Kidney stone differential diagnosis: Difference between revisions

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Line 12: Line 12:
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |History
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |History
! colspan="11" align="center" style="background:#4479BA; color: #FFFFFF;" + |Signs and Symptoms
|
! colspan="10" align="center" style="background:#4479BA; color: #FFFFFF;" + |Signs and Symptoms
|
! colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Physical Examination
! colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Physical Examination
! colspan="10" align="center" style="background:#4479BA; color: #FFFFFF;" + |Laboratory abnormalities
! colspan="10" align="center" style="background:#4479BA; color: #FFFFFF;" + |Paraclinical studies
|-
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Pain'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Nausea/vomiting'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Nausea/vomiting'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Hematuria'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Hematuria'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Location of pain'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Fever'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Fever'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Tachycardia'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Tachycardia'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Hypotension'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Hypotension'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Hypertension'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Hypertension'''
!BP
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Anorexia'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Anorexia'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Constipation'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Constipation'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Urinary frequency/Urgency/Dysuria'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Rebound abdominal tenderness'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Rebound abdominal tenderness'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Urinary frequency/Urgency/Dysuria'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Costovetebral angle tenderness'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Costovetebral angle tenderness'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Pelvic Examination'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Pelvic Examination'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Rectal Examination'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Rectal Examination'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Complete Blood Count (CBC)'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''CBC'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Urinalysis'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Urinalysis'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''BUN'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''BUN'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Creatinine'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Cr'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Stone analysis'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Urine Beta- hCG'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Urine Beta- hCG'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Abnormal Liver Function Tests (LFTs)'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''LFT'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Serum Amylase/Lipase'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Serum Amylase/Lipase'''
!PTH
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Abdominal/Pelvic CT scan'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Abdominal/Pelvic CT scan'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Serum Parathyroid hormone levels (PTH)'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Serum Parathyroid hormone levels (PTH)'''
Line 45: Line 48:
|'''Nephrolithiasis'''
|'''Nephrolithiasis'''
|
|
* Primary hyper parathyroidism
* Inadequate dietary [[calcium]] intake
* Inadequate dietary [[calcium]] intake
* [[Hypercalciuria]]
* [[Hyperoxaluria]]
* [[Cystinuria]]
* [[Renal tubular acidosis]]
* [[Renal tubular acidosis]]
* Infection with urease producing bacteria (''[[Ureaplasma urealyticum]]'', ''Klebsiella'', ''Protues'')
