Dyad 6 guomanman chenya

Exams and Tests

The classic presentation of renal colic associated with blood in the urine suggests the diagnosis of kidney stone. Unfortunately, many other conditions can mimic this disease, and the physician or healthcare provider may need to order tests to confirm the diagnosis. There should always be a concern about the possibility of a leaking abdominal aortic aneurysm when dealing with a patient who presents with the typical symptoms of a kidney stone.

Physical examination is not very helpful in patients with kidney stones, aside from the finding of flank (side of the body between the ribs and hips) tenderness. The examination is often directed to ensuring that other potentially dangerous diagnoses don't exist. As examples, when examining the abdomen, the physician will be looking for a palpable mass that pulsates, which may be a sign of an aneurysm. Tenderness under the right rib cage margin may signal gallbladder disease.

Symptom control is very important, and medication for pain and nausea may be provided before the confirmation of the diagnosis occurs.

A urinalysis will show whether there is blood in the urine. It is also done to ensure that there is no infection associated with the kidney stone.

Blood tests are usually not done, except when the physician has concerns about the diagnosis or is worried about kidney stone complications.

CT scanning of the abdomen is the diagnostic test of choice. It is done without asking the patient to drink contrast material to outline the bowel and without intravenous dye injection. The scan will show the anatomy of the kidneys, ureter, and bladder and will show if a stone exists, how big it is, and how much blockage it is causing. The CT also demonstrates many other organs in the abdomen, like the appendix, pancreas, and aorta and may give extra information in case the preliminary diagnosis of kidney stone was wrong.

Ultrasound is another way of looking for kidney stones and obstruction and may be useful when the radiation risk of a CT scan is unwanted (for example, if a woman is pregnant).

In those patients who already have the diagnosis of a kidney stone, plain abdominal x-rays may be used to track its movement down the ureter toward the bladder.

http://www.emedicinehealth.com/kidney_stones/page3_em.htm

Self-Care at Home

* Prevention is always the preferable way to treat kidney stones. Remaining well hydrated and keeping the urine dilute will help prevent kidney stones from forming.

* Those who have never passed a kidney stone may not appreciate the severity of the symptoms. There is little a person can do with debilitating pain and vomiting other than seek emergency care. If this is the first episode and no previous diagnosis has been established, it is important to be seen by a physician as well. For those who have a history of stones, then home therapy may be appropriate. Most kidney stones, given time, will pass on their own, and treatment is directed towards symptom control. The patient should be instructed to consume oral fluids. Ibuprofen can be used as an anti-inflammatory agent, and if further pain medication is needed, contacting the primary care provider may allow stronger narcotic pain medication to be prescribed.

Follow-up

* For the first-time kidney stone patient, there should be an attempt to catch the stone by straining the urine, so that it can be sent for analysis. The stone may be so tiny that it may not be recognized. While most stones are made of calcium oxalate, should that not be the case, knowing what type of stone is the culprit may be helpful in preventing further episodes. For those whose stone disease is recurrent and the kind of stone is known, this instruction is omitted.

* Drinking plenty of water will help push the stone down the ureter to the bladder and hasten its elimination.

* A follow-up visit with a urologist will be arranged one to two weeks after the initial visit, allowing the stone to pass on its own.

* Patients should call their physician or return to the emergency department if the pain medication is not working to control the pain, if there is persistent vomiting, or if a fever occurs.

Prevention

* While kidney stones and renal colic probably cannot be prevented, the risk of forming a stone can be minimized by avoiding dehydration. Keeping the urine dilute will not allow the chemical crystals to come out of solution and form the nidus of a stone. Making certain that the urine remains clear and not concentrated (yellow) will help minimize stone formation.

* Medication may be prescribed for certain types of stones, and compliance with taking the medication is a must to reduce the risk of future stone episodes.

Die Another Day”: A qualitative analysis of Hmong experiences with kidney stones.
BybKathleen A. Culhane-Pera, MD MA Associate Medical Director West Side Community Health Services
and
Mayseng Lee, MD, MPH Internal Medicine Residency University of Minnesota Hmong Studies
MA and Mayseng Lee, MD, MPH, Hmong Studies Journal, 2006, 7:1-34.
Abstract
Background: A chart review at a urological office revealed that Hmong patients present with higher rates of kidney stones, uric acid stones, and complications from kidney stones than non-Hmong patients. In order to ultimately redress this health disparity, a conference of Hmong and non-Hmong health care providers decided that we needed to first understand the pertinent social, cultural, economic, and biological factors contributing to the disparity. This research project sought to elicit Hmong patients and family members’ explanatory models, decision-making processes, and experiences with the health care
system.
Methods: We conducted in–depth interviews with 10 Hmong kidney stone patients, 11 family members of 9 patients, and 4 traditional healers. All 10 patients had received urological interventions, including ureteroscopy (, percutaneous lithotomy (5) and nephrectomy (2). Some patients had postponed medical assistance (6) and had refused procedures (4). We qualitatively analyzed the transcribed and translated interviews with an Excel spread sheet and N6 computer software. Results were discussed with patients and a community advisory council.
Results: Hmong concepts of kidney function and explanatory models of kidney stones are a blend of traditional and biomedical concepts. Kidney stones are understood as acute health problems caused by hard substances in water and food that stick to the kidney, which weak kidneys cannot excrete. Kidney stone sufferers do not know they have stones until they pass a stone or they see stones on X-rays, as pain or hematuria are non-specific symptoms. They prefer medications, including herbal medicines, to invasive urological procedures. In making decisions about urological interventions, Hmong patients balance fear of disease (pain and renal failure) with fear of doctors (complications from interventions and anesthesia). While patients have variable balance points to accept interventions, the basic philosophy of “die another day” captures people’s preference to act today so as to postpone “death” ---whether by disease or procedure – until tomorrow.
Conclusions: These findings identify Hmong patients and family’s experiences with this health disparity. This information could be used to increase the Hmong community and patients’ knowledge of the disease and decrease their fear of urological interventions. Urologists, primary care providers and community health educators could educate the Hmong community and patients about the recurrent and nearly asymptomatic but potentially life-threatening nature of kidney stones, and encourage early diagnosis of renal stones. health care workers should make institutional changes that could increase
trusting relationships and decrease patients’ fears of providers and procedures.

