The Most PAINFUL Thing a Human Can Experience?? | Kidney Stones

Kidney stones are one of the most painful things  that a human being can possibly experience,   and the older you get the more likely it is that   you are going to get to experience  one of these "rocky bundles of joy". So in today's video we're going  to use the cadavers to take a   look at the inside of a kidney and see  exactly where, why, and how they form. And on top of that, we're gonna be  able to see why they hurt so much. Let's do this! I will never forget this. It must have been maybe two or three years ago,  and I was here in the lab, and I had a group of   students here with me, and I was teaching the  kidneys and we were talking about kidney stones. One of the students looks at me with the most  intensely serious face I've ever seen — like just   straight dead in the eyes, and she says to me... "I've had six children... I would rather have all   six of them — all natural — back to back,  than ever have kidney stones again..." And I remember it was just super quiet,  and I just look at her and I say, "well   I don't have a uterus, and I've never  personally had a kidney stone myself,   so I'm just gonna have to  take your word for it..." What you have to understand  is that her experience and   sentiment surrounding kidney  stones is very, very common. A lot of people do compare  kidney stones with childbirth. But the thing you have to understand is  that pain is actually very subjective. Meaning that if I was somehow  able to give this exact same   kidney stone to two different people and then   they had the exact same experience, they're  still going to process the pain differently. And that doesn't make one  more real than the other. Just understand pain is subjective. I can't tell you how painful kidney   stones are because there's a lot of  different factors that go into it. Like I said, it's the person...  but it's also their overall health,   it's the size and shape of the kidney stone,  it's the hardness of the kidney stone. There are a lot of factors that go into it. Just understand that kidney stones are painful,   and it it may be more painful  than childbirth, it may not. Either way, you do not want to have these things. So let's go ahead and take a look  at the cadaver and see exactly why. You are looking at a left kidney, and I know that   because this ureter right here is behind these  blood vessels which tells me that it's a left. Now you need to also understand that the left  kidney happens to be a little bit bigger,   and a little bit higher in the body  when compared to the right kidney. That's because the liver — which is  on the right side — is so massive   it shrinks the kidney a little  bit and also lowers it slightly. On the outside of the kidney there  is a bunch of connective tissue. You can see some of it kind of "chewed up" here. That's just due to handling that it's  kind of been roughed up like that. This outer connective tissue  layer is called the Renal Capsule,   or the Fibrous Capsule — you can kind  of choose which one you want to call it. But this is true for most structures in the  body, that they have a connective tissue outer   layer that's just going to be very protective and  just help with a variety of different problems. One of my favorite things to do here in the lab  is this next part, and you're going to love this. I can actually grab the  kidney and reflect it open. That's because we've cut the kidney in  what's known as the Coronal or Frontal Plane. That basically just means that we've cut the  kidney so there is an anterior or front portion,   and a posterior or back portion. This allows us to see a ton of  really cool and interesting anatomy. I'm gonna go ahead and take this half, place  it over here, and we're gonna focus today   right here because this is gonna allow us to  see pretty much everything we need to see. Now, in order to best understand kidney stones,   we also need to understand how  the kidney works in general. The kidney does a variety of different things,   but if you could just sum it up real  nice and easy, it filters your blood. That's going to be the most relevant function  of the kidney for our purposes today. How it does that, is this structure  right here is called the Renal Artery. The Renal Artery is going to start   taking blood — unfiltered blood —and as  you notice it's going to start splitting. As it starts splitting, it's going to  start heading up to this portion here. It's going to be difficult to see  exactly where those splits are,   but it's going to head to this outer rim here. This is known as the Renal Cortex. Cortex just translates to "bark" — like "bark  of a tree", so it's a surface type region. This is where most of the interesting  things in the kidney actually occurs. The problem is it's too small  for us to see with the naked eye. Inside of this cortex   are a bunch of tiny little filtration units  that are going to filter the blood for us. We take the unfiltered blood to  the cortex, it becomes filtered,   and then what's going to happen is that  newly filtered blood will be deposited   into the venous system, and it's going to go  back that same pathway it'll just be a different   tube, and it will then exit the kidney right  here in this structure known as the Renal Vein. So we bring blood in through the Renal Artery,   and then we take blood out that's  been filtered to the Renal Vein. The Renal Vein is then going  to connect to a larger blood   vessel which will then transport it to the heart. Think about it like this — the heart  pumps blood to the kidneys to be   filtered, it gets filtered, and  then gets sent back to the heart. It doesn't send obviously all the blood at once,   otherwise it'd be a closed loop  and you'd never get blood anywhere. This whole process is happening 24/7... 365. You are always filtering your blood. That's a good thing! Because if you weren't filtering your blood,  the blood becomes very toxic, very quickly. We'll see exactly how that  happens in just a moment. When it does filter out these  particulates, they have to go somewhere. Where they're going to go is into  this next region here, that we call   the Renal Medulla or Medulla  (pronounced slightly differently). That just basically means "marrow". It's just this middle-ish portion. We have the cortex on the rim, and then we have  this inner portion that we call the medulla. Inside of the medulla are  going to be all these really   cool looking structures called Renal Pyramids. If I had done the dissection differently,  we would actually be able to see that   these structures do in fact have a pyramidal  shape to them — they're really, really cool. Human beings have on average  around seven to eight of these   inside of the kidney, but  you can actually have more. This just comes down to  variability within the species. What's going to happen is when the blood  has been filtered, all the stuff that   your body decided it didn't want is going  to be dropped into these Renal Pyramids. It's going to drop down these tiny little  tubules just located inside of here,   and it's then going to get to these next  structures right here, called the Renal Papillae. Papilla just means "nipple". If you were to look at these, they do have a  kind of "nipular" shape, I guess you could say. This structure is going to be important for  kidney stone formation as we go forward on. We also have to understand that  now we have a new substance. We are now going to start