DR module 2
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Wilkes University *
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550-IK
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Medicine
Date
Feb 20, 2024
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docx
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2
Uploaded by ProfessorHawk10181
I believe the probable diagnosis for this patient is a kidney stone. This could be either an obstructing or non-obstructing stone. The patient’s medical history should be obtained to determine if they have had kidney stones in the past, since a prior history would put them at a higher risk of recurrence (Shastri et al., 2023). Certain comorbidities, such as diabetes, kidney disease, and cardiovascular disease, also increase the risk of kidney stones (Shastri et al., 2023). The patient should describe their daily exercise and diet regimen, as these can also affect the occurrence of kidney stones (Shastri et al., 2023). A non-contrast computed tomography (CT) of the abdomen and pelvis scan should be ordered to determine if a stone can be seen, and to evaluate the location and size of any stones present (Shastri et al., 2023). An ultrasound of the kidneys, ureters, and bladder (KUB) can be performed to get a better picture of the stone, as well as to view any abnormalities in the urinary tract (Yildirim et al., 2021). A urinalysis and urine culture should be completed to check for the presence of infection, as well as hematuria or crystalluria (Shastri et al., 2023). Lab work should include a complete metabolic panel (CMP) to check for a fluid or electrolyte imbalance and to evaluate the patient’s kidney function (Shastri et al., 2023). Other labs should include analysis of uric acid, phosphate, and parathyroid hormone (Shastri et al., 2023). A complete blood count with differential (CBC) should be drawn as well to monitor blood levels, infection, and any potential bleeding (Shastri et al., 2023). Stone analysis can be completed on a stone that is either surgically removed or collected with a urine strainer (Shastri et al., 2023). Fluids should be ordered since the patient is nauseated and in pain and may not be able to take in enough fluid by mouth to help pass the stone (Hughes et al., 2020). Antibiotics may also be ordered if the urine shows a bacterial infection (Hughes et al., 2020).
References
Hughes, T., Ho, H.C., Pietropaolo, A., & Somani, B.K. (2020). Guideline of guidelines for kidney and bladder stones. Turkish Journal of Urology, 46
(1), S104-S112. doi:
10.5152/tud.2020.20315
. Shastri, S., Patel, J., Sambandam, K.K., & Lederer, E.D. (2023). Kidney stone pathophysiology, evaluation, and management: Core curriculum 2023. American Journal of Kidney Diseases, 82
(5), 617-634. https://doi.org/10.1053/j.ajkd.2023.03.017. Yildirim, K., Bozdag, P.G., Talo, M., Yildirim, O., Karabatak, M., & Acharya, U.R. (2021). Deep
learning model for automated kidney stone detection using coronal CT images. Computer
in Biology and Medicine, 135,
104569. https://doi.org/10.1016/j.compbiomed.2021.104569
.
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