: → Elleria:我看到後來是kidney的問題就跳針想到echo了 sorry啦 XD 07/14 23:
: 推 Elleria:我有問題 APN會常有RLQ pain或LLQ pain嗎? 07/14 23:
: 推 johnliou:不常, ureter stone比較會有RLQ or LLQ pain 07/15 00:
再次引用敝科教科書的文字 (別鞭我只看這本...專科醫師考完不到一年記憶猶新...)
p.621 Ch.96 Urologic Stone Disease
Diagnosis - Physical Examination
1....可能有某些嚴重的心血管疾病會很像renal colic必須被排除(略)...The presence
of fever or hypotension suggests the possibility of concurrent infection or
an alternating diagnosis.
2.Mild tenderness may be noted over the site of an impacted stone. However,
peritoneal findings (eg, guarding or rebound) or abdominal distention is not
an usual component of acute renal colic, but if present other pathologies
should be considered.
Diagnostic Imaging:
1.Helical CT is generally the preferred imaging modality to diagnose renal
colic. Ultrasound is preferred in pregnant women to minimize radiation....
是否每個人都需要照imaging?目前仍不明,但對於年輕診斷明確的病人,影像可於OPD安排
...
CT
1. 好處是sensitive and specific. 壞處是無法顯示renal function或者阻塞程度
2. 先做noncontrast看石頭及阻塞, 萬一無發現就再做contrast排除泌尿以外問題
IVP
2.可顯示renal function, excellent specificity. 缺點是耗時, 有顯影劑
石頭太小, radiolucent, 已經掉落到bladder, 或者只有部分阻塞, 會呈現偽陰性
PAR
1. low sensitivity/specificity. Weak likelyhood ratio表示它無法診斷renal colic
2. 最大功能是排除其他問題, 以及追蹤已知存在的radiopague stones
Sensitivity Specificity LR(+) LR(-)
Noncontrast CT 94-97% 96-99% 24-無限大 0.02-0.04
IVP 64-90% 94-100% 15-無限大 0.11-0.15
Ultrasound 63-85% 79-100% 10-無限大 0.10-0.34
PARs 29-58% 69-74% 1.9-2.0 0.58-0.64
Microscopic U/A 89% 29% 1.3 0.38
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※ 編輯: oneders 來自: 220.134.113.54 (07/15 06:55)