Examination + investigations Flashcards
Flank pain exam position?
UC writhe in pain,
peritonitis sit still
Flank pain exam tenderness?
renal/ureteric stones have flank tenderness.
Flank pain exam masses?
central, laterally expansile mass could be leaking AAA.
Flank pain exam spine?
test range of motion and tenderness along vertebrae.
Flank pain exam lower limb?
if spinal pathology is suspected conduct neuro exam of lower limb.
If AAA suspected conduct cardio exam of lower limb as it can compromise their blood supply. If theres a strong popliteal pulse suspect popliteal aneurysm, 50% of patients with these also have AAA.
Flank pain exam temerature?
indicates inflammatory process like pyelonephritis
Flank pain investigations urinalysis?
urate stones have acidic urine,
alkali urine indicates urease producing bacteria that can predispose to stone formation
Flank pain investigations urine microscopy culture and sensitivity (MC&S)?
red cell casts indicate glomerular damage and white cell casts suggest pyelonephritis.
Flank pain investigations Urea, creatinine and electrolytes?
assess renal function as stone obstruction can precipitate renal damage.
Flank pain investigations bedside USS?
to look for AAA (CT shows if its leaking).
Flank pain investigations non-contrast CT KUB?
shows any stones or rare causes of ureter obstruction causing renal colic.
Flank pain investigations KUB XR?
useful for following progression of confirmed stones.
Flank pain Patients with confirmed kidney stone should be admitted if?
upper UTI,
evidence of renal failure,
refractory pain,
bilateral obstructing stones.
Flank pain kidney stone management?
regular multimodal analgesia (paracetamol + NSAID), encourage fluid intake. removal if appropriate.
Flank pain active kidney stone removal?
<0.5mm have 50% chance of passing, patient should recover stone for analysis and have follow up.
>0.5mm; lithotripsy (shock waves break stone), ureterorenoscopic removal (fine telescope inserted via urethra), stenting to prevent hydronephrosis, antibiotic cover.
Flank pain Acute pyelonephritis treatment?
IV fluid boluses, O2 if required, blood cultures, VBG, 2 weeks antibiotics, analgesia.
Flank pain types of kidney stone Calcium?
80% treated depending on presence of underlying metabolic imbalance. Patients with hypercalciuria should be investigated to exclude hyperparathyroidism and then treated with thiazides. Those with hyperuricosuria can be given allopurinol, those with hypocitraturia can be given potassium citrate.
Flank pain types of kidney stone stuvite?
15% most common in women and are secondary to infection, treat that
Flank pain types of kidney stone Urate?
5% form in presence of acid urine so potassium citrate may be given to alkalinize the urine. Allopurinol can be used to lower urate production.
Flank pain types of kidney stone Cystine?
1% form secondary to cystinuria. Increase fluid intake
Flank pain kidney stones what to look for on an XR?
Stones themselves, hydronephrosis or hydroureter (dilated ureters) due to obstruction, perinephric fluid.
Where in the renal tract do stones cause obstructions?
Pelvoureteric junction, pelvic brim, vesicoureteric junction.