* Infection
|<nowiki>+</nowiki>
|
* [[Flank Pain|Flank]]/[[back pain]] radiating to groin
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|
|
* [[Flank Pain|Flank]]/[[back pain]] radiating to groin
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| -
| -
|
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
Line 68: Line 67:
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Nl
|
|
|
* [[Hematuria]]
* [[Hypercalciuria]]
* [[Hyperoxaluria]]
* [[Cystinuria]]
|
|
|
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Nl
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|↑↓
|
* Radiolucent stone
|
|
* Non-contrast [[Computed tomography|CT scan]] may show stone as radiolucency
|<nowiki>+/-</nowiki>
|-
|-
|'''[[Pyelonephritis]]'''
|'''[[Pyelonephritis]]'''
Line 87: Line 91:
* [[Pregnancy]]
* [[Pregnancy]]
* Presence of [[urinary catheter]], [[stent]], [[nephrostomy]] tube
* Presence of [[urinary catheter]], [[stent]], [[nephrostomy]] tube
|<nowiki>+</nowiki>
|<nowiki>+ (microscopic)</nowiki>
|
|
* [[Costovertebral angle]]
* [[Costovertebral angle]]
* Positive renal punch sign
* Positive renal punch sign
|<nowiki>+</nowiki>
|<nowiki>+ (microscopic)</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
| -
| -
|
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 112: Line 117:
|
|
|
|
|<nowiki>-</nowiki>
| -
| -
|Nl
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|
|
* Globaly decreased contrast uptake
* Globaly decreased contrast uptake
Line 130: Line 135:
* [[Coagulopathy]]
* [[Coagulopathy]]
* [[Atherosclerosis]]
* [[Atherosclerosis]]
|
* [[Flank pain]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|
* [[Flank pain]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| +
| +
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 153: Line 159:
|
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Nl
|
|
|
|
Line 170: Line 176:
* [[Vasculitis]]
* [[Vasculitis]]
* [[Renal vein thrombosis]]
* [[Renal vein thrombosis]]
|
* [[Flank pain]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+ (microscopic)</nowiki>
|<nowiki>+ (microscopic)</nowiki>
|
* [[Flank pain]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| +
| +
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 193: Line 200:
|
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Nl
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>-</nowiki>
|
|
* Blunted [[renal calyces]]
* Blunted [[renal calyces]]
Line 212: Line 219:
* [[Malaise]]
* [[Malaise]]
* Flank mass
* Flank mass
|
* [[Flank pain]]
| +
| +
|<nowiki>+ (microscopic)</nowiki>
|<nowiki>+ (microscopic)</nowiki>
|
* [[Flank pain]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| +
| +
|
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
Line 236: Line 244:
|
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Nl
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| -
|
|<nowiki>-</nowiki>
|
|
* Non-contrast CT:
* Non-contrast CT:
Line 253: Line 261:
* [[Urinary catheterization]]
* [[Urinary catheterization]]
* Direct [[Penis|penile]] trauma
* Direct [[Penis|penile]] trauma
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
Line 259: Line 268:
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 272: Line 281:
|
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Nl
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 289: Line 298:
* [[Tuberculosis]]
* [[Tuberculosis]]
* [[Actinomycosis]]
* [[Actinomycosis]]
|
* Right/left upper quadrant
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Right/left upper quadrant
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|
Line 315: Line 325:
|
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Nl
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>-</nowiki>
|
|
* Thickening of the [[uterosacral ligaments]]
* Thickening of the [[uterosacral ligaments]]
Line 331: Line 341:
* Sharp [[pain]] aggravated by walking
* Sharp [[pain]] aggravated by walking
* Intermittent/colicky [[pain]]
* Intermittent/colicky [[pain]]
|
* Unilateral poorly localized [[Lower abdominal pain|lower abdominal]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Unilateral poorly localized [[Lower abdominal pain|lower abdominal]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 353: Line 364:
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Nl
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>-</nowiki>
|
|
* Twisted [[ovarian]] pedicle
* Twisted [[ovarian]] pedicle
Line 374: Line 385:
* Increased [[maternal]] age
