Diagnosis of Stones
a patient is evaluated for a suspected urinary calculus, a thorough
and complete physical examination is essential. Most patients with
stone disease present to the Emergency Room or physician's office
with severe renal colic and will be obvious distress. A patient
with ureteral colic tosses about and is unable to find comfort in
a single position. This patient usually exhibits diaphoresis, tachycardia
and tachypnea. Hypertension may be seen and is usually resulting
from discomfort. The stone patient is usually not febrile unless
infection is associated with obstruction.
patient's abdomen should be carefully examined, especially the flank
area, where an early obstructed, hydronephrotic kidney may be palpable.
Tenderness on palpation of the kidney or in the costovertebral angle
is frequently present. It is not unusual for the bowel sounds to
be hypoactive and an ileus to be present clinically and radiographically.
The bladder should be palpated, as urinary retention not infrequently
occurs with acute ureteral colic, especially when the stone is positioned
in the intramural ureter.