Wells K A
Diagnosis Department, Los Angeles College of Chiropractic, Whittier, Calif. 90604, USA.
J Manipulative Physiol Ther. 2000 Mar-Apr;23(3):196-201. doi: 10.1016/s0161-4754(00)90249-5.
To describe a less common initial symptom of nephrolithiasis, its diagnostic pitfalls, risk factors, and mimicry of other conditions. Intervention and long-term management of nephrolithiasis is also discussed.
A Caucasian man aged 25 years had sudden bilateral inguinal and occasional periumbilical pain. The initial symptom suggested an abdominal pathologic condition; however, costovertebral angle pain followed 1 hour later with no radiation between the 2 anatomic sites. The initial urine dipstick result was negative for hematuria, but a kidney, ureter, and bladder radiograph revealed a smooth 2-mm x 3-mm stone lodged at the left: vesico-ureteral junction.
The patient was referred to a regional university medical center to receive extracorporeal shockwave lithotripsy several days after his initial visit. He was given pain medicine for the waiting period and received daily lumbar spine adjustments with a mild reduction in pain. He eventually received ureteroscopic laser lithotripsy because the shock-wave unit had malfunctioned before his appointment. The fragment analysis showed a calcium oxalate composition, and the patient was advised to lower his intake of oxalates. The patient had become a vegetarian approximately 3 months before this first stone episode.
Nephrolithiasis is a condition commonly seen in chiropractic practice. Although it is usually easy to recognize, the diagnosis can be elusive if the typical historic factors and diagnostic results are absent or altered. The short-term management of nephrolithiasis is pain management, stone elimination, and the collection of a specimen to identify the composition and underlying metabolic abnormality. Long-term management is to prevent the recurrence of stones. Conservative comanagement by the chiropractic physician can be implemented through nutritional means.
描述肾结石一种较不常见的初始症状、其诊断陷阱、危险因素以及与其他病症的相似之处。还讨论了肾结石的干预措施和长期管理。
一名25岁的白人男性突然出现双侧腹股沟疼痛，偶尔伴有脐周疼痛。初始症状提示腹部存在病理状况；然而，1小时后出现肋脊角疼痛，这两个解剖部位之间无放射痛。初始尿液试纸检测结果显示血尿为阴性，但肾脏、输尿管和膀胱X线片显示左膀胱输尿管交界处有一枚光滑的2毫米×3毫米结石。
患者在初次就诊几天后被转诊至一家地区性大学医学中心接受体外冲击波碎石术。在等待期间给他服用了止痛药，并每天进行腰椎调整，疼痛稍有减轻。由于冲击波设备在他预约前出现故障，他最终接受了输尿管镜激光碎石术。结石成分分析显示为草酸钙，建议患者减少草酸盐的摄入量。该患者在首次结石发作前约3个月开始吃素。
肾结石是整脊治疗中常见的病症。虽然通常很容易识别，但如果缺乏或改变了典型的病史因素和诊断结果，诊断可能会很困难。肾结石的短期管理是疼痛管理、结石清除以及采集标本以确定成分和潜在的代谢异常。长期管理是预防结石复发。整脊医生可以通过营养手段实施保守的联合管理。