* Increased [[maternal]] age
* [[Cigarette smoking]]
* [[Cigarette smoking]]
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|
|
* [[Lower abdominal pain|Lower abdominal]]  
* [[Lower abdominal pain|Lower abdominal]]  
* Unilateral [[Shoulder Pain|shoulder]] or [[neck pain]] (referred)
* Unilateral [[Shoulder Pain|shoulder]] or [[neck pain]] (referred)
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+ (if ruptured)</nowiki>
|<nowiki>+ (if ruptured)</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|
Line 394: Line 406:
* Low platelet distribution width (decreased platelet activation)
* Low platelet distribution width (decreased platelet activation)
* [[Monocytosis]]
* [[Monocytosis]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+/-</nowiki>
|Might be abnormal
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|N/A
|N/A
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 419: Line 431:
* [[Urinary tract infection]]
* [[Urinary tract infection]]
* [[Urinary catheterization]]
* [[Urinary catheterization]]
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|
|
* [[Perineal]] pain
* [[Perineal]] pain
* [[Lower back pain]]
* [[Lower back pain]]
* Suprapubic pain
* Suprapubic pain
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 447: Line 460:
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Nl
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>-</nowiki>
|
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 459: Line 472:
* Black ethnicity
* Black ethnicity
* Age > 50 years
* Age > 50 years
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
Line 465: Line 479:
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 482: Line 496:
|
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Nl
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>-</nowiki>
|
|
* Focal areas of mass-like enhancement in the peripheral [[prostate]]
* Focal areas of mass-like enhancement in the peripheral [[prostate]]
Line 500: Line 514:
* [[Undescended testes]]
* [[Undescended testes]]
* [[Low birth weight]]
* [[Low birth weight]]
|
* Sudden onset unilateral [[testicular pain]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Sudden onset unilateral [[testicular pain]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>+/-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|
Line 522: Line 537:
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Nl
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>-</nowiki>
|
|
* [[Doppler ultrasound]] > [[Computed tomography|CT scan]] for diagnosis (abscence of [[blood]] flow in the affected [[Testicle|testis]])
* [[Doppler ultrasound]] > [[Computed tomography|CT scan]] for diagnosis (abscence of [[blood]] flow in the affected [[Testicle|testis]])
Line 537: Line 552:
* [[Prostatitis]]
* [[Prostatitis]]
* [[Prostatic hypertrophy]] or [[calculi]]
* [[Prostatic hypertrophy]] or [[calculi]]
|
* Abrupt onset of [[testicular pain]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Abrupt onset of [[testicular pain]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|
Line 560: Line 576:
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Nl
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>-</nowiki>
|
|
* [[Ultrasound]] > [[Computed tomography|CT scan]] for diagnosis ([[Testicular masses]] or swollen [[testicles]] with hypoechoic and hypervascular areas)
* [[Ultrasound]] > [[Computed tomography|CT scan]] for diagnosis ([[Testicular masses]] or swollen [[testicles]] with hypoechoic and hypervascular areas)
Line 578: Line 594:
* Increasing age
* Increasing age
* [[Total parenteral nutrition]]
* [[Total parenteral nutrition]]
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|
|
* [[Right upper quadrant pain|Right upper abdominal quadrant pain]]
* [[Right upper quadrant pain|Right upper abdominal quadrant pain]]
* [[Flank pain]]
* [[Flank pain]]
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 596: Line 613:
|
|
* [[Leukocytosis]]
* [[Leukocytosis]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|
* [[Bilirubin]] (pigment) stones
* [[Bilirubin]] (pigment) stones
* [[Cholesterol]] stones
* [[Cholesterol]] stones
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Might be abnormal
| +/-
| +/-
|
|
|
* [[Gallbladder]] distention
* [[Gallbladder]] distention
Line 620: Line 637:
* Diet low in fiber and high in refined [[carbohydrates]]
* Diet low in fiber and high in refined [[carbohydrates]]
* History of [[appendicitis]] in first degree relatives
* History of [[appendicitis]] in first degree relatives
