Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2721_Библиотеки_им_академика_М_И_Перельмана
.pdf
Endoscopy (RUGBE):
Endoscopic Hemostasis and
Proton Pump Inhibition are
Associated with Improved
Outcomes in a Real-Life
Setting. Am J Gastroenterol.
2004; 99:1238–1246.
10. Barkun A, Bardou M, Marshall
JK, for the Nonvariceal Upper
GI Bleeding Consensus
Conference Group. Consensus
recommendations for managing
patients with nonvariceal upper
gastrointestinal bleeding. Ann
Intern Med. 2003; 139:843–857.
11. Wrenn KD, Thompson LB.
Hemodynamically stable upper
gastrointestinal bleeding. Am
J Emerg Med. 1991 Jul; 9:
309–312.
12. Longstreth GF, Feitelberg SP.
Successful outpatient
management of acute upper
gastrointestinal hemorrhage:
use of practice guidelines in a
large patient series. Gastrointest
Endosc 1998; 47:219–222.
13. Laine L, Peterson WL. Bleeding
peptic ulcer. N Engl J Med.
1994; 331:717–727.
14. Cipolletta L, Bianco MA,
Rotondano G, et al. Outpatient
management for low-risk
nonvariceal upper GI bleeding:
a randomized controlled trial.
Gastrointest Endosc. 2002;
55:1–5.
15. Lee JG, Turnipseed S, Romano
PS, et al. Endoscopy-based
triage significantly reduces
hospitalization rates and costs
of treating upper GI bleeding: a
randomized controlled trial.
Gastrointest Endosc. 1999;
50:755–761.
Upper Gastrointestinal (GI) Bleeding
050
21:14:20
Subpart IVH
Chapter
47
Clinical – Gastrointestinal
Dehydration, Gastroenteritis,
and Vomiting
Elizabeth A. Rees, MD
Bret A. Nicks, MD, MHA, FACEP
Background
Many patients, from newborns to the elderly,
present to the emergency department (ED) every
year with a chief complaint related to dehydration. Presenting symptoms can be as varied
as the potential sources of dehydration. The challenge of the emergency physician is piecing
together from the history and physical examination the potentially life threatening and
treatable sources of dehydration as well as correcting the dehydration and associated electrolyte abnormalities. The management of the
dehydrated patient can vary widely from simple
encouragement of increased oral intake to
aggressive intravenous (IV) fluid and electrolyte
replacement. Hospital admission rates related to
dehydration have a bimodal distribution, with
peaks in the very young and very old.
1
The cost
of caring for dehydrated patients is spread
among ambulatory care services, EDs, observation units (OUs), and inpatient hospitalizations.
As it relates to observation, dehydration, often
from gastroenteritis, accounts for 2% to 11.7% of
the adult ED observation unit (ED OU) population.
2
The A gency for Healthcare Research and
Quality considers dehydration to be a frequent,
potentially preventable, acute cause of hospital
admission.Thisissupportedbyasmallretrospective single center observational study in
which the diagnosis of dehydration was identified as the highest risk diagnosis for early return
visit to the ED and subsequent admission to the
hospital on early return.
3
In the elderly alone the
cost of dehydration management in the inpatient
setting is greater than one billion dollars a year.
4
Early and successful management of acute dehydrationisanareaofpotentialsavingsoflimited
health care dollars – and ED OU management is
essential in this process.
Pathophysiology
Dehydration is the end result of total body water
loss. It can be due to a multitude of causes that
result from decreased intake, excessive losses, or
fluid shifts from extracellular spaces. The average
healthy adult requires approximately 1 to 1.5 liters
of water per day. Water losses occur from urine,
feces, sweating, and respiration. These losses
increase with renal concentrating problems, medication effects, diarrhea, vomiting, environmental
exposure, and fever. Fluid losses with vomiting,
diarrhea, etc. and/or decreased fluid intake – and
even the fluid shifts that can occur with ascites,
effusions, and sepsis – can result in effective
volume depletion and clinical dehydration.
