reply to discussion board

Please write a reply to this classmates discussion board. 300 words. Please use 3 valid and reliable peer reviewed sources.

" In the case of a 48-year-old white male patient presented to my office in the primary care setting, expressing he is experiencing unremitting right flank pain, I would begin by obtaining a full set of vitals. During intake I would inquire if he has been keeping up with annual physicals, as well as obtaining his personal medical history. Depending on the date of his last physical, at an appropriate time, I would briefly discuss the importance of preventive care. Additionally, if the patient is new to the practice, it is of critical importance to obtain a thorough history and physical (H&P). Furthermore, I would inquire about the patient's family medical history. According to the symptoms outlined by the National Institute of Diabetes and Digestive and Kidney Diseases (2019) the patient’s presenting symptoms align with a potential diagnosis of Renal Calculi. However, it is still pertinent to determine whether the patient has a family history of renal disease, Gastrointestinal (GI) conditions or disease, prostate conditions, or any cancer, as this may increase the likelihood of inheritance. In addition, I would also inquire about his urinary habits as well as discuss his bowel habits to differentiate between or rule out GI and bowel causes.

Probable diagnosis:

• Renal Calculi

Potential differential diagnoses:

• Severe constipation/ bowel obstruction
• Pyelonephritis
• Appendicitis
• Prostate Cancer
• Colon Cancer

According to both Belyayeva & Jeong (2024), as well as Patti & Leslie (2021) patients presenting with suspected renal conditions like renal colic or acute pyelonephritis it is wise to conduct diagnostic testing such as a urinalysis, kidneys, ureters, and bladder x-ray, renal ultrasound or CT scan. I would order these diagnostic studies listed above, in the order of their reliability for an accurate diagnosis, their ability to assess for potential differential diagnosis, as well as their accessibility, availability and least to greater risk. If the diagnostic findings indicate that the patient experiencing renal calculi are small enough to pass, I would advise the patient to stay well hydrated - increase fluids and take a NSAID (nonsteroidal anti-inflammatory drug) such as ibuprofen as needed for pain and schedule a follow up for one week. Additionally, I would advise the patient that if he experiences an onset of fever, increase or worsening symptoms seek emergency care. Furthermore, if the findings showed an emergency condition such as a bowel obstruction, pyelonephritis or appendicitis I would have the patient transported to the emergency room. Moreover, if it is an urgent condition but not emergent, I would request an immediate (STAT) referral to a Urologist or Gastroenterologist.

References

Belyayeva, M., & Jeong, J. M. (2024). Acute pyelonephritis. National Library of Medicine;

StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK519537/

National Institute of Diabetes and Digestive and Kidney Diseases. (2019). Symptoms & Causes

of Kidney Stones. NIDDK. https://www.niddk.nih.gov/health-information/urologic-diseases/kidney-stones/symptoms-causes

Patti, L., & Leslie, S. W. (2021). Acute Renal Colic. PubMed; StatPearls Publishing.

https://www.ncbi.nlm.nih.gov/books/NBK431091/"