Failure to Diagnose & Delay in Treatment of Acute Abdomen Due to Kidney Stone (Renal Calculus, Calculi, Nephrolithiasis)

Evaluate breaches in the standard of care when evaluating the Failure to Diagnose & Delay in Treatment of Acute Abdomen Due to Kidney Stone (Renal Calculus, Calculi, Nephrolithiasis)

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following symptoms did the patient present? (Choose all that apply)
    Pain while urinating (dysuria)
    Flank pain/lower abdominal pain
    Blood in urine (hematuria)
    Nausea /vomiting
    None of the above
    Urinary frequency
    Not elicited
    Answer unknown
    Why is this important?
    Patients with kidney stones may have pain while urinating, see blood in the urine, or feel a sharp pain in the back (flank) or lower abdomen. The pain may last for a short or long time. Patients with nephrolithiasis typically present with debilitating flank pain and hematuria.
    (2006) 53 EPDCNA 3 479-491

  • Was a medical history obtained? Why is this important?
    Answer this question
    A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's examination, enables the clinician to make educated evaluations, and be better equipped to advise the patient.
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  • With which of the following risk factors did the patient present?(Choose all that apply) Why is this important?
    Answer this question
    A risk factor is a variable that has a causal association with a disease or disease process; the presence of the variable in an individual or a population is associated with an increased risk of the presence or future development of the disease. Thus, risk factors may be useful for identifying subjects at increased risk for a disease or for a particular outcome that results from a disease process.
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  • Was a physical examination performed? Why is this important?
    Answer this question
    A complete and carefully focused physical examination serves as the core of the diagnostic process.
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  • Was the patient discharged and later diagnosed with kidney stones? Why is this important?
    Answer this question
    The differential diagnosis of kidney stones may be broad; in principle it includes all causes of acute abdominal or flank (back) pain. Some conditions to be considered include acute pyelonephritis , various gynecologic conditions, acute appendicitis , acute cholecystitis, and musculoskeletal pain.
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  • Which of the following diagnostic laboratory investigations were performed?(Choose all that apply) Why is this important?
    Answer this question
    Routine laboratory studies can provide important clues to diagnosis.
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  • Which of the following diagnostic imaging studies were performed? (Choose all that apply) Why is this important?
    Answer this question
    Helical CT is considered as the gold standard in the diagnosis of kidney stone. Ultrasound is also considered a good imaging modality for diagnosis of kidney stone, in conditions where CT is not available or contraindicated. An advantage of using ultrasound is that it does not expose the patient to radiation, which makes it the preferred test in pregnant women.
    (2008) 28 SNFLGY 2 99-110

  • Was the size of the kidney stone determined? Why is this important?
    Answer this question
    Spontaneous passage is dependent upon stone size. Most stones smaller than 5 mm pass spontaneously. Few stones larger than 1 cm pass spontaneously.
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  • To which of the following specialists was the patient referred?(Choose all that apply) Why is this important?
    Answer this question
    Once priorities and goals have been agreed on, referral to the appropriate professionals should be made in a timely manner. To deliver care requires a coordinated approach that allows sharing of skills and expertise. The skills of members from all professional disciplines should be utilized to enable all patients to achieve their maximum potential.
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  • Were conservative treatment options advised? Why is this important?
    Answer this question
    Conservative management of urolithiasis involves aggressive hydration and dietary modification. Dietary modifications, including increased fluid intake and decreased animal protein and sodium intake, may be beneficial. Increasing fluid intake to at least 2 L/d will increase urine flow rate and lower the urine solute concentration, both of which might protect against stone formation.
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  • Which of the following conservative treatment methods were initiated?(Choose all that apply) Why is this important?
    Answer this question
    An effective approach suggested for out-patient management is the combined use of an oral Non-Steroidal Anti-Inflammatory Drug (NSAID) and an oral opioid medication . NSAIDS, such as diclofenac, ketorolac, and ibuprofen, can manage pain of renal colic because of the combined anti-inflammatory and spasmolytic effects. Opioids, such as codeine, morphine, and meperidine, are effective in relieving pain caused by obstructive uropathy.
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  • Did the patient respond to conservative therapy? Why is this important?
    Answer this question
    Stones measuring 4 mm or less will pass spontaneously in about 95 percent of patients within 40 days.
    (2013) 31 ESURGO 7 354-361

  • Which of the following complications did the patient develop? (Choose all that apply) Why is this important?
    Answer this question
    Nephrolithiasis is the most common cause of both acute and chronic urinary tract obstruction. Obstructive diseases of the urinary tract are a frequent cause of urosepsis.
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  • Were the complications managed? Why is this important?
    Answer this question
    Nephrolithiasis is the most common cause of both acute and chronic urinary tract obstruction. Obstructive diseases of the urinary tract are a frequent cause of urosepsis. Kidney stones infrequently lead to kidney failure. However, severe forms of nephrolithiasis may lead to progressive loss of kidney function, sepsis and, in extreme cases, end-stage renal disease.
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  • Was patient information/education provided? Why is this important?
    Answer this question
    It is important to instruct patients to document stone passage because symptom relief is not an accurate indicator that the stone has passed. Patients should be instructed to strain their urine for stone fragments and to submit them for chemical analysis, which provides information essential in preventing recurrences.
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  • Were follow-up evaluation advised? Why is this important?
    Answer this question
    Routine follow-up evaluations are necessary to offset any complications that may arise.
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  • Which of the following indications for surgery/procedure did the patient possess?(Choose all that apply) Why is this important?
    Answer this question
    Absolute indications for surgical intervention are manifested by a deterioration of the patient's clinical condition.
    (2013) 31 ESURGO 7 354-361

  • Was an informed consent obtained? Why is this important?
    Answer this question
    The laws of most states require that surgeons obtain informed consent before providing treatment.
    (2011) 23 EOMSCA 3 475-484

  • Was a pre-anesthesia evaluation performed? Why is this important?
    Answer this question
    The American Society of Anesthesiologists (ASA) standards and guidelines require that the patient have a pre-anesthetic evaluation. The timing of the pre-anesthetic evaluation is probably the most critical element for the efficient delivery of care. Pre-anesthesia evaluation is an exercise in patient communication and co-ordination of resources delivered in as cost effective mode as possible. When information including laboratory or diagnostic reports are necessary, physician's offices or hospital departments may be closed requiring either postponing the procedure, obtaining the information closer to the surgery and hoping that there are no major issues, or repeating a test which may have been done only a couple of weeks earlier.
    (2004) 22 EANESC 1 141-153