Patients at increased risk for dehydration are
those with comorbid illness as well as those with
dependence on others for access to nourishment
such as the very young and the debilitated elderly.
Young children have an increased risk of dehydration related to their relative increase in total
body water and their increased body surface area
when compared to adults, as well as their dependence on others for hydration. As we age we have a
relative decrease in total body w ater due to an
increase in fat and decrease in skeletal muscle,
but the risk of dehydration increases due to multiple other factors.
5
Evaluation
A careful history and physical examination is
required in patients presenting with dehydration.
Historical features that are important to identify
include the underlying health status of the patient,
medications, and health problems, and the ability
to access fluids. The physical examination when
assessing for dehydration should focus on identifying potential critical, life-threatening conditions
051
21:14:16
that exist. Vital signs should be performed, noting
in particular the presence of fever, tachycardia, or
hypotension. The physical examination should
include the patient’s general appearance, skin
turgor, mucous membrane hydration, and capillary refill to evaluate the extent of dehydration.
5
An abdominal examination should be performed
to evaluate for acute emergencies, such as evidence of appendicitis, cholecystitis, or incarcerated hernias.
Radiographic and laboratory studies should be
performed at the evaluating physician’s discretion
to determine the extent of disease process as well to
identify and rule out potentially life-threatening
and treatable conditions. When indicated, studies
to consider include ultrasonography and abdominal CT to evaluate for surgical pathology, and
serum electrolytes or liver function tests to evaluate for complications related to dehydration itself
or the precipitating cause of dehydration. Urinalysis should be considered in those patients
prone to recurrent urinary tract infections or
those with symptomatic dysuria. Urine output
and urinalysis parameters have been used by some
to assess the degree of dehydration.
6
Various
dehydration scales have been suggested for assessing the degree of dehydration, but these scales
have only been used in pediatric patients, particularly infants and young children.
6,7
Urine pregnancy testing should be performed in all women
of childbearing age to assess for hyperemesis as a
cause of their dehydration.
8
ED OU Patient Selection – Inclusion
Criteria
Careful patient selection is key to successful management in the OU setting. Appropriate patients
should be hemodynamically stable with anticipation of discharge within the next 24 hours. Only
mild to moderate dehydration stemming from
treatable or self-limiting causes should be enrolled
in the OU. Examples of appropriate presentations
for OU admission are dehydration related to
acute gastroenteritis, pharyngitis, or hyperemesis
gravidarum, but not dehydration from an acute
abdomen or diabetic ketoacidosis. If laboratory
studies are performed during the initial patient
evaluation, only mild electrolyte abnormalities
should be present.
ED OU Patient Selection – Exclusion
Criteria
Certain patients require complex care or prolonged
management for treatment of dehydration and are
considered poor candidates for observation dehydration protocols. In general, high-risk patients
(such as those with renal failure, congestive heart
failure, or liver failure) and those with hemodynamic instability should be excluded from the ED
OU. Severe dehydration and marked electrolyte
abnormalities are indications for hospital admission given the high likelihood of prolonged course
to recovery. Conditions resulting in dehydration
that require specific, focused treatment such as
bowel obstruction, diabetic ketoacidosis, appendicitis, and sepsis are not amenable to ED OU care.
Management/Intervention
Observation management of dehydration allows for
multiple different treatment options and interventions. IV hydration can be provided if indicated for
those unable to tolerate oral fluids. Serial examinations and vital signs can be performed to evaluate
response to treatment. A variety of anti-emetics can
be provided to help decrease the rate of fluid loss as
well as improve tolerance of oral rehydration. Most
importantly, patients can be monitored for tolerance of oral fluids and ability to keep down essential
medications that may factor greatly in coordinating
care disposition – whether home or to an inpatient
service.
