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Saturday, May 14, 2011

Urinary Stone Diagnosis Tips

Posted by Prahallad Panda on 7:26 AM Comments

Kidney stones usually form within the kidneys and descend down the urinary tract to cause symptoms. They usually follows an infection, stagnation or abnormality in the urinary tract, and can also occur due to excessive calcium intake, hyperparathyroidism, blood disorders like sickle cell disease, or gout. Kidney stones may be found in the renal pelvis, ureter, urinary bladder or in the urethra.
The most common variety are composed of a phosphate salt of calcium and /or magnesium. Around 40 to 50 percent of stones show as a shadow in x-rays of the abdomen and pelvis.
As with any disease, a complete medical history is the most important part of diagnosing this condition. Any history of other diseases like sickle cell disease, gout or hyperparathyroidism may give a clue to the diagnosis.
  • Some of the symptoms include, haematuria, blood in urine. and severe pain in the abdomen with location depending upon site of the stone, which can cause nausea and vomiting. The pain may be a dull aching or a severe colicky pain, which is not relieved by any change in the patient's position, and often radiates into the groin. A fever may be present, if there is a secondary infection.
On examination;
  • Abdomen is usually soft without any distension and may have some pain on pressure over the site of impaction of stone.
  • There may or may not be any true muscular guarding in abdomen or rebound tenderness i.e. pain after release of pressure.
Its diagnosis is both easy and difficult. When pain is felt in the upper abdomen due to stone in the kidney most often simulates acid peptic disease, cholecystitis or pancreatitis. Pain in right lower abdomen may confuse with appendicitis.
Common investigations usually required are;

  • A plain x-rays examination will often show the stone as a radiopaque shadow, taking the shape of the site in urinary tract where it is impacted. In renal pelvis, it typically takes shape of stag horn. In ureter, it may be round or elliptical. In bladder it is usually round in shape.
  • Ultrasonogram is an invaluable tool in the diagnosis of urinary stone.
  • Blood in urine is a corroboratory finding.

Tips for correct diagnosis:
  • The nature of pain; i.e. patient does not get comfort in any position; either lying or sitting is very typical of stone in ureter.
  • Radiating pain from loin to groin.
  • Lack of true guarding in abdomen and rebound tenderness differentiate it from appendicitis and some other GI diseases giving rise to pain in abdomen.
  • Associated painful haematuria.
  • Plain X-rays examination of abdomen and pelvis.
  • Ultrasonogram
With the proper history taking, a careful examination and common investigations diagnosis of a stone in the urinary tract is possible with reasonable accuracy. However, more investigations like intravenous urogram (IVU), retrograde urogram (RGU), CT and some other blood tests may be required for proper evaluation and treatment of a patient.

First Published in Technorati
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