What Are the Different Types of Calculi?

A solid mass formed in the lumen of a catheter or in a cavity of a luminal organ (such as the kidney, ureter, gallbladder, or bladder) in a human or animal body. It is mainly found in the gallbladder, bladder, and renal pelvis, as well as in the lumen of pancreatic ducts and salivary ducts. Stones are composed of inorganic salts or organic matter. There is usually a core in the stone, which is composed of exfoliated epithelial cells, bacterial clumps, parasite eggs or worm bodies, feces or foreign bodies, and inorganic salts or organic materials are deposited on top of the core. Due to the different organs involved, the components, shapes, textures, and effects on the body of the stone formation mechanism are different. In general, stones can cause luminal obstruction, affect the discharge of fluid from affected organs, and cause symptoms such as pain, bleeding, or secondary infections.

Basic Information

English name

lithiasis

Visiting department

General Surgery, Urology

Common causes

Cholesterol crystals, calcium oxalate, calcium phosphate, etc. can cause stones

Common symptoms

Urinary stones are pain, hematuria, and gallbladder stones are biliary colic

Causes of stones

Taking gallbladder stones as an example, the reasons for the formation of stones are described. Under normal circumstances, bile acids, phospholipids, and cholesterol in human bile are maintained at a certain ratio, and crystal polymerization inhibitors are also present in bile, which can ensure that no stones form in the gallbladder. Once a certain factor disrupts this balance, it will lead to the formation of cholesterol crystals in the gallbladder and eventually gallbladder stones.

Clinical manifestations of stones

The clinical manifestations of stones in different parts are very different. The stones in the same part will have different clinical manifestations due to the size of the stones and the presence of secondary infection. The main symptoms of upper urinary stones are pain and hematuria. Patients usually develop gross or microscopic hematuria, the latter being more common. If the secondary infection can be manifested as acute pyelonephritis and renal empyema. Severe obstruction caused by bilateral upper urinary stones can lead to uremia in patients. Typical symptoms of bladder stones are sudden interruption of urination, pain radiating to the distal urethra and the head of the penis, with difficulty urinating and bladder irritation. Most of the gallbladder stones have no clinical symptoms. The typical symptoms of gallbladder stones are biliary colic, and some of them can also manifest as cholecystitis. Some patients may present with Mirrizzi syndrome (cholestyritis, obstructive jaundice, cholangitis). If stones are discharged into the bile ducts, they can cause bile duct stones. Patients with bile duct stones may be asymptomatic, or they may present with abdominal pain and jaundice. Fever, abdominal pain, and jaundice can be manifested in patients with bile duct infection, and severe symptoms such as shock and psychoneurological system may occur. Some gallbladder stones may also cause the onset of biliary pancreatitis.

Stone diagnosis

Combining typical clinical manifestations and imaging (mainly ultrasound), the diagnosis of stones is generally not difficult to make. After the diagnosis of stones, it is also necessary to understand whether the stones have damaged the related organ functions by means of related methods. For example, urinary lithiasis should be actively evaluated for the presence of perinephric abscess and renal function reserve.

Stone treatment

The treatment of stones in different parts is not the same. The treatment plan for stones in the same part should be based on factors such as the size of the stones and the overall state of the patients. Taking gallbladder stones as an example, the principles of treating gallbladder stones are described below. Surgery is recommended for symptomatic gallstones. Surgical treatment for asymptomatic gallstones should also be considered:

1. Stone diameter 3cm;

2. Gallbladder polyps> 1cm;

3. Gallbladder wall thickening, calcification or porcelain gallbladder;

4. Found gallbladder stones for more than 10 years;

5. People with diabetes and cardiopulmonary dysfunction;

6. Gallbladder stones in children;

7. Remote or underdeveloped areas, field workers;

8. Merging requires open surgery.