As with most ED OU patients, factors related to
care disposition are multifactorial. In the dehydrated patient, consideration of the underlying
cause concurrent with any comorbid etiology, age,
and available outpatient resources greatly impact
the decision making. General guidelines for admission from the unit include unstable vital signs, cause
of dehydration identified during observation
requiring admission (i.e., bowel obstruction), or
persistent inability to tolerate oral fluids. Patients
are often safe for further management at home if
their vital signs are within appropriate hemodynamic ranges, symptoms improve and the patient
tolerates oral fluids, and electrolyte abnormalities
resolve (if these were initially assessed). Studies of
the efficacy of ED OU treatment of adults with this
common condition are needed.
Dehydration, Gastroenteritis, and Vomiting
051
21:14:16
References
1. Agency for Healthcare
Research and Quality.
Preventable Hospitalizations.
Part II. Detailed Statistics by
Health Condition. http://
archive.ahrq.gov/data/hcup/
factbk5/factbk5c.htm
(Accessed March 1, 2012)
2. Zalenski RJ, Rydman RJ,
McCarren M, et al. Feasibility
of a rapid diagnostic protocol
for an emergency department
chest pain unit. Ann Emerg
Med 1997;29:99–108.
3. Gordon JA, An LC, Hayward
RA, Williams BC. Initial
emergency department
diagnosis and return visits: risk
versus perception. Ann Emerg
Med 1998;32:569–573.
4. Xiao, et al. Economic burden of
dehydration among
hospitalized elderly patients;
Am J Health Sys Pharm 2004;
Dec 1; 61(23):2534–2540.
5. Armstrong J. Assessing
hydration status: The elusive
gold standard. AmJ Clin Nutr
Oct 2007; 26(5):575s–584s.
6. Gorelick MH, Shaw KN,
Murphy KO. Validity and
reliability of clinical signs in
the diagnosis of dehydration.
Pediatrics 1997; 99(5).
Available at: www.pediatrics
.org/cgi/content/full/99/
5/e6
7. Goldman RD, Friedman JN,
Parkin PC. Validation of the
clinical dehydration scale for
children with acute
gastroeneteritis. Pediatrics
2008; 122(3):545–549.
8. Cheuvront SN, Ely BR,
Kenefick RW, Sawka MN.
Biological variation and
diagnostic accuracy of
dehydration assessment
markers. Am J Clin Nutr 2010
Sep;92(3):565–573.
Elizabeth A. Rees and Bret A. Nicks
051
21:14:16
Subpart IVI
Chapter
48
Clinical – Genitourinary
Urolithiasis
Claire Pearson, MD, MPH
Robert D. Welch, MD, MS
Introduction
Urolithiasis (“urinary” or “ kidney” stones) is a
common medical problem for which patients
often seek medical care for the symptoms of
acute pain, nausea, and vomiting. The incidence
of urolithiasis is over 5% of the U.S. population
with a lifetime risk of 10–15% for developing a
stone.
1
The majority, 70%, occur between the
third and sixth decade of life, with males more
commonly affected than females (7% and 3%
respectively).
2
The prevalence of kidney stones
has been on the rise for the past several decades.
3
Individuals that have a history of kidney stones
aremorelikelytohaveasecondstonewitha50%
reoccurrence within 5 years and 80% within the
next 20 years.
1
The costs associated with management of urolithiasis in the United States is
estimated to be over $2.1 billion dollars.
4
Outpatient visits predominate but roughly 600,000
emergency department (ED) visits occur and a
portion of these cases will require observation
or admission.
4
The frequency of occurrence, the need for
treatment of symptoms, and, since many procedures can be done on an outpatient basis, the
general lack of need for long-term hospitalization
make this condition suitable for observation services. Although this section includes information
on the initial diagnosis, much of the focus for
observation services is on the patient in which
the diagnosis has been established. Patient selection and short-term management issues are the
important factors.
