Renal Calculi

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍rightleft ‍flank painCVA pain

Onset was ‍gradualsudden, started ‍whileafter ‍

Radiation ‍none to ‍

Rated at ‍012345678910 / 10 ‍

Described as ‍crampingsharp

Pattern ‍persistentintermittent

Episodes last for ‍ ‍, recur ‍ times per ‍

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍changes in stools

‍hematuria

‍urinary urgency

‍urinary frequency

‍cloudy urine



Contributing factors:

‍low water intake

‍high protein diet

‍high sodium diet

‍high oxalate diet

no history of: ‍kidney stones, ‍gout, ‍hypercalciuria, ‍hypertension, ‍AAA

no family history of: ‍kidney stones





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Pelvic: external genitalia ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍cervical motion tenderness

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia

Skin: ‍rashlesions on ‍

Thoracic

Lumbar spine: ‍tenderness on ‍, range of motion ‍fulllimited





ASSESSMENT:

‍Renal colic ‍likelysuspectedpossible

DDx: kidney stone, pyelonephritis, urinary tract infection, ureteropelvic junction obstruction, bladder stones, urethral stricture, renal cell carcinoma, glomerulonephritis, interstitial nephritis, diverticulitis, appendicitis, aortic aneurysm, constipation, musculoskeletal pain, herpes zoster, thoracolumbar spine pathology, polycystic kidney disease





PLAN:

Investigations:

- 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

Treatments:

- ‍Acetaminophen

- ‍NSAIDs

- ‍Opioids

- ‍Tamulosin

- Keep well hydrated

- Filter urine with coffee filter to catch stone

Further care:

- Referral to urologist

- Follow-up in ‍ ‍daysweeksmonths

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