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|
|
* [[Pain]] in umblical area
* [[Pain]] in umblical area
* Radiating to [[Right lower quadrant abdominal pain resident survival guide|right lower abdominal quadrant]]
* Radiating to [[Right lower quadrant abdominal pain resident survival guide|right lower abdominal quadrant]]
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 642: Line 660:
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Nl
|<nowiki>-</nowiki>
| + (if perforation)
| + (if perforation)
|
|
|
* Larger than 6 mm in diameter,
* Larger than 6 mm in diameter,
Line 662: Line 680:
* Low [[Fiber|fiber diet]]
* Low [[Fiber|fiber diet]]
* Old age
* Old age
|
* [[Left lower quadrant abdominal pain resident survival guide|Left lower abdominal quadrant]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* [[Left lower quadrant abdominal pain resident survival guide|Left lower abdominal quadrant]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
Line 686: Line 705:
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Nl
|<nowiki>-</nowiki>
| + (if [[Perforation of inflamed diverticulum|perforation]])
| + (if [[Perforation of inflamed diverticulum|perforation]])
|
|
|
* [[Colon|Colonic]] wall thickening (wall thickness is greater than 3 mm on the short axis of the lumen)
* [[Colon|Colonic]] wall thickening (wall thickness is greater than 3 mm on the short axis of the lumen)
Line 699: Line 718:
* [[Cigarette smoking]]
* [[Cigarette smoking]]
* [[Pulsatile Flow|Pulsatile]] [[abdominal mass]]
* [[Pulsatile Flow|Pulsatile]] [[abdominal mass]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|
* [[Epigastric pain]]
* [[Epigastric pain]]
* Deep boring [[pain]] in the [[back]]
* Deep boring [[pain]] in the [[back]]
* May radiate to [[flank]]
* May radiate to [[flank]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 720: Line 741:
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Nl
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|
* Ultrasound more sensitive than CT scan
* Ultrasound more sensitive than CT scan
Line 742: Line 762:
* [[Cirrhosis]]
* [[Cirrhosis]]
* [[Pregnancy]] and [[post-partum]]
* [[Pregnancy]] and [[post-partum]]
|
* [[Abdominal]] or [[lumbar pain]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* [[Abdominal]] or [[lumbar pain]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| + (if [[bowel]] [[ischemia]] or [[infarction]]-secondary to extension of [[thrombus]] to [[superior mesenteric vein]])
| + (if [[bowel]] [[ischemia]] or [[infarction]]-secondary to extension of [[thrombus]] to [[superior mesenteric vein]])
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
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|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Might be abnormal
|<nowiki>+</nowiki>
| + (if [[bowel]] [[infarction]], [[perforation]])
| + (if [[bowel]] [[infarction]], [[perforation]])
|
|
|
* On non-contrast CT:
* On non-contrast CT:
Line 786: Line 807:
* Female gender
* Female gender
* [[Family history]] of [[Duodenal ulcer|duodenal ulcers]]
* [[Family history]] of [[Duodenal ulcer|duodenal ulcers]]
|
* [[Epigastric pain]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* [[Epigastric pain]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| + (if [[Bowel perforation|perforation]])
| + (if [[Bowel perforation|perforation]])
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 808: Line 830:
|
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Nl
|<nowiki>-</nowiki>
| + (if [[bowel perforation]])
| + (if [[bowel perforation]])
|
|
|
* [[Endoscopy]] > [[CT scan]] for diagnosis
* [[Endoscopy]] > [[CT scan]] for diagnosis
Line 822: Line 844:
* [[Hypoalbuminemia]]
* [[Hypoalbuminemia]]
* [[Diabetes mellitus]]
* [[Diabetes mellitus]]
|
* Acute-onset [[abdominal cramping]] 
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Acute-onset [[abdominal cramping]] 
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
| + (if [[necrosis]] and [[sepsis]])
| + (if [[necrosis]] and [[sepsis]])
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
| + (if transmural [[necrosis]])
| + (if transmural [[necrosis]])
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
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|
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Nl
|<nowiki>-</nowiki>
|<nowiki>+ (if bowel perforation)</nowiki>
|<nowiki>+ (if bowel perforation)</nowiki>
|
|
|
* [[Bowel]] wall thickening
* [[Bowel]] wall thickening