Discussion
Risk factors for the development of kidney stones
include family history, male gender, dehydration,
hot, arid climates, and history of kidney stones.
2
Metabolic diseases may also predispose to kidney
stones including Crohn’s disease, primary hyperparathyroidism, recurrent urinary tract infections
(UTI), renal tubular acidosis, and gout.
2
Diabetes
and obesity are considered to be major risk factors.
3
Pathophysiology
Kidney stones are composed from a variety of
materials, the most common being calcium oxalate, calcium phosphate, cystine, struvite, and uric
acid. The majority of stones (75%) are composed
of calcium oxalate with or without calcium phosphate.
2
Hyperexcretion of calcium contributes to
stone formation and high-quantity dairy intake
may contribute to the formation of calcium-based
stones.
2
Recurrent UTI with urea-splitting bacteria such as Proteus, Klebsiella, Pseudomonas,
and Staphylococcus contribute to struvite stone
formation. Medications such as protease inhibitors, antibiotics, and some diuretics increase the
risk of some kidney stones.
5
The size of the stone plays a role in the ability
for it to pass out of the genitourinary system.
Roughly 90% of stones less than 5 mm width pass
spontaneously within 4 weeks. Only 15% of stones
5mm to 8mm width pass spontaneously and only
5% greater than 8 mm will pass.
2
The location of
the stone from the kidney to the bladder determines the chan ce of it becoming impacted along
with the size of the stone. A stone may lodge in
the calyx of the kidney or renal pelvis. The junction of the ureter and the renal pelvis is only
2–3 mm in diameter and impaction may occur
at this site. The location in which the ureter
crosses the iliac vessels is another area in which
stone passage may be obstructed but the most
common area for impaction is at the ureterovesicular junction. Approximately 75% of stones are
located in the distal third of the ureter at the time
of diagnosis. The final place a stone may be
impacted is at the bladd er outlet.
2
052
21:14:43
History
Renal colic is classically acute in onset frequently
with nausea and at times with vomiting. However,
at times the patient may be relatively asymptomatic. Past medical problems, family history, and
dietary information should be assessed during the
history. Additionally, one should probe into
factors that may indicate alternative causes of
flank or groin pain.
Colic or spasmodic, severe intermittent pain
from the flank to the groin is common for kidney
stone pain. Pain in the proximal ureter or renal
pelvis causes posterior flank pain and pain in the
distal ureter may cause radiation of pain to the
ipsilateral testicle and labia. In the ureter lower
and anterior flank pain predominates and at the
ureterovesical junction lower flank pain with
accompanying scrotal or vulvar pain is co mmon.
Urinary symptoms may also exist including frequency and urgency.
Physical Examination
The physical examination is best used to evaluate
for other causes of flank and groin pain. The
classic finding of a patient with renal colic is that
of someone in severe pain, but some patients can
have minimal symptoms. Any important abdominal tenderness should lead one to consider and
search for other causes of the pain, but the
absence of major tenderness does not exclude
other causes such as abdominal aortic aneurysm.
Laboratory Tests
The standard evaluation will often include a basic
metabolic panel, renal function tests (blood urea
nitrogen and creatinine), and urinalysis and
analysis of a stone’s composition.
3
Urinalysis is
performed looking for red blood cells (RBCs),
white blood cells (WBCs), proteins, and crystals.
A urinary tract stone may be present in the
absence of RBCs as about 15% will not have
hematuria and RBCs may occur from other conditions such as infection, menses, appendicitis,
and diverticulitis. Electrolytes should be obtained
for all first-time patients presenting with a history
concerning for stones, but may not be needed in
all cases of patients with recurrent disease.
3
The collection of a 24-hour urine and evaluation of urinary pH can impart information
regarding stone formation.
3,5
It is not clear if a
12-hour collection (a more realistic goal for
observation patients) would suffice since daily
variations in fluid intake, diurnal metabolism,
and other variations would not be captured.
