Question

A 56-year-old male anatomy professor at a well-known university in North Hollywood was brought to the emergency room at the UCLA Ronald Reagan Medical Center. His chief complaint was right flank pain. History of present IlIness: One day prior to admission, the patient developed a change in the color of his urine from pale yellow to red in color. There was no associated fever, painful urination, or penile discharge. He decided to consult with his primary physician the following day One hour prior to admission, the patient developed severe right flank pain associated with nausea. His wife was brought him to the UCLA Ronald Reagan Medical Center. Upon admission, the patient was noted by the ER physician to be in severe pain, with a pain scale of 9 from a visual analog pain scale from 1 to 10. On physical exam, patient had the following findings: . Vital Signs BP: 140/90 . Heart rate: 110/minute Respiration rate: 15/minute patient was afebrile - All exam findings for the head, neck, heart, lungs, and abdomen were normal. On examination of the back, patient had tenderness on the right flank upon palpation On examination of the genitalia, there was no penile discharge. Note of a 1 x 1 cm tophus on right big toe. . . . The following diagnostic exams were ordered: CBC with WBC differential count Urinalysis . . Serum uric acid . KUB x-ray MRI Scan abdominopelvic area He was immediately injected by IV with a strong analgesic to relieve the pain. Past Medical History: Diagnosed with gout one year prior to admission On medication with allopurinol No heart and lung disease No diabetes or hypertension . . . .

Answer 1

1.The patient can be diagnosed for Renal calculi

The pathogenesis of the disease seems to be as following

The wide ranges of causes and triggering factors (lifestyle, smoking,alcohol, poor food habits)>>leads to the formation of the stone >>deposits either in the pre renal,renal or post renal>>obstruction in flow of urine>>decreased urin output >>injury in the renal or its pathway due to obstruction>>haematuria>>clinical symptoms

2.The clinical symptoms are

• Difficulty in passing urine,decreased urine output, heamaturia
• Nausea and vomiting
• Radiating pain

3.The CBC reports within normal limits indicates that the patient had no infection and loss of blood resulting in anemia

The urinanalysis indicates that the patient had uric acid deposition and it is the because of nephrolithiasis in this patient.The presence of RBC is duw to infection

The increase in uric acid level may be due to metabolic disorder and can lead to gout

4.The X Ray KUB indicates the location of the renal calculi at the kidney and at ureter.The Coronal MRI locates the presence of calculi exactly at the ureter