calling it urine. Urine is going to be composed of   particulates — things that the body deemed  as being waste or just outright didn't need. It's going to mix that with water to form urine. It's then going to go into the urinary tract. This is where the urinary tract is  going to begin, in these Renal Pyramids,   to the Renal Papillae, and it's then  going to go into another structure here   called the Calyces or the  Calyces (pronounced differently). Now Calyx means "husk", like the "husk  of corn" — that's where it gets its name. This is going to be very important  for kidney stone formation. It's then going to come over to this  structure here called the Renal Pelvis. Pelvis is "base ", so this is the "base of the  kidney", because renal also means "kidney". Then the urine is going to go down this  very long tube that we call the Ureter. The Ureter — which we've obviously cut here  — would then be connected to the bladder. Then the bladder — which is just a storage  facility for the urine — would then have   the Urethra coming out of it  to drain the urine out of it. Now that we know how the kidneys filter blood   we can begin to discuss the process  with which kidney stones will form. And probably unsurprising to you it's  going to happen in the urinary tract. The urinary tract again begins here inside of  the collecting tubules of the Renal Pyramids,   and then will end with the urethra. Now kidney stones come in a variety  of different "flavors" — types... I don't know... there's probably  a better way to say that... [There are] about five types on average, but  we're just going to go ahead and kind of even   the playing field and just say that it's one  type and that's going to be calcium oxalate. The reason why I say that is because  calcium oxalate make about 80%   or so of the stones that do form, and that's  pretty much throughout the entire urinary tract. What you need to understand is that they  form due to what's known as supersaturation. Urine, again, is going to be a byproduct — so  the blood filters it, and it comes down here,   and you're going to have a lot of different  components inside of your urine in this area,   such as urea — which helps to give urine its  name — but you're also going to have water. You're going to have hormones. You're going to have things  that are basically just   outright waste products — are toxic to your body. You're also gonna have things your body just   has too much of ,such as hormones like  Human Chorionic Gonadotropin — that's HCG. That's the hormone of pregnancy. It's what alerts the body to let  you know that you're pregnant. So what will happen is you will urinate  out the excessive amounts of it,   and then we can detect that with a pregnancy test. We can do that with a variety  of different substances. But one of the things that is also  going to be in there are electrolytes. Now electrolytes are not just found in  Gatorade — they're all throughout your body. These are going to be charged particles,  such as calcium, sodium, potassium. Now calcium is going to be the most  relevant to us due to the fact that   we're dealing with calcium oxalate stones,   but just understand that electrolytes  are also going to attract water to them. For urine to flow throughout your urinary tract,   what will happen is the kidney  will actually deposit in   electrolytes to attract water from the blood, from  the interstitial tissue of the kidney itself, into   there so then you have this liquid that'll more  easily be transported down through the system. Now the thing is though, if you have too many  electrolytes — specifically in this instance   we're going to say calcium, oxalate and phosphate  — what will happen is you get supersaturation. When it's supersaturated, crystals can  begin to form inside of the urinary tract. Now typically they're going to form here in  the collecting tubules of that Renal Pyramid   and in the Papilla of the Renal Pyramid. This is where you have this  event called nucleation occur. Then what's going to happen is it's  slowly going to start to get bigger,   and all the crystals just start merging into  what we call aggregation — so they start   getting larger — we have an aggregation event. That's when it's going to  form a much larger stone. I actually have a kidney stone   right here that we can look at to get an  understanding as to the size of this thing. I went ahead and measured this kidney stone  beforehand, and it's about seven millimeters. You have to understand that below five  millimeters is often seen as being   "easily passable" — I don't know if that's always   the right term for it — meaning that it  usually doesn't require intervention. All you have to do is observe it, let it  pass, and things are going to be fine. Between five and ten millimeters it's  still passable, but you're probably   going to need some kind of intervention such as  medications or — we'll kind of get there in a bit. They can get even bigger than that! They can get all the way up to 20 millimeters! That's ridiculous! That's like three times the  size of this stone right here. You can see that once it — let's go back here. Once it nucleates and aggregates, it's then going  to set up shop in either the Calyces or the Renal   Pelvis or the Ureter — any of those places  we mentioned earlier — and it's just going   to continue to grow and grow and grow until it  gets pretty massive to the point where it will   then detach, and it will start flowing through  with the urine until it reaches this point here. This is where we begin to  have a pretty big problem,   because you can see already that this stone  is going to be bigger than the tube itself. The Ureter's diameter is about four millimeters. This is why five millimeters and below  is more "handleable" — is that a word? I don't know if that's a word... And then anything above that  is going to create issues. You can see that the shape  is also going to be crazy... These kidney stones can have some crazy shapes  that look like they're from the bowels of hell   or something like that. What'll happen is... this not only  is it massive, it's pokey and jagged,   and it's going to start to go into this tube. Now one thing you have to understand too is  how — and I'll move this kidney stone for a   second — is how the urinary tract puts  urine or moves urine through the body. What will happen is this tube here   is layered, and there is a muscular  layer to it that will actually contract. What will happen is the Ureter is  normally closed, which makes sense. You don't want to have the tube just permanently  open because imagine if you did a handstand...   all the urine from your bladder would  go up the ureter and back to the kidney. That doesn't make much sense. It's going to be closed off. As the Kidneys filter more blood and make urine,  what'll happen is it'll eventually open up   and it'll allow urine to flow into  it and then it will close behind it.   so you have this discrete chunk of urine  that's going to be [going] through here,   and then the tube is going to  contract and squeeze it down. We call this Peristalsis, and this  happens in other places in the body too,   like your cardiovascular system,  and your digestive system. This is how you're going to move  urine down into the bladder. I'm sure you know exactly what I'm talking  about — and if you don't... you're lying.... Have you ever been sitting on the toilet, you know   on your phone for way too long and all  of a sudden just more pee comes out? [You] wait a little bit longer,  then more pee comes out? That's pretty much the Peristalsis in  action, just kind of moving that — that's   the amount of urine you've been making while  you've been sitting there, essentially. The reason why I bring this up is because —  now I'll bring the kidney stone back — when   that kidney stone — if I can try and center this  a little bit — kidney stone reaches this point,   it's going to start to try to go down. As it does that, the tube is  going to start cramping around   it and it's going to attempt to push it down. This is one of the biggest  reasons for having so much pain. The tube is just contracting — that muscular layer   is just cramping and pushing around it in an  attempt to push that entire stone down here. I'm gonna do my best... let's look at this and  see if we can get a side-by-side comparison...   