6
Determining the type of stone can aid in the
outpatient treatment and prevention for individuals with stones. Metaboli c stone tests are used to
help identify the underlying causes of stone formation; this typically involves a 24-hour urine
collection. Knowing the stone composition can
aid in identifying underlying medical conditions
and certain medical conditions can aid in predicting stone composition.
7
Imaging
Computerized tomography (CT) has become the
first choice in emergency imaging with 92–100%
sensitivity for the evaluation of urinary and nonurinary flank pain.
8
Data from the National Hospital Ambulatory Care Survey described a change
in the use of CT for emergency evaluation of flank
pain increasing from 19.6% of cases in 2000 to
45.5% in 2008 with no change in the proportion
of patients (about 20%) diagnosed as having a
stone.
9
The increased use is in part due to the
added benefit of potentially providing a diagnosis
of other sources of abdominal or flank pain, and
CT is widely available in the United States. Duel
energy CT utilizing advanced post-acquired processing can identify the composition of various
types of stones and potentially could help guide
long-term management.
10
More recent research has evaluated the ability
of CT to provide accurate diagnostic images using
reduced radiation doses (low-dose CT) thereby
limiting exposure. It has been shown to be an
effective diagnostic modality for most patients
but image quality may not be ideal for patients
with a very low or high body-mass index.
11–13
For
patients with a body-mass index under 30, lowdose CT imaging had 95% sensitivity and 97%
specificity for ureteral stones and was 100% sensitive for those with ureteral stones larger than
3 mm.
11
This area requires more information to
help determine if low-dose CT differs in the ability to identify stones in the kidney compared to
the ureter
11,14,15
and to determine ideal radiation
dosing parameters.
16
Some suggest that this technique may be utilized as a first-line diagnostic
study if the clinician understands its limitations,
but it may best be used for patients with known
Claire Pearson and Robert D. Welch
052
21:14:43
disease to follow progress or diagnose recurrent
disease.
12
Figure 48.1(a)–(d) shows images of a
low- and normal-dose CT of the same patient.
Ultrasound is useful in the diagnosis of kidney
stones. Advantages of ultrasound include there are
no known important side effects, no radiation
exposure, availability for rapid assessment, repeatability, it can detect the majority of calculi, and
it is associated with low cost.
17,18
Additionally
useful information can be obtained regarding the
anatomy of the kidney and ureters. For patients
with the clinical finding of hematuria and flank
pain, emergency limited ultrasound was found to
have reasonably good sensitivity and specificity
19
and another study suggested that emergency ultrasound can be utilized to diagnose obstructive uropathy and is easily learned by physicians training
in ultrasound.
20
A more recent study found that
(a) (b)
(c) (d)
Figure 48.1 Low-Dose CT Images Compared to Full-Dose CT Images, (a) axial image using a standard-dose radiation protocol, (b)
coronal image using a standard-dose radiation protocol, (c) axial image using a low-dose radiation protocol, and (d) coronal image
using a low-dose radiation protocol. Both sets of images demonstrate densities in the right kidney. Two stones are seen on the
coronal cuts and the incidental finding of a large right renal cyst is noted.
(Images are courtesy of Jason B. Wynberg, MD; Director, Detroit Medical Center, Kidney Stone Center)
Urolithiasis
052
21:14:43
bedside ultrasonography had only moderate sensitivity and specificity for the detection of ureteral
stones and had minimal impact on physicians’ clinical impression of patients with possible stones.
21
Other disadvantages of ultrasound include false
positives, which are secondary to surrounding
anatomy, and inability to detect small stones. Additionally this diagnostic study is dependent on
sonographer ability and technical quality.
17,18
Kidney/Ureter/Bladder (KUB) radiography
used to be a popular imaging modality but sensitivity was low, often around 45% to 59%.
22
Plain
radiography (KUB technique) use has significantly decreased from 2000 to 2008 while ultrasound use has remained stable.
