What is the differential diagnosis? 2 What other questions would you ask about? 3 What is the most likely diagnosis? 4 What other investigations would you request? 5 How should this patient be managed?
A 32-year-old man presents to his GP with colicky pain which radiates from
his back to his groin on the left. He has also been feeling nauseated and has vomited several times. The patient relates that he has never had this kind of problem before and that nobody else in his family has either. He is a fit and well man with no medical problems and does not take any
medications. He has not had any urinary symptoms or fever. He does eat a lot of chocolate and drinks a lot of tea. He works outdoors as a gardener and so often gets very hot and does not always have time for a drink. The pain comes in waves and can last about 30 minutes.
* On examination
On examination he is very tender in the left loin. The pain radiates into his
left groin. The rest of his abdomen is soft and non-tender. His urine dipstick shows non-visible haematuria and is negative for nitrites and leucocytes. His temperature is 38.2. He is clinically dehydrated and is still vomiting.
* examination
When in hospital the patient had his IV urogram which showed no evidence of
obstruction. His renal ultrasound showed a 4 mm stone. The patient passed the stone and when analysed it was found to be a calcium oxalate stone. The patient was fit for discharge.
1 What is the differential diagnosis?
2 What other questions would you ask about?
3 What is the most likely diagnosis?
4 What other investigations would you request?
5 How should this patient be managed?
6 What advice should you give this patient?
7 Risk factors for calcium oxalate?
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