References
1. Abelson, R.P., & Levi, A. (1985). Decision making and decision theory. In L. Gardener, & L. Aronson. (Eds.), The handbook of social psychology, Vol 1 (Pp 231-309). New York, NY: Random House. Cited in Garro, L. (1998a). On the rationality of decision-making studies: Part 1: Decision models of treatment choice. Medical Anthropology Quarterly, 12(3), 319-340.
2. Barret, B., Shadick, K., Schilling, R., Spencer, L., del Rosario, S., Moua, K., & Vang, M. (1998). Hmong/medicine interactions: improving cross-cultural health care. Family Medicine, 30(3), 179-84.
3 .CDC- Centers for Disease Control and Prevention. (2000) Eliminating Racial and
4 Ethnic Health Disparities. Office of Minority Health. http://www.cdc.gov/omh/AboutUs/disparities.htm (cited May 29, 2006).
5. Cha, D. (2003). Hmong American concepts of health, healing, and conventional medicine. New York, NY: Routledge.
6 Cohen, M.A., Tripp-Reimer, T., Smith, C., Sorofman, B., & Lively, S. (1994). Explanatory models of diabetes: Patient-practitioner variation. Social Science and Medicine, 38(1), s59-66

Response: UTI- FOLLOW-UP GUIDELINES AND MORTALITY
By: Dyad2: Gil Legarda / Joanalyn Balino


URETHRAL STONES CLINICAL GUIDELINES PANEL SUMMARY REPORT ON THE MANAGEMENT OF URETERAL CALCULI
By: Joseph W. Segura, Glenn M. Preminger, Dean G. Assimos, Stephen P. Dretler, Robert I. Kahn, James E. Lingeman, Joseph N. Macaluso Jr.


This research study made by Segura J. W. et al to analyze the literature regarding available methods for treating urethral calculi and to make practice policy recommendations based on the treatment outcomes data. The panel of this study used the MEDLINE data base for all the articles relevant to urethral calculi that were published fro 1966 to January 1996. The articles were reviewed first before approval and included in the research. The articles were underwent meta-analysis to identify outcomes estimates for alternative treatments of urethral calculi. Based on findings most of the urethral stones will pass spontaneously and those stones which can not pass can be removed only by either shock wave lithotripsy or uretroscopy.


This study show that there was an indicated up to 98 percent of stones less than 0.5 centimetres in diameter especially in the distal part of the urethra. It is recommended to have a shock wave lithotripsy in the first line treatment for most of the patients with stones 1 centimetre or less in the proximal part of the ureter.


There are stones that can pass spontaneously in the ureter but for stone can not needs to be removed by either ureteroscopy or shock wave lithotripsy as a new modern procedure to eliminate the kidney stones formed. As per reviewed and experimented the blindbasket extraction without the fluoroscopic control guide wires is not recommended also to prevent trauma or accident in the procedure. This research is helpful for the modern times because kidney stones is very common as a cause for renal failure which requires hemodialysis and we all know that this therapy is very expensive and requires a life time treatment if renal transplant is not possible.


Reference:
Segura J. W. et al (1997). Urethral stones clinical guidelines panel summary report on the management of urethral calculi. The Journal of Urology. Volume 158 Pages 1915-1921.

Pediatric urolithiasis: experience at a tertiary care pediatric hospital
Laura Chang Kit, MD,* Guido Filler, MD,† John Pike, MD,* and Michael P. Leonard, MD*
Can Urol Assoc J. 2008 August; 2(4): 381–386.

The incidence of pediatric urolithiasis is uncommon among the developed countries. However, studies conducted in pediatric centers in the US shows an increased in the incidence of children acquiring urolithiasis. In pediatric clients, the degree of having recurrent stone formation is high which may lead to early and quick destruction of the fragile kidneys among children. This study is conducted in order to determine the risk factors, clinical characteristics, evaluation and the course of patient’s recovery with urolithiasis. This is a retrospective research wherein children identified with urolithiasis for the first time from January 1, 1999 and July 4, 2004 will be included. The cases will be reviewed for demographics, presentation, family history, diagnostic methods and management as well as the incidence of recurrence.

The results revealed that most of the presenting factors includes abdominal or flank pain with or without gastrointestinal complaints. Microscopic hematuria is manifested mostly in children with urolithiasis. Recurrent stone formation also occurred during a 2.8 year follow-up.

The manifestations of kidney stones in adults may present similar characteristics for pediatric patients. Physicians providing primary care should be more cautious in assessing the presenting signs and symptoms of stone formation. The children who had their first diagnosis of renal stone should be investigated further knowing that recurrence is common among pediatric clients. It is therefore recommended that a long-term follow-up care as well as patient and parent education is necessary in order to minimize risk of recurrence. Education regarding importance of increased fluid intake and compliance with medical regimen should be emphasized.

References:
Articles from Canadian Urological Association Journal are provided here courtesy of Canadian Urological Association
Copyright : © 2008 Canadian Urological Association or its licensors