9
Advantages of
using radiography include the minimal exposure
to radiation and the utility for following stone
passage after procedures such as extracorporeal
shock wave lithotripsy (ESWL).
Studies have found that ultrasound combined
with plain radiography (KUB) is more costeffective and utilizes considerably less radiation
than CT for discovering clinically significant
stones.
23,24
Further studies are needed to determine
if combined ultrasound and plain KUB could
replace CT scan as the primary diagnostic imaging
study and if these can be adequately performed at
the bedside and interpreted by ED physicians.
Prior to CT, intravenous pyelog raphy had
been used for years and may still be used in
places without readily available CT. One study
found the sensitivity to be 94.2% and a specificity of 90.4 %.
25
It is likely that many institutions have all but abandoned this diagnostic
study for diagnosis among ED or observation
unit (OU) patients.
Differential Diagnosis
Among the most immediately life-threatening
mimics of renal colic are abdominal aortic
aneurysm rupture and aortic dissection; these
conditions must not be overlooked. Additional
considerations include appendicitis, ectopic
pregnancy, cholecystitis, pancreatitis, bowel
obstruction, pyelonephritis, varicella-zoster, and
musculoskeletal pain.
Patient Criteria
Most patients in whom the diagnosis of a urinary
tract stone is made in the ED can be treated as an
outpatient. Admission for short-term observation
and treatm ent is indicated when adequate pain
control cannot be achieved or for intractable
nausea and vomiting.
2
Additionally, severely
dehydrated patients may also require observation.
Patients with renal failure or patients with signs of
sepsis from a urinary tract infection with tachycardia, fever, hypotension, and shock will typically need inpatient admission.
2
Surgical intervention may be required for
those with persistent obstruction, halting of stone
progress, or unrelenting renal colic.
26
Those with
complete obstruction require urology consultation and will need to be admitted.
2
Management
Since the cost of kidney stone diagnosis and treatment is high and reoccurrence rates are sizeable,
evaluation of the underlying cause is important.
3
Medical Therapy
Initialmedicalmanagement includesthe use of nonsteroidal anti-inflammatory drugs (NSAIDS) and/
or opioids for acute renal colic. NSAIDs are preferredas opioids tend to have more adverse effects.
27
In a 2006 prospective trial of acute renal colic treatment, the combination of morphine and ketorolac
had greater pain relief then either analgesic drug
singularly.
28
Fluid management has not been shown
to have significant improvement in pain or to facilitate acute management; diuretics and high-dose
fluids can cause damage.
29
However, adequate fluid
hydration can help prevent reoccurrences.
Stable patients are started on oral pain management as tolerated. Adjuvant therapy includes alpha
agonists (tamsulosin, terazosin, and doxazosin) or
calcium channel blocker (nifedipine) to enhance
stone passage. The pharmacology behind these
two drug classes is the ability to inhibit smooth
muscle contraction. Singh et al. performed a systematic review of trials using alpha agonist and
calcium channel blockers and found that both offer
significant benefit for stone expulsion.
4
Special Considerations
Pregnant women may develop kidney stones and
the risks of imaging with radiation exposure must
outweigh the potential delay in diagnosis or infection, renal pathology, or premature labor. Physiologic changes of pregnancy including dilation of
the renal calices, pelvis, and ureter may occur and
Claire Pearson and Robert D. Welch
052
21:14:43
mimic renal colic. Ultrasound has low sensitivity
during pregnancy and ureteroscopy may be the
study of choice for pregnant women who require
interventional therapy.
30
For patients with recurrent kidney stones the
use or potential overuse of CT imaging should be
evaluated. CT radiation exposure acts cumulatively, which may put individuals at increased
risk for later malignancy. Although the threshold
for radiation exposure is unknown, a study by
Manohar et al. evaluated patients treated for
kidney stones and found what was felt to be
excessive exposure to radiation.
