A 56-year-old male was brought to the emergency room with a chief complaint was
ID: 137186 • Letter: A
Question
A 56-year-old male was brought to the emergency room with a chief complaint was right flank pain. History of present Illness: One day prior to admission, the patient developed a change in the color of his urine from pale yellow to red in color. There was no associated fever, painful urination, or penile discharge. He decided to consult with his primary physician the following day. One hour prior to admission, the patient developed severe right flank pain associated with nausea. Upon admission, the patient was noted by the ER physician to be in severe pain, with a pain scale of 9 from a visual analog pain scale from 1 to 10. On physical exam, the patient had the following findings: Vital Signs BP: 140/90 mm Hg Heart rate: 110 bpm Respiration rate: 15 breaths per minute patient Temperature: 98.6 deg C All exam findings for the head, neck, heart, lungs, and abdomen were normal. On examination of the back, the patient had tenderness on the right flank upon palpation. On examination of the genitalia, there was no penile discharge. Note of a 1 x 1 cm tophus on right big toe. The following diagnostic exams were ordered CBC with WBC differential count Urinalysis Serum uric acid KUB x-ray MRI Scan abdominopelvic area Past Medical History: Diagnosed with gout one year prior to admission On medication with allopurinol No heart and lung disease No diabetes or hypertension.
Questions and topics for discussion:
1. After considering his signs, symptoms, findings, and diagnostic exams, what would be the clinical diagnosis in this patient?
2. What is causing the hematuria to occur?
3. Why are his vitals (BP, HR, breathing) elevated?
4. What is causing the severe right flank pain?
5. How are the elevated levels of serum uric acid and positive uric acid crystals in the urinalysis related to your diagnosis?
6. What pain medication would you provide to this patient? Why would you choose this medication?
7. What treatment would you recommend for removing the cause of his pain? Explain your answer.
Explanation / Answer
After considering his signs, symptoms, findings, and diagnostic exams, what would be the clinical diagnosis in this patient?
A kidney stone is a solid, crystal-like mineral material enclosed within the kidney or urinary area. Kidney stones are a characteristic motive for blood and frequently serious agony in the midriff, flank, or crotch. Kidney stones are here and there called renal calculi.
What is causing the hematuria to occur?
A kidney stone is a firm, crystal-like mineral solid shaped within the kidney otherwise urinary zone. Kidney stones are here and now and formerly named renal calculi. The state of partaking stones is named nephrolithiasis.
Why are his vitals (BP, HR, breathing) elevated?
Kidney stones ordinarily don't cause side effects while they shape inside the kidney. On the off chance that the stone goes into the ureter the thin tube that associates the kidneys to bladder it might cause torment if/when it gets held up in the tube. Pain produced by a kidney stone might alteration to an substitute zone or increment in power as the stone travels through your ureter. The agony from the stone isn't from it moving down the ureter, but instead from the blockage it is causing, consequently decreasing the kidney's capacity to deplete legitimately. In this way, the torment may reduce or vanish when the stone changes area inside the ureter to a position where it isn't obstructing the stream of pee from the kidney towards the bladder.
What is causing the severe right flank pain?
A kidney rock might not source side effects until the point when it moves around inside your kidney or goes into your ureter, the tube associating the kidney and bladder. By then, you may encounter these signs and indications: Severe irritation in the lateral and backbone, beneath the ribs.
How are the elevated levels of serum uric acid and positive uric acid crystals in the urinalysis related to your diagnosis?
A high measure of uric corrosive in the pee can likewise be an sign of kidney stones. Kidney stones are strong masses made of precious stones. The abundance uric eroding in the physique causes the development of these precious stones in the urinary tract alongside blood in the pee.
What pain medication would you provide to this patient? Why would you choose this medication?
-NSAIDS. NSAIDS, or non-steroidal calming drugs, incorporate such basic agony executioners as ibuprofen, diclofenac, naproxen sodium, and headache medicine.
-Paracetamol. Paracetamol is most regularly known as acetaminophen, you'd remember it by the brand name Tylenol, and is the most usually utilized pain relieving in America.
-Opioids.
What treatment would you recommend for removing the cause of his pain? Explain your answer.
Most little kidney gravels won't need obtrusive treatment. You might have the capacity to cruise a little stone by:
-Drinking water.
-Pain relievers.
-Medical treatment.
Kidney gravel that can't be cured with preservationist measures either on the estates that they're too massive to permit deprived of anybody different or in bright of the detail that they reason failing, kidney damage or progressing urinary tract diseases may require increasingly broad treatment. Strategies may include:
-Using sound waves to separate stones.
-Surgery to expel expansive stones in the kidney
-Using an extension to evacuate stones.
-Parathyroid organ medical procedure.
Anticipation of kidney gravels might incorporate a blend of way of life changes and medicines.
-Drink water for the duration of the day.
-Eat less oxalate-rich sustenances.
-Choose an eating regimen low in salt and creature protein.
-Continue eating calcium-rich sustenances, however utilize alert with calcium supplements.
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