I'll pull this up here so you  can see just how big this is. Even if it's going parallel  it's still a pretty big stone. If it's even going this way  that's even more of a problem! I even have other stones — look at this. I measured this stone and this  stone... these stones here — again   I don't know their exact composition...  I haven't done any kind of analysis. I imagine they're probably calcium oxalate or  calcium phosphate, but they get to be bigger. The biggest stone we have here is going to be I  think this one, which is around nine millimeters. You can see the problem here! Just compare the tube, and  then compare the size of it. You can see that we have a pretty big problem  here, that it's just not going to fit. That's where you're definitely going to have  to start doing what are known as interventions. Interventions are going to be  things like medications such as   painkillers or muscle relaxers, which are going to  focus on that ureter — which makes a ton of sense! If you can get it to relax and open up, it's going  to be easier for that stone to then pass through. It's also going to be things like surgical  procedures such as shockwave lithotripsy. This is where you'll lay down and they  will send focused sound waves through water   and your back into the kidney  to help pulverize the stone. This depends on the hardness of the stone,   which depends on what it's made  of... it depends on the location. It may take only one session. It may take multiple sessions. Or that may not even be the best way to go. They may have to go in and cut through  your skin, into the kidney itself, and   extract the stone that way. Another option is going to be  what's known as a ureteroscopy. In a ureteroscopy they go up the urethra,  into the bladder, up the entire ureter,   and then into the kidney itself  if they need to go that far,   and they have a little basket that they  can actually grab the stone and pull it. Or they can even have a laser attached to it  which will laser the stone and then they use   the basket to capture the stone fragments or  as much as they can and pull it out, like so. These are going to be things that makes  things easier, but they come with their   own set of issues and each of them have  complications, they have their own set of pain. It's one of those things that — let's say you  were able to obliterate it and make it smaller...   well you still have to pass a lot of fragments. If we just did the shockwave lithotripsy,  you're still going to have to pass those   fragments and they may be much smaller — they  should be smaller than four millimeters — which   will make it much easier, but it's not as though  it's going to be outright comfortable to do so. But in the end it's going to be  obviously much better than if you didn't   laser it or obliterate it with  shock waves in the first place. So you're probably wondering, now  that I've terrified you to your core,   or if you've had these before  you already know — "what can   I do to prevent this from happening?  What's causing it in the first place?" It really comes down to two main ones, and that's  going to be a genetic predisposition — you have   a family history of it — or it's  going to be based around your diet. But even if it's one of those  two things, the end result   is going to be that supersaturation  that we mentioned — you're going to   have too much calcium and oxalate and  phosphate inside of your urinary tract. Diet is going to be something  that you can very readily control,   and you're going to want to partake in  foods that are going to be lower in oxalate. You want to avoid things like beans or  potatoes or spinach, for that nature. You can find lists of the foods that are going  to be lower in oxalate or higher in oxalate. You're going to want to have foods  that have a better source of calcium. But the main thing — well I shouldn't...  maybe I shouldn't say the main thing — but   one of the biggest factors is actually  just going to be... be properly hydrated. You're gonna want to make sure that you're  urinating, because if you are properly hydrated   through proper sources of hydration — not just  drinking say like soda, or cola specifically. Because colas have also been shown to have  a strong link to kidney stone formation. If by drinking enough water — well maybe I  should say this first... if you're dehydrated,   then you're going to have supersaturation because  there's less water content inside of your urine. If you're properly hydrated you can  have a more normal saturation level   and make it far less likely  for you to have those stones. So it's probably no surprise to anyone  that the answer, or at least the best   remedy or prevention method is going to be  a better overall diet and drinking water. So why are kidney stones so painful? Well it's a combination of things! It happens to be the fact that there's a  stone forming inside of your urinary tract   which can obstruct flow and create  pressure inside of the kidney... It's the fact that it's sharp and jagged  often times or just oddly shaped and it's   pushing its way through a tube that the  tube is smaller than the stone itself... Then it's scratching and scraping its way down —  the entire way down, by the way — and sometimes   you might get a moment of respite or relief when  it gets to the bladder but sometimes you may not. You also have the residual leftover  feeling even if it is in the bladder   or if it's out the urethra, of the fact that  your body just went through a traumatic event. It's trying to heal that way. Then it's going to go through  the urethra and — by the way,   this is one of the very few times in human  biology that it's worse to be a male,   because he's going to have an obviously longer  urethra that he's then going to have to go out... So it's a combination of all of those types  of things coming together to create this   just insanely, insanely,  horrifyingly painful experience. Thanks for watching everybody! Hopefully you learned something in this video! And if the only thing you'll learn in this  video is that to prevent kidney stones   or at least give yourself the  best shot at not having them   is to have a better diet and stay hydrated,  I am considering this an outright win! As always, be sure to like, comment, subscribe. In the comments below, if you have an idea for a   video that you want Jonathan or myself  to do in the future, just let us know. We're always open to your ideas. We want to give you videos that you're interested  in, not just ones that we're interested in. But again, thanks for watching, and  I will see you in the next video.