31
Since the
increased use of CT scans has not lead to an
increase in the portion of patients presenting
with flank pain who are diagnosed with a renal
stone, overuse of radiation should be a concern
for the clinician.
9
Alternative imaging or diagnostic studies previously mentioned should be
strongly considered for patients with recurrent
urolithiasis and pri or CT imaging.
Outcome
For patients in observation the goals are progression to oral pain management and ability to tolerate oral dietary intake. Adequate hydration
should be assured.
Conclusion
Kidney stones are a common emergency condition that account for significant health care
dollars. Some patients will require obse rvation
and this is gener ally for symptom management.
References
1. Emmett M, Fenves AZ,
Schwartz JC, editors. Approach
to Patient with Kidney Disease.
9th ed. St. Louis: Elsevier; 2011.
2. Ban KM, Easter JS, editors.
Emergency Medicine, Concepts
and Clinical Practice. 7th
ed. Philadelphia: Mosby;
2009.
3. Lipkin ME, Preminger GM.
Demystifying the medical
management of nephrolithiasis.
Rev Urol. 2011;13(1):34–38.
PubMed PMID: 21826126.
Pubmed Central PMCID:
3151585. Epub 2011/08/10. eng.
4. Singh A, Alter HJ, Littlepage A.
A systematic review of medical
therapy to facilitate passage of
ureteral calculi. Ann Emerg
Med. 2007 Nov;50(5):552–563.
PubMed PMID: 17681643.
Epub 2007/08/08. eng.
5. Frassetto L, Kohlstadt I.
Treatment and prevention of
kidney stones: an update. Am
Fam Physician. 2011 Dec 1;
84(11):1234–1242. PubMed
PMID: 22150656. Epub 2011/
12/14. eng.
6. Cameron M, Maalouf NM,
Poindexter J, Adams-Huet B,
Sakhaee K, Moe OW. The
diurnal variation in urine
acidification differs between
normal individuals and uric
acid stone formers. Kidney
international. 2012 Jun;
81(11):1123–1130. PubMed
PMID: 22297671. Pubmed
Central PMCID: 3352978.
Epub 2012/02/
03. eng.
7. Pak CY, Poindexter JR,
Adams-Huet B, Pearle MS.
Predictive value of kidney stone
composition in the detection of
metabolic abnormalities.
Am J Med. 2003 Jul;115(1):
26–32. PubMed PMID:
12867231. Epub 2003/07/18. eng.
8. Tamm EP, Silverman PM,
Shuman WP. Evaluation of the
patient with flank pain and
possible ureteral calculus.
Radiology. 2003 Aug;228(2):
319–329. PubMed PMID:
12819343. Epub 2003/06/
24. eng.
9. Hyams ES, Korley FK, Pham
JC, Matlaga BR. Trends in
imaging use during the
emergency department
evaluation of flank pain. J Urol.
2011 Dec;186(6):2270–2274.
PubMed PMID: 22014815.
Epub 2011/10/22. eng.
10. Zilberman DE, Ferrandino
MN, Preminger GM, Paulson
EK, Lipkin ME, Boll DT. In
vivo determination of urinary
stone composition using dual
energy computerized
tomography with advanced
post-acquisition processing.
Journal of Urology. 2010
Dec;184(6):2354–2359.
PubMed PMID:
ISI:000284037900050. eng.
11. Poletti PA, Platon A,
Rutschmann OT, Schmidlin
FR, Iselin CE, Becker CD.
Low-dose versus standard-dose
CT protocol in patients with
clinically suspected renal colic.
AJR Am J Roentgenol. 2007
Apr;188(4):927–933. PubMed
PMID: 17377025. Epub 2007/
03/23. eng.
12. Niemann T, Kollmann T,
Bongartz G. Diagnostic
performance of low-dose CT
for the detection of urolithiasis:
a meta-analysis. AJR Am
J Roentgenol. 2008 Aug;191(2):
396–401. PubMed PMID:
18647908. Epub 2008/07/
24. eng.