Revision as of 22:27, 4 August 2018

Kidney stone Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2] Amandeep Singh M.D.[3]

Overview

Nephrolithiasis should be differentiated from other conditions presenting with acute flank or upper abdominal pain, hematuria, nausea and vomiting.

Differentiating Nephrolithiasis from other Diseases

Nephrolithiasis should be differentiated from other conditions presenting with acute flank or upper abdominal pain, hematuria, nausea and vomiting. The differentials include the following:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]

Category Disease History Signs and Symptoms Physical Examination Paraclinical studies
Pain Nausea/vomiting Hematuria Fever Tachycardia Hypotension Hypertension BP Anorexia Constipation Urinary frequency/Urgency/Dysuria Rebound abdominal tenderness Costovetebral angle tenderness Pelvic Examination Rectal Examination CBC Urinalysis BUN Cr Urine Beta- hCG LFT Serum Amylase/Lipase PTH Abdominal/Pelvic CT scan Serum Parathyroid hormone levels (PTH)

Renal Pathology

Nephrolithiasis + - + - - +/- - + - - - - Nl - Nl - ↑↓
  • Radiolucent stone
Pyelonephritis + + (microscopic) + + + - +/- - + + + - - Nl -
  • Globaly decreased contrast uptake
  •  Foci from abscess pockets
-
Renal infarct + + + + - + - - - - - - - - Nl -
Renal papillary necrosis - + (microscopic) + +/- - + - - + - - - - - Nl - -
Renal cell carcinoma + + (microscopic) - - - + + +/- - - - - -
  • Anemia
- Nl -
  • Non-contrast CT:
  • Contrast-enhanced:
    • Homogenous (small lesions) to irregular (large lesions) contrast enhancement
-
Uretral stricture - - +/- - - - - - - + - - - - - - - Nl - - -

Gynecological Pathology

Pelvic inflammatory disease
  • Right/left upper quadrant
- - + + + - + - + - - - - Nl -
  • Thickening of the uterosacral ligaments
  • Haziness of the pelvic fat
  • Periovarian stranding
  • Enhancement of the adjacent peritoneum
  • Thick-walled, complex fluid collection with septa formation (abscess pockets)
-
Ovarian torsion
  • Sudden acute pain
  • Sharp pain aggravated by walking
  • Intermittent/colicky pain
+ - - + - - - - - - - - - - - - - Nl -
  • Twisted ovarian pedicle
  • Enlarged ovary (>4.0 cm)
  • Distended pedicle
  • Possible underlying ovarian lesion
-
Ectopic pregnancy + - - + - - + - + + (if ruptured) - -
  • Low platelet distribution width (decreased platelet activation)
  • Monocytosis
- - - + Might be abnormal - N/A -

Prostate Pathology

Prostatitis - + + + - - - - + - - - - - - Nl - -
Prostatic cancer - - + - - - - + - + - - - - - Nl - -

Testicular Pathology

Testicular torsion + - - + - - +/- - +/- - - - - - - - - Nl - -
Orchitis + - + + - - - - +/- - - - - - - - Nl - -

Abdominal Pathology

Cholecystitis + - + + - - + - - - - - - - - - Might be abnormal +/-
  • Gallbladder distention
  • Wall thickening
  • Mucosal hyperenhancement,
  • Pericholecystic fat stranding or fluid
  • Gallstones
-
Appendicitis + - + + - - + - +/- + - - -
  • Leukocytosis
- - - - Nl + (if perforation) -
Diverticulitis + - + + - - + + - - - - - - - - Nl + (if perforation)
  • Colonic wall thickening (wall thickness is greater than 3 mm on the short axis of the lumen)
  • Pericolic fat stranding
-
Abdominal aortic aneurysm - - - + + - - - - + (if rupture) - - - - - - - - Nl -
  • Ultrasound more sensitive than CT scan
  • CT scan may accurately predict the aneurysmal size
  • Helical CT has faster scanning time (30 to 60 seconds) and the ability to obtain all images in one breath hold
-
Portal vein thrombosis + - + + + - + - - + (if bowel ischemia or infarction-secondary to extension of thrombus to superior mesenteric vein) - - - - - - Might be abnormal + (if bowel infarction, perforation)
  • On non-contrast CT:
    • Hyperdense thrombus
  • On contrast CT
    • Non-enhancing defect of bland thrombus
    • Tumor thrombus exhibits enhancement
Duodenal ulcer + - + + + - - - - + (if perforation) - - - - Nl + (if bowel perforation) -
Ischemic colitis + - + + + (if necrosis and sepsis) + + + - + (if transmural necrosis) - - - - Nl + (if bowel perforation) -

