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Calculus (medicine)

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From Wikipedia, the free encyclopedia

Solid mineral mass which forms in a bodily organ or duct

For other uses, seeCalculus (disambiguation).

Medical condition

Calculus
Other names	Stone

An 8-mmkidney stone
Symptoms	Pain
Complications	Inflammation
Prevention	Diet
Treatment	Drinking water,surgery

Acalculus (pl.:calculi), often called astone, is a concretion of material, usuallymineral salts, that forms in anorgan orduct of the body. Formation of calculi is known aslithiasis (/ˌlɪˈθaɪəsɪs/). 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 withgastroliths, which are ingested rather than grownendogenously.

Types

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Human gallstones, all removed from one patient. Grid scale 1 mm.

Calculi in theinner ear are calledotoliths
Calculi in theurinary system are calledurinary calculi and includekidney stones (also called renal calculi or nephroliths) andbladder stones (also called vesical calculi or cystoliths). They can have any of several compositions, including mixed. Principal compositions includeoxalate andurate.
Calculi in theprostate are calledprostatic calculi.
Calculi in themammary gland are calledbreast microcalcifications ormammary microcalcifications.
Calculi of thegallbladder andbile ducts are calledgallstones and are primarily developed frombile salts andcholesterol derivatives.
Calculi in the nasal passages (rhinoliths) are rare.
Calculi in thegastrointestinal tract (enteroliths) can be enormous. Individual enteroliths weighing many pounds have been reported in horses.
Calculi in thestomach are called gastric calculi (not to be confused withgastroliths which are exogenous in nature).
Calculi in thesalivary glands are called salivary calculi (sialoliths).
Calculi in thetonsils are called tonsillar calculi (tonsilloliths).
Calculi in theveins are called venous calculi (phleboliths).
Calculi in the skin, such as insweat glands, are not common but occasionally occur.
Calculi in thenavel are calledomphaloliths.

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

Cause

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From an underlying abnormal excess of the mineral, e.g., with elevated levels ofcalcium (hypercalcaemia) that may causekidney stones, dietary factors forgallstones.
Local conditions at the site in question that promote their formation, e.g., local bacteria action (in kidney stones) or slower fluid flow rates, a possible explanation of the majority ofsalivary duct calculus occurring in thesubmandibular salivary gland.
Enteroliths are a type of calculus found in theintestines ofanimals (mostlyruminants) andhumans, and may be composed ofinorganic ororganic constituents.
Bezoars are lumps of indigestible material in thestomach and/or intestines; most commonly, they consist of hair (in which case they are also known ashairballs). A bezoar may form the nidus of an enterolith.

Inkidney stones,calcium oxalate is the most common mineral type (seenephrolithiasis).Uric acid is the second most common mineral type, but anin vitro study showed uric acid stones and crystals can promote the formation of calcium oxalate stones.^[1]

Pathophysiology

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Stones can cause disease by several mechanisms:^{[citation needed]}

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:^{[citation needed]}

Nephrolithiasis (kidney stones)
- Can causehydronephrosis (swollen kidneys) andkidney failure
- Can predispose topyelonephritis (kidney infections)
- Can progress tourolithiasis
Urolithiasis (urinary bladder stones)
- Can progress tobladder outlet obstruction
Cholelithiasis (gallstones)
- Can predispose tocholecystitis (gall bladder infections) andascending cholangitis (biliary tree infection)
- Can progress tocholedocholithiasis (gallstones in the bile duct) andgallstone pancreatitis (inflammation of thepancreas)
Gastric calculi can causecolic, obstruction, torsion, andnecrosis.

Diagnosis

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Diagnostic workup varies by the stone type, but in general:^{[citation needed]}

Clinical history and physical examination
Imaging studies:
- Some stone types (mainly those with substantial calcium content) can be detected onX-ray andCT scan
- Many stone types can be detected byultrasound
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

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Modification of predisposing factors can sometimes slow or reverse stone formation. Treatment varies by stone type, but, in general:^{[citation needed]}

Healthy diet and exercise (promotes flow of energy and nutrition)
Drinking fluids (water andelectrolytes like lemon juice, diluted vinegar e.g. in pickles, salad dressings, sauces, soups,shrubs cocktail)
Surgery (lithotomy)
Medication /antibiotics
Extracorporeal shock wave lithotripsy (ESWL) for removal of calculi

History

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

The care of this disease was forbidden to thephysicians that had taken theHippocratic Oath^{[citation needed]} because:

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

Etymology

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The word comes from Latincalculus "small stone", fromcalx "limestone,lime",^[3] probably related to Greekχάλιξchalix "small stone, pebble, rubble",^[4] which many trace to aProto-Indo-European language root for "split, break up".^[5]Calculus was a term used for various kinds of stones. In the 18th century it came to be used for accidental or incidental mineral buildups in human and animal bodies, like kidney stones and minerals on teeth.^[5]