The differential diagnosis of nephrolithiasis necessary for clinical practice, don't forget these six diseases!

Introduction Nephrolithiasis is a common and frequently-occurring disease in urology
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Some data show that the incidence of kidney stones in China is 1.
61%-20.
54%, and it has been on the rise in recent years
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Although it is not difficult to diagnose kidney stones clinically, we should be careful about the differential diagnosis related to it! In order to avoid misdiagnosis, what diseases should kidney stones be differentiated from? Acute pancreatitis Acute pancreatitis is due to the activation of pancreatic enzymes, digestion of the pancreatic tissue itself, resulting in pancreatic tissue edema, hemorrhage and even necrosis
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Abdominal pain is the main symptom of acute pancreatitis, and it often appears after overeating
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Abdominal pain usually begins in the upper abdomen, but can also be limited to the right or left upper abdomen
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Pain is continuous and progressive, sometimes sharp, knife-like pain (according to the type of disease)
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Pain can radiate to the shoulders and back
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Identification: According to the patient's medical history, clinical manifestations, and determination of blood and urine amylase, most acute pancreatitis can generally be diagnosed
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Abdominal B-ultrasound showed pancreatic enlargement and abnormal echoes around the pancreas and pancreas.
Abdominal CT could further clarify the severity of acute pancreatitis
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Ectopic pregnancy (ectopic pregnancy) Ectopic pregnancy refers to the implantation of a fertilized egg outside the uterus, also known as ectopic pregnancy
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In recent years, the incidence of ectopic pregnancy has been on the rise, and its early symptoms include abdominal pain, nausea, and vomiting, which are easily misdiagnosed as kidney stones
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After the rupture of the pregnant egg, the patient will experience acute severe abdominal pain, vaginal bleeding, and even life-threatening
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Therefore, when receiving suspicious patients, careful identification should be made
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Identification: Clinicians can ask patients about their menstrual history (mostly 6-8 weeks of menopause), sexual life history, measure blood and urine HCG (human chorionic gonadotropin), and improve abdominal B-ultrasound examinations.
Stone identification
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Ovarian Cyst Torsion Ovarian Cyst Torsion is a twisting of the blood vessels supplying the cyst, which often occurs when a patient changes position suddenly
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After the torsion of the pedicle occurs, the patient will experience severe lower abdominal pain, often accompanied by nausea, vomiting, and even shock
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Once pedicle torsion is diagnosed, laparotomy should be performed as soon as possible
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Identification: Generally, the mass can be palpated through gynecological examination, plus abdominal B-ultrasound examination, the location, size and shape of the mass can be detected, and it can be differentiated from kidney stones
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Acute appendicitis Acute appendicitis is a common acute abdomen in general surgery
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The typical symptom of appendicitis is metastatic right lower quadrant pain—in 70% to 80% of patients, epigastric pain at the beginning of the onset, then the pain metastasizes to the right lower quadrant, sometimes accompanied by symptoms such as fever, nausea, and vomiting
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Identification: Patients with acute appendicitis have tenderness and rebound tenderness at McBurby's point (the junction of the Chinese and external 1/3 of the line connecting the right anterior superior iliac spine and the umbilicus)
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When renal colic occurs in patients with right kidney stones, it should be distinguished from acute appendicitis
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In order to avoid misdiagnosis, the patient's medical history should be carefully inquired, abdominal physical examination should be carried out, blood routine examination, abdominal B-ultrasound and other examinations should be improved
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The vast majority (90%) of patients with acute appendicitis have increased white blood cell counts, which is an important basis for clinical diagnosis
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Abdominal pain in acute appendicitis presents as a localized and fixed tender point in the right lower quadrant, which is diagnostically important
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If the symptoms are atypical or the appendix is ​​ectopic, the identification should be combined with other symptoms
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Gallstones Gallstones are common and frequently-occurring diseases in general surgery
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When gallstones are complicated with cholecystitis, persistent pain in the right upper quadrant may occur
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Larger gallbladder stones can cause upper middle or right upper quadrant discomfort
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Identification: Gallstones can cause biliary colic, which is easily confused with right renal colic
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Physical examination of the patient was positive for Murphy's sign, and a swollen and large sac on the right inferior costal border was sometimes palpable with respiration
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Abdominal B-ultrasound can help to diagnose gallstones (high specificity and sensitivity), showing high-amplitude echoes and shadows
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Renal Tuberculosis Renal tuberculosis occurs mostly in adults and is the most common type of urinary tract tuberculosis
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Renal tuberculosis often has refractory bladder irritation symptoms (the most important and the earliest symptom), which is ineffective after general antibiotic treatment
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The patient may also have symptoms such as urgency and dysuria while urinating frequently
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Identification: Patients with severe renal tuberculosis may have tuberculous pyonephrosis, which can also cause back pain
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In a small number of patients, when the pus mass passes through the ureter, it can also cause renal colic
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Nephrolithiasis complicated with obstruction and infection should be differentiated from renal tuberculosis
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Cystoscopy (an important diagnostic method) in patients suspected of renal tuberculosis can detect lesions characteristic of intravesical tuberculosis
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In addition, X-rays can also be used for examination, such as plain urethra, intravenous pyelography, etc.
, and the diagnosis can be made by observing typical tuberculosis images.

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Reference materials: https:// Submission email: tougao@medlive.
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