References

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  2. Semins MJ, Matlaga BR (February 2010). "Medical evaluation and management of urolithiasis". Ther Adv Urol. 2 (1): 3–9. doi:10.1177/1756287210369121. PMC 3126068. PMID 21789078.
  3. Venkatesh L, Hanumegowda RK (June 2017). "Acute Pyelonephritis - Correlation of Clinical Parameter with Radiological Imaging Abnormalities". J Clin Diagn Res. 11 (6): TC15–TC18. doi:10.7860/JCDR/2017/27247.10033. PMC 5535453. PMID 28764263.
  4. Garin EH, Olavarria F, Araya C, Broussain M, Barrera C, Young L (July 2007). "Diagnostic significance of clinical and laboratory findings to localize site of urinary infection". Pediatr. Nephrol. 22 (7): 1002–6. doi:10.1007/s00467-007-0465-7. PMID 17375337.
  5. Lee DG, Jeon SH, Lee CH, Lee SJ, Kim JI, Chang SG (April 2009). "Acute pyelonephritis: clinical characteristics and the role of the surgical treatment". J. Korean Med. Sci. 24 (2): 296–301. doi:10.3346/jkms.2009.24.2.296. PMC 2672131. PMID 19399273.
  6. Saeed K (2012). "Renal infarction". Int J Nephrol Renovasc Dis. 5: 119–23. doi:10.2147/IJNRD.S33768. PMC 3437809. PMID 22969301.
  7. Mahamid M, Francis A, Abid A, Awawde M, Abu-Elhija O (2014). "Embolic renal infarction mimicking renal colic". Int J Nephrol Renovasc Dis. 7: 157–9. doi:10.2147/IJNRD.S59745. PMC 4011809. PMID 24812524.
  8. Korzets Z, Plotkin E, Bernheim J, Zissin R (October 2002). "The clinical spectrum of acute renal infarction". Isr. Med. Assoc. J. 4 (10): 781–4. PMID 12389340.
  9. Brix AE (2002). "Renal papillary necrosis". Toxicol Pathol. 30 (6): 672–4. doi:10.1080/01926230290166760. PMID 12512867.
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  11. Ng CS, Wood CG, Silverman PM, Tannir NM, Tamboli P, Sandler CM (October 2008). "Renal cell carcinoma: diagnosis, staging, and surveillance". AJR Am J Roentgenol. 191 (4): 1220–32. doi:10.2214/AJR.07.3568. PMID 18806169.
  12. Ares Valdés Y, Amador Sandoval B, Morales JC, Alonso Domínguez F, Carballo Velásquez L, Fragas Valdés R, Shou Rodríguez A (September 2004). "[The role of CT scan in the diagnosis of renal cell carcinoma]". Arch. Esp. Urol. (in Spanish; Castilian). 57 (7): 737–42. PMID 15536955.
  13. Leveridge MJ, Bostrom PJ, Koulouris G, Finelli A, Lawrentschuk N (June 2010). "Imaging renal cell carcinoma with ultrasonography, CT and MRI". Nat Rev Urol. 7 (6): 311–25. doi:10.1038/nrurol.2010.63. PMID 20479778.
  14. Tritschler S, Roosen A, Füllhase C, Stief CG, Rübben H (March 2013). "Urethral stricture: etiology, investigation and treatments". Dtsch Arztebl Int. 110 (13): 220–6. doi:10.3238/arztebl.2013.0220. PMC 3627163. PMID 23596502.
  15. Mundy AR, Andrich DE (January 2011). "Urethral strictures". BJU Int. 107 (1): 6–26. doi:10.1111/j.1464-410X.2010.09800.x. PMID 21176068.
  16. Maciejewski C, Rourke K (February 2015). "Imaging of urethral stricture disease". Transl Androl Urol. 4 (1): 2–9. doi:10.3978/j.issn.2223-4683.2015.02.03. PMC 4708283. PMID 26816803.
