Assessment

172 Calculi, Renal hematuria, nausea, vomiting, and anorexia. In cases in which a urinary tract infection is also present, the patient may report chills and fever. Determine the patient's history to identify risk factors.

PHYSICAL EXAMINATION. Inspection reveals a patient in intense pain who is unable to maintain a comfortable position. Assess the patient for bladder distension. Monitor the patient for signs of an infection such as fever, chills, and increased white blood cell counts. Assess the urine for hematuria. Auscultate the patient's abdomen for normal bowel sounds. Palpate the patient's flank area for tenderness. Percussion of the abdominal area is normal, but percussion of the costovertebral angle elicits severe pain.

PSYCHOSOCIAL. Patients with renal calculi may be extremely anxious because of the sudden onset of severe pain of unknown origin. Assess the level of the pain, as well as the patient's ability to cope. Since diet and lifestyle may contribute to the formation of calculi, the patient may face lifestyle changes. Assess the patient's ability to handle such changes.

Diagnostic Highlights

General Comments: The physician uses diagnostic tests to eliminate cholecystitis, peptic ulcers, appendicitis, and pancreatitis as the cause of the abdominal pain.

Test

Normal Result

Abnormality with Condition

Explanation

Helical computed tomography scan without contrast

Image of normal abdomen

Calculi present

Visualizes size, shape, relative position of stone. Contrast not used; with contrast entire urinary collecting system would appear white, masking the stones.

Kidney-ureter-bladder (KUB) and abdominal x-rays

No renal stones

Presence of renal stones, most of which are radiopaque

Reveals most renal calculi except cystine and uric acid stones

Intravenous pyelography (IVP)

Normal anatomy of the kidney/ collection system

Obstructing stone

Performed when renal colic is severe and obstruction is suspected

Other Tests: Other supporting tests include kidney ultrasonograph; urinalysis; complete blood count; serum electrolytes; urine culture and sensitivity; serum calcium and phosphorus levels; 24-hour urine for calcium, oxalate, uric acid, sodium, phosphorus, citrate, magnesium, creatinine, total volume.

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