Kidney Stones

HISTORY:

‍RightLeft ‍flank painCVA pain for ‍ ‍hoursdays

Onset: ‍gradualsudden, following ‍

Radiation: ‍none

Severity: ‍mildmoderatesevere, ‍012345678910 / 10

Type: ‍crampingsharp

Pattern: ‍constantintermittent

Worsening factors: ‍none

Treatments tried: ‍none, ‍effectiveineffective

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍changes in stools

‍hematuria

‍urgency

‍frequency



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

CVA tenderness: ‍negativepositive on Rpositive on L

Pelvic: vulva ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍no cervical motion tenderness

Genital: ‍normal, testicles ‍normal, penis ‍normal

Skin: ‍no rash

Thoracic

Lumbar spine: ‍no tenderness on ‍, range of motion ‍fulllimited



ASSESSMENT:

‍Renal colic ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍BUN, ‍CRP, ‍calcium, ‍phosphate, ‍uric acid, ‍β-HCG

- Urine: ‍urinalysis, ‍urine culture, ‍24-hour urine collection for calcium, oxalate, uric acid, citrate, sodium

- Abdominal ultrasound

- CT scan of abdomen

- CT pyeloscan

- ‍Acetaminophen

- ‍NSAIDs

- ‍Opioids

- ‍Tamulosin

- Keep well hydrated

- Filter urine with coffee filter to catch stone

- Referral to urologist

- Follow-up in ‍ ‍daysweeksmonths

- Return if uncontrolled pain, if new symptoms develop such as fever, or if symptoms persist