Left-side Ureteric Colic Case Study

Left-side Ureteric Colic Case StudyCase Study grouping BIntroductionA 46 year old depository was admitted to requisite with odd(a)-side ureteric colic. She had a similar case 3 historic period ago and she passed a small tartar spontaneously. She has been winning cimetidine (for the last 6 months), for dyspepsia treatment. Physical inquiry revealed a tenderness in the left loin.SymptomsLeft-side ureteric colic.Small calculus passed spontaneously (3 years ago).Tenderness in the left loin.Medication TakenCimetidine (last 6 months) for dyspepsia treatment.Serum Results (compared to shape)Creatinine 150 umol/L (50-110)Na+ 141mM (135-145)K+ 4.2mM (3.5-5.1)Total CO2 20nM (23-29)carbamide 8.1Mm (4.0-8.2)Albumin 40g/L (35-50)Calcium 3.49mM (2.1-2.5)Phosphate 0.60mM (1.0-1.5)ALP Activity 160U/L (20-140)Results that disaccord from normal levels are underlined.Suspected/Differential DiagnosisThis affected role has been admitted to emergency with 3 major symptoms, all of which occ urred in spite of appearance the last 3 years (symptoms are stated above). Along with this the longanimous role has been subscribed cimetidine for the last 6 months which is advised to not be suck upn when the persevering is cognize to have kidney problems, this could potentially be increasing the problematic symptoms.The most new symptom, to which the diligent was initially admitted, is left-side ureteric colic. This is motived by movement of the calculus that produces unpleasant sensations of group AB pain practically in waves (colicky) or sometimes a ageless pain, both of which will typically move until it reaches the hypochondrium (or groin area). This supports the results from the physical examination which state that there was a tenderness in the perseverings left loin, collectible to the movement of the calculus and pain from there-forth.These symptoms are most commonly demonstrable after passing of a kidney precious stone, such(prenominal) as the small calcul us that this patient passed 3 years ago. These stones can be static or moving, the latter of which can be more than painful and birth more symptoms as it travels.Renal calculi are generally formed when the water system is too saturated with minerals and salts such as atomic number 20 and others. This is supported by the patients business-serum results which indicate a high amount of calcium (3.49mM) where the deification level is around 2.1-2.5mM. Kidney stones are primarily made out of 60-80% calcium, so the overplus amount implant in the patients affinity can easily result in a build-up of a calculus.In addition to the excess of calcium, there is likewise an excess of other substrates in the blood. One of which is creatinine which is ideally found between 50-110 umol/L but the patient contains excess of 150 umol/L. High amounts of creatinine is cognize to effect the ability for the kidneys to drip fluid within the body. This will lead to a build-up of certain substra tes in the blood such as the calcium mentioned previously. Therefore, high amounts of creatinine can cause a domino effect where high amounts of creatinine = high amounts of other substrates, this could cause major problems in the body if not treated immediately.Also within the results of the patients blood-serum probe is the abnormality of low amounts of CO2 (20nM) known as hypocapnia, this is can be utilise to indicate that the patient may be beginning to show signs of kidney failure.Similarly, low amounts of phosphate are shown (0.60mM), this is also an indication of kidney failure due to inadequate filtration of substrates by the kidney to be excreted as water system. The parathyroid hormone (PTH) regulates the amount of phosphate and calcium in the blood, typically the substrates react oppositely as phosphate increases, calcium will decrease. callable to there beingness a great excess in calcium the PTH hormone reacts to decrease the amount of phosphate in the blood serum. Finally, as phosphate is used to repair bones, help the function of nerves and tendon conshareion, low amounts of it can cause a severe problem in the patient. This links into the high amounts of ALP activity that are found in this patients blood-serum at 160U/L which can be caused by stones such as the small calculus being obstructive. This can lead to problems with bones, which being linked to low amounts of phosphate also, could cause severe problems in the patient and even bone cancer. However, high amounts of ALP have been found in women in the third trimester of pregnancy, which could be the case with this patient, but this is currently unknown.Further Tests to abide the diagnosisUrine examination can be used to get under ones skin if there is all blood in the patients urine (haematuria) which often occurs after passing a stone. Also the pH of the urine can be examined to indicate either the urine is normal, sulfurous (8.0) indicating that an infection could be present fr om organisms such as Proteus or Pseudomonas. As well as this, the urinalysis can show substrate crystals such as calcium oxalate- quite likely due to excess calcium in the patient.Imaging (X-ray, Ultrasound etc.) Firstly, KUB x-rays can be used to show abnormalities in the kidneys, ureters or bladders, these are indicated by dark shadows in the nephritic-tract but can be mistaken for phleboliths which is venous and not a form of calculus.Ultrasounds are easy and quick and does not use any form of radiation, this method will indicate stones that are of 0.5cm in diameter or larger.Next, Intravenous Pyelogram (IVP) provides a clear outline of the urinary tract system and shows-up many indicators of kidney problems such as mild hydronephrosis, however this test can cause unwanted reactions in the patient that are better(p) avoided.Finally, a test for the PTH hormone can be undertaken with the calcium, phosphate and ALP blood tests. This will help to identify hyperparathyroidism, which is a hyperactivity of the hormone, as well as finding the cause for the high amounts of calcium in this patient.Treatments and PrognosisThe patient that is throe from left-side ureteric colic, small calculi and tenderness in the left loin should absorb plenty of liquids, primarily water. This will encourage any further renal stones to be passed and it will also begin to reduce any feasible damage to the functionality of urinary/renal tracts.If there are further stones found in the patient (possible due to high calcium amongst other substrate fluctuations) then with liquids they should pass spontaneously, unless they are large in-which they will need particularised removal that could involve surgery. Spontaneous movement and passing of stones may take as long as 40 day so the patient is likely to be under a lot of pain that is often compared to being worse than child birth, therefore pain killers such as paracetamol at a standard dosage of 1 or 2 tablets up to 4 times a day for an adult such as this patient, may be required to alleviate the pain.If by taking further tests, such as the urinary examination, it is found that the patient is suffering from an infection (pyonephrosis) then treatment is required such as percutaneous nephrostomy. This is usually an emergency procedure that is used to relieve an obstructed and septic renal collecting system by percutaneous puncture with ultrasonography guidance.Also, Medical Expulsive Therapies can be used such as calcium antagonists. These work by blocking the calcium ion channels to supress the fast agent for contracting the ureter, this in turn will help relax the glint muscles and help stones to pass more easily.Overall, the patient is likely to be in a lot of pain for some time, therefore, strong painkillers will be required and if in the case of infections then antibiotics could also be unavoidable to overcome the patients symptoms and to finally be cured.ReferencesClinical chemistry-Marshall, William J .,Bangert, S. K.,Lapsley, Marta2012. pen 05.01.14Clinical biochemistry an Illustrated Colour Text-Gaw, Allan, eauthor2013. referenced 05.01.14Royal College of Physicians and Surgeons of Canada. Normal Values. Referenced 05.01.14 royalcollege.caSalman S, Castilla C, Vela N R. Action of calcium antagonists on ureteral dynamics.Actas Urol Esp1989. PubMed Referenced 05.01.14Freeman SJ, Sells H, Investigation of loin pain, Imaging (2005) 17, 19-33, British Journal of Radiology. Referenced 05.01.14Miller OF, Kane CJ Time to stone passage for observed ureteral calculi a guide for patient education. J Urol. 1999. Referenced 05.01.14Amiel J, Choong S Renal stone disease the urological perspective. Nephron Clin Pract. 2004. Referenced 05.01.14