Channel: Institute of Human Anatomy

Views: 9,741,948

Keywords: kidney stones, kidney pain location on body, kidney failure symptoms, kidney stone removal lithotripsy procedure, kidney stone passing through urine video, kidney stones symptoms, why do kidney stones hurt, what are kidney stones, what are kidney stone, what are kidney stones symptoms, what are kidney stones made out of, kidneys, most painful thing a human can go through, most painful thing a human can experience, pain, how much pain can a, how much pain can a human take, anatomy

Id: dVWngXTb0LI

Length: 21min 31sec (1291 seconds)

Published: Thu Jun 03 2021

Reddit Comments

[u/MicrobialBuffalo]

Mods, can we put this video in the sidebar? An excellent and informative reference for anyone on this forum. Would be nice to direct people to this video and is less of a pain having to source it every time a relevant question gets asked

[u/evangamer9000]

Looks like a solid video from a good source, thanks for sharing

[u/Rbfoges]

Wow! This is such a great video! I would love this guy to do more videos! Its so interesting ti learn about thr human body! Its also validating for how painful stones are

[u/Puckmarin]

Fascinating video, thank you for posting!

[u/OutDoorLover27]

This was incredibly informative! Having it visually explained and broken down like this helped me understand what happens SO much more! Thanks for the fantastic video.

[u/Chonksolidus]

Very informative

[u/Poet_Fabulous]

This reminds me of my Old University days Straight forward helpful response Nowadays you have to read between the lines of everything Including my current employment You need a support person outside your circle ⭕️ To bring positive vibes and feedback no matter what the circumstances