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Block Y: EBM Case 3

Block Y: EBM Case 3. Intern Charles Vincent O. Uy. General Data. Patient is P.N. 35/M from Laguna, married, Roman Catholic, R handed consulting at PGH for the first time for R flank pain. History of Present Illness.

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Block Y: EBM Case 3

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  1. Block Y: EBM Case 3 Intern Charles Vincent O. Uy

  2. General Data • Patient is P.N. 35/M from Laguna, married, Roman Catholic, R handed consulting at PGH for the first time for R flank pain .

  3. History of Present Illness • Patient is nondiabetic, nonasthmatic, nonhypertensive apparently well with good functional capacity until… • 2 months PTC, when patient started experiencing non radiating R flank colicky pain described as “makirotparangtinutusok” graded 8/10, episodic lasting for 2-3 minutes occuring about 3-5 times a day partially relieved by mefenamic acid (8/10  5/10) not aggravated by movement.

  4. History of Present Illness • (-)fever (-)anorexia (-)weight loss (-)nausea (-)vomiting (-)dysuria (-)urinary frequency (-)nocturia (-)urgency(-)intermittency (-)hematuria (-)penile discharge • 1 month PTC, consult done at a private MD, KUB UTZ done showed nephrolithiasis non obstructing 0.23cm x 0.18 x 0.18 at R kidney, given unrecalled medications for one month and advised follow up thereafter

  5. History of Present Illness • Patient was compliant with the medications, self medicated with red juice, sambong leaves and renal care food supplement with no note of resolution of symptoms • On follow up, patient was advised abdominal CTscan since the findings in the UTZ does not correlate well with the “small” nephrolithiasis

  6. History of Present Illness • Patient consulted at our institution for second opinion, for possible CT scan and for possible shock wave therapy.

  7. Review of Systems • (-)headache (-)dizziness (-)chest pain (-)DOB (-)orthopnea (-)easy fatigability (-) palpitations (-)cough (-)colds (-)diarrhea (-)constipation (-)rashes (-)hematemesis (-)hematochezia (-)melena (-)polyuria(-)polydipsia (-)polyphagia (-)joint pains (-)tremors (-)inguinal pain

  8. Past Medical History • (-)hospitalizations/surgeries • (-) DM/HPN/PTB/BA/allergies • (-) UTI/STD

  9. Family Medical History

  10. Personal Social History • (-) vices, 1 NPSP, HS graduate, an OFW in Qatar, works as a welder, wife is a plain housewife

  11. Physical Examination • Awake alert ambulatory NICRD • BP 120/70; HR 84; RR 20; T 36.8 • Wt 65kg; Ht 170cm; BMI 22.5 • Anictericsclerae, pink conjunctivae, (-)cervical lymphadenopathy • Equal chest expansion, clear breath sounds (-)crackles/wheezes • Adynamicprecordium, distinct heart sounds, normal rate regular rhythm (-) murmurs

  12. Physical Examination • Soft flat normoactive bowel sounds, slight R flank tenderness (grade 3/10) (-)organomegaly • Full and equal pulses, pink nailbeds (-)cyanosis (-)edema • DRE: intact rectal vault, good sphincter tone, (-)blood/feces per examining finger

  13. Assessment • Nephrolithiasis R

  14. Plan • Diagnostics: none • Therapeutics: Mefenamic acid 500 mg TID prn for R flank pain on full stomach • Increase oral fluid intake • Refer to surgery/urology • Advised

  15. Therapeutic Dilemma • “ Okay lang bang ituloykoangpag-inomngsambong, makakatulongbaito?” • In middle aged (25-45), Asian patients with nephrolithiasis how effective is sambong (BlumeaBalsamifera) compared to in dissolving kidney stones?

  16. Therapeutic Dilemma

  17. Diagnostic Dilemma • “Magpapa-CT scan pa baako?” • In patients with flank pain, what is the specificity and sensitivity of abdominal CT scan compared to KUB UTZ in diagnosing nephrolithiasis? 30% 90%

  18. Diagnostic Dilemma

  19. Thank You!

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