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Medical Case Study: Renal Colic Management in a Filipino Patient

This case study involves a 35-year-old Filipino male experiencing right flank pain, possibly related to nephrolithiasis. The patient is seeking a second opinion and exploring treatment options, including the use of alternative herbal remedies. The text discusses the patient's history, symptoms, physical examination findings, diagnosis, and treatment plan, highlighting the therapeutic and diagnostic dilemmas faced by the healthcare team.

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Medical Case Study: Renal Colic Management in a Filipino Patient

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Presentation Transcript

  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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