Aralin 1Kaugnay na renal at urinary tract anatomy: kidney, collecting system, ureteral course, relations na nagdudulot ng referred painAng seksyong ito ay sumusuri sa renal at ureteral anatomy na may kaugnayan sa stone disease, kabilang ang calyces, pelvis, ureteral narrowing points, vascular at pelvic relations, at mechanisms ng referred pain sa flank, groin, at genital regions.
Renal cortex, medulla, and collecting systemRenal pelvis and calyceal anatomyUreteral course and narrow segmentsRelations to vessels, bowel, and pelvisPathways of referred flank and groin painAralin 2Mga elemento ng kasaysayan: onset, prior stones, metabolic history, family history, medication/occupation risk factorsAng seksyong ito ay nagbabanghay ng mga pangunahing elemento ng kasaysayan sa suspected nephrolithiasis, kabilang ang pain chronology, prior stones, metabolic at systemic disease, family history, diet, medications, occupation, at factors na naghuhula ng komplikasyon o recurrence.
Character and timing of pain episodesPast stones, procedures, and outcomesMetabolic and systemic disease historyFamily history and genetic conditionsDiet, fluid intake, drugs, occupationAralin 3Mga physical exam maneuvers: costovertebral angle tenderness, abdominal exam, testicular/inguinal exam kapag indicatedAng seksyong ito ay nagdedetalye ng nakatuon na physical examination sa acute flank pain, kabilang ang vital signs, abdominal at costovertebral angle assessment, genital at inguinal exams kapag indicated, at findings na nagmumungkahi ng alternative diagnoses.
Vital signs and overall illness severityCostovertebral angle tenderness techniqueAbdominal exam for peritonitis or massGenital and inguinal exam when neededSigns pointing away from stone diseaseAralin 4Stone prevention basics: metabolic workup indications, 24-hour urine testing, dietary at pharmacologic prevention strategiesAng seksyong ito ay nag-i-introduce ng stone prevention, kabilang ang indications para sa metabolic evaluation, 24-hour urine testing, dietary counseling, fluid goals, at pharmacologic therapies na na-customize sa stone type at individual risk profile.
Who needs full metabolic workupCollecting and interpreting 24-hour urineFluid intake and urine volume targetsDietary sodium, protein, and oxalate advicePharmacologic prevention by stone typeAralin 5Acute management: analgesia ladder (NSAIDs vs opioids), antiemetics, medical expulsive therapy evidence at limitsAng seksyong ito ay sumasaklaw sa acute management ng renal colic, kabilang ang NSAID-based analgesia, cautious opioid use, antiemetics, hydration, medical expulsive therapy evidence at limits, at pamantayan para sa observation versus admission.
Analgesia ladder and NSAID first strategyOpioid indications and safety concernsAntiemetics and fluid managementMedical expulsive therapy evidenceDisposition, follow-up, and return precautionsAralin 6Mga pinagmulan ng ebidensya: mga pangunahing gabay at pagsusuri para sa suspected kidney stones (mga pangalan at taon para sa paghahanap)Ang seksyong ito ay nagbubuod ng mga pangunahing gabay at pinagmulan ng pagsusuri para sa suspected kidney stones, na nagbibigay-diin sa mga pangunahing lipunan, taon ng publikasyon, at kung paano epektibong maghanap at suriin ang ebidensya upang gabayan ang diagnostic at therapeutic decisions.
Major urology and nephrology guidelinesEmergency medicine stone care guidelinesHigh-impact systematic reviews and yearsSearching PubMed and guideline portalsAppraising guideline strength and gapsAralin 7Initial diagnostics: urinalysis para sa hematuria/infection, urine microscopy, serum electrolytes, renal function, inflammatory markersAng seksyong ito ay nagdedetalye ng initial laboratory evaluation sa suspected nephrolithiasis, kabilang ang urinalysis, urine microscopy, serum chemistries, renal function, at inflammatory markers, na may interpretation para sa diagnosis at risk stratification.
Urinalysis for hematuria and infectionUrine microscopy for crystals and castsSerum creatinine and estimated GFRElectrolytes, calcium, and uric acidInflammatory markers and sepsis cluesAralin 8Mga indikasyon para sa emergent urology referral: obstruction na may infection, refractory pain, impaired renal function, anuriaAng seksyong ito ay tinutukoy ang mga sitwasyon na nangangailangan ng emergent urology involvement, kabilang ang obstructed infected systems, uncontrolled pain o vomiting, solitary kidney o renal failure, anuria, at special considerations sa pregnancy at pediatrics.
Obstruction with sepsis or high feverRefractory pain or intractable vomitingAcute kidney injury and solitary kidneyAnuria, bilateral obstruction, pregnancyPediatric and complex comorbidity casesAralin 9Imaging strategy: kailan gumamit ng non-contrast CT KUB, ultrasound sa pregnancy, plain radiography limitations, contrast indicationsAng seksyong ito ay naglalarawan ng imaging choices para sa suspected stones, na nakatuon sa non-contrast CT, ultrasound sa pregnancy at young patients, limited roles ng plain radiography, at kailan kailangan ng contrast studies para sa komplikasyon.
Non-contrast CT KUB indicationsUltrasound in pregnancy and youthStrengths and limits of plain radiographyWhen to use contrast CT or urographyRadiation exposure and dose reductionAralin 10Stone pathophysiology at types: calcium, uric acid, struvite, cystine — formation mechanisms at metabolic risk factorsAng seksyong ito ay sumusuri sa stone composition at formation, na sumasaklaw sa calcium, uric acid, struvite, at cystine stones, crystal nucleation, urinary supersaturation, infection-related mechanisms, at metabolic at anatomic risk factors.
Calcium oxalate and calcium phosphate stonesUric acid stone formation mechanismsStruvite stones and urease-producing bacteriaCystine stones and inherited disordersMetabolic, urinary, and anatomic risk factorsAralin 11Karaniwang klinikal na presentasyon: colic characteristics, hematuria, nausea/vomiting, pain radiation sa groin/scrotum/labiaAng seksyong ito ay nagpapaliwanag ng classic at atypical klinikal na tampok ng renal colic, kabilang ang pain quality, timing, radiation, associated urinary at gastrointestinal symptoms, at pulang bandila na nagmumungkahi ng alternative o life-threatening diagnoses.
Pain onset, severity, and colicky patternRadiation to flank, groin, and genitaliaHematuria and lower urinary symptomsNausea, vomiting, and autonomic signsRed flags for alternative diagnoses
