.CHINESE DISEASE CATEGORIZATION: The clinicalsymptoms of urolithiasis mostly fall under the categories ofshi lin, stone strangury, sha lin, sand strangury, and xue lin,bloody strangury, yao tong, low back pain, xiao fu tong, lowerabdominal pain, fu zhang, abdominal distention, e xin, nausea,and ou tu, vomiting.