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Terms in this set (49)

Bedside examination is typically unremarkable (perhaps demonstrating some tenderness in the affected flank) - perhaps signs of dehydration from reduced fluid intake secondary to associated vomiting.

Urine dip - May display microscopic haematuria, or suggest infection (will need to send urine culture if positive for infection markers)
Pregnancy testing should be considered/performed in all women of child-bearing age presenting with abdominal pain, as unexpected pregnancies do occur, and ruptured ectopics can present with a wide variety of patterns of pain.
ECG - ECGs are performed in most patients that attend A&E, or are admitted to hospital. It is a quick, simple, inexpensive test that allows us to examine the heart rhythm, evaluate tachycardia, and can show signs of a number of conditions that otherwise might not be suspected.
Retrieval of the stone (If pt. notices passing the stone when urinating) à send for analysis
For patients with recurrent nephrolithiasis, 24-hour urine measurements allow risk factors to be identified and corrected

As ever, bloods provide a wealth of information that helps to delineate between all of our differentials, and are a quick, simple, and relatively safe and minimally-invasive test. Important tests here include:
•Full Blood Count
•Hb drop might suggest Perforated peptic ulcer/Ruptured AAA
•Raised WCC would suggest infection, such as Concurrent infection in Urolithiasis/Pyelonephritis/Lower lobe pneumonia
•If positive, would lend further weight to the infective picture
•Look at the renal function, which is often impaired in obstructive uropathy - this would be a post-renal cause of AKI
•Electrolytes may show a raised calcium
•Urate (along with Calcium)
•Help to analyse risk factors for stone formation
•LFTs - If on the Right Hand Side

AXR - Used in some centres for initial assessment. Disadvantages:
1.Not all stones are radio-opaque
2.High radiation exposure (much higher than a CXR, as a higher dose is needed to image through the denser abdomen)

Renal Tract USS - Often used concurrently in known stone disease ?hydronephrosis.
1.Often detect renal stones
2.No radiation
1.Ureteric stones not often detected
2.operator dependent

Non-contrast CT KUB (CT Kidneys, Ureters, Bladder) - This is the Gold Standard as it has a high sensitivity and specificity in identifying stone disease AND concurrent assessment of alternative pathology.

Intravenous Urograms = injection of contrast and subsequent series of AXRS à demonstrate any filling defect. Rarely used due to having the following disadvantages:
1.High radiation exposure
2.The relative superiority of CT imaging