  17. Soper DE (August 2010). "Pelvic inflammatory disease". Obstet Gynecol. 116 (2 Pt 1): 419–28. doi:10.1097/AOG.0b013e3181e92c54. PMID 20664404.
  18. Paavonen J (October 1998). "Pelvic inflammatory disease. From diagnosis to prevention". Dermatol Clin. 16 (4): 747–56, xii. PMID 9891675.
  19. Lee MH, Moon MH, Sung CK, Woo H, Oh S (December 2014). "CT findings of acute pelvic inflammatory disease". Abdom Imaging. 39 (6): 1350–5. doi:10.1007/s00261-014-0158-1. PMID 24802548.
  20. Eggert J, Sundquist K, van Vuuren C, Fianu-Jonasson A (October 2006). "The clinical diagnosis of pelvic inflammatory disease--reuse of electronic medical record data from 189 patients visiting a Swedish university hospital emergency department". BMC Womens Health. 6: 16. doi:10.1186/1472-6874-6-16. PMC 1624808. PMID 17054801.
  21. Washington C, Carmichael JC (December 2012). "Management of ischemic colitis". Clin Colon Rectal Surg. 25 (4): 228–35. doi:10.1055/s-0032-1329534. PMC 3577613. PMID 24294125.
  22. Chawla YK, Bodh V (March 2015). "Portal vein thrombosis". J Clin Exp Hepatol. 5 (1): 22–40. doi:10.1016/j.jceh.2014.12.008. PMC 4415192. PMID 25941431.
  23. "Imaging of Abdominal Aortic Aneurysms - - American Family Physician".
  24. Aggarwal S, Qamar A, Sharma V, Sharma A (2011). "Abdominal aortic aneurysm: A comprehensive review". Exp Clin Cardiol. 16 (1): 11–5. PMC 3076160. PMID 21523201.
  25. Destigter KK, Keating DP (August 2009). "Imaging update: acute colonic diverticulitis". Clin Colon Rectal Surg. 22 (3): 147–55. doi:10.1055/s-0029-1236158. PMC 2780264. PMID 20676257.
  26. Hameed AM, Lam VW, Pleass HC (February 2015). "Significant elevations of serum lipase not caused by pancreatitis: a systematic review". HPB (Oxford). 17 (2): 99–112. doi:10.1111/hpb.12277. PMC 4299384. PMID 24888393.
  27. "Imaging for Suspected Appendicitis - - American Family Physician".
  28. "CT Findings of Acute Cholecystitis and Its Complications : American Journal of Roentgenology : Vol. 194, No. 6 (AJR)".
  29. "Epididymitis and Orchitis: An Overview - - American Family Physician".
  30. Jia JB, Houshyar R, Verma S, Uchio E, Lall C (January 2016). "Prostate cancer on computed tomography: A direct comparison with multi-parametric magnetic resonance imaging and tissue pathology". Eur J Radiol. 85 (1): 261–267. doi:10.1016/j.ejrad.2015.10.013. PMID 26526901.
  31. Bratt O, Lilja H (January 2015). "Serum markers in prostate cancer detection". Curr Opin Urol. 25 (1): 59–64. doi:10.1097/MOU.0000000000000128. PMC 4315142. PMID 25393274.
  32. "Prostate Cancer (Prostate Carcinoma): Symptoms - National Library of Medicine - PubMed Health".
  33. Eskicioğlu F, Özdemir AT, Turan GA, Gür EB, Kasap E, Genç M (November 2014). "The efficacy of complete blood count parameters in the diagnosis of tubal ectopic pregnancy". Ginekol. Pol. 85 (11): 823–7. PMID 25675798.
  34. Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW (October 2011). "Diagnosis and management of ectopic pregnancy". J Fam Plann Reprod Health Care. 37 (4): 231–40. doi:10.1136/jfprhc-2011-0073. PMC 3213855. PMID 21727242.