Nace Extra Flashcards
Case 1 presentation
Flank pain, vomiting, working outside, radiation to the pelvis, severity of the pain, male
What is the lifetime risk of having a kidney stone?
10%. High rate of recurrence
How can you explain the evolution of the pts symptoms?
Stones that stay in the pelvis aren’t symptomatic
Where is a stone likely to get stuck?
Angulations, ureteropelvic junction, iliac vessel crossing (ureter crosses iliac), bladder entry or outlet.
DDx?
Diverticulitis, appendicitis, hernia
Acute cholecystitis, acute appendicitis, pyelo, AAA (consider with older people, be sure you can exclude this)
How can you decide if a stone will pass?
You can decide based on size. Less than 5mm will usually pass. Greater than 7 probably won’t.
What do you do when they don’t pass?
Can be fragmented using lithotripsy (ESWL)- esp for stones that are more proximal,
ureteroscopy also good for proximal+mid and distal stones- visualize and fragment the stone with a laser),
percutaneous nephrolithotomy- not done very often, go through the kidney and done
What is the best way to control kidney stone pain?
Control the pts pain (the best way is by NSAIDS- they are better and safer than opiates), control the vomiting, send him home with a strainer.
Avoid NSAIDs if pt has decreased excretory function.
Pt brings in the stone, then you send it for analysis. Always need to do this.
Would imagining help?
(KUB- kidney ureter bladder, plain radiograph study)
Which stones are radiolucent upon x-ray?
Uric acid stones (most all other stones are radiopaque)- on plain x-ray
Helical CT is the most sensitive, doesn’t require contrast, does require radiation.
Ultrasound- pretty specific in the pelvic, but ureteral stones are hard to see in the ultra sound, can see hydronephrosis which would be good evidence in the right clinical setting.
Many people would say this is the first choice (low radiation, fairly accurate, but won’t see the stone specifically)