13. Heldt JP, Smith JC, Anderson
KM, Richards GD, Agarwal G,
Smith DL, et al. Ureteral calculi
detection using low dose
computerized tomography
protocols is compromised in
overweight and underweight
patients. J Urol. 2012 Jul;
Urolithiasis
052
21:14:43
188(1):124–129. PubMed
PMID: 22578728. Epub 2012/
05/15. eng.
14. Paulson EK, Weaver C, Ho LM,
Martin L, Li J, Darsie J, et al.
Conventional and reduced
radiation dose of 16-MDCT for
detection of nephrolithiasis and
ureterolithiasis. AJR Am
J Roentgenol. 2008 Jan;190(1):
151–157. PubMed PMID:
18094305. Epub 2007/12/
21. eng.
15. Heneghan JP, McGuire KA,
Leder RA, DeLong DM,
Yoshizumi T, Nelson RC.
Helical CT for nephrolithiasis
and ureterolithiasis:
comparison of conventional
and reduced radiation-dose
techniques. Radiology. 2003
Nov;229(2):575–580. PubMed
PMID: 14526095. Epub 2003/
10/04. eng.
16. Sung MK, Singh S, Kalra MK.
Current status of low dose
multi-detector CT in the
urinary tract. World Journal of
Radiology. 2011 Nov 28;
3(11):256–265. PubMed PMID:
22132296. Pubmed Central
PMCID: 3226959. Epub 2011/
12/02. eng.
17. Rao PN. Imaging for kidney
stones. World Journal of
Urology. 2004 Nov;22(5):323–7.
PubMed PMID: 15290203.
Epub 2004/08/04. eng.
18. Hyams ES, Shah O. Evaluation
and follow-up of patients with
urinary lithiasis: minimizing
radiation exposure. Current
Urology Reports. 2010 Mar;
11(2):80–86. PubMed PMID:
20425094. Epub 2010/04/29.
eng.
19. Gaspari RJ, Horst K.
Emergency ultrasound and
urinalysis in the evaluation of
flank pain. Acad Emerg Med.
2005 Dec;12(12):1180–1184.
PubMed PMID: 16282510.
Epub 2005/11/12. eng.
20. Jang TB, Casey RJ, Dyne P, Kaji
A. The learningcurve of resident
physicians using emergency
ultrasonography for obstructive
uropathy. Acad Emerg Med.
2010 Sep;17(9):1024–1027.
PubMed PMID: 20836789.
Epub 2010/09/15. eng.
21. Moak JH, Lyons MS, Lindsell
CJ. Bedside renal ultrasound in
the evaluation of suspected
ureterolithiasis. Am J Emerg
Med. 2012 Jan;30(1):218–221.
PubMed PMID: 21185667.
Epub 2010/12/28. eng.
22. Levine JA, Neitlich J, Verga M,
Dalrymple N, Smith RC.
Ureteral calculi in patients with
flank pain: correlation of plain
radiography with unenhanced
helical CT. Radiology. 1997
Jul;204(1):27–31. PubMed
PMID: 9205218. Epub 1997/07/
01. eng.
23. Ekici S, Sinanoglu O.
Comparison of conventional
radiography combined with
ultrasonography versus
nonenhanced helical computed
tomography in evaluation of
patients with renal colic. Urol
Res. 2012 Mar 14. PubMed
PMID: 22415439. Epub 2012/
03/15. eng.
24. Catalano O, Nunziata A, Altei F,
Siani A. Suspected ureteral colic:
primary helical CT versus
selective helical CT after
unenhanced radiography and
sonography. AJR Am
JRoentgenol. 2002 Feb;178(2):
379–387. PubMed PMID:
11804898. Epub 2002/01/24. eng.
25. Pfister SA, Deckart A, Laschke
S, Dellas S, Otto U, Buitrago C,
et al. Unenhanced helical
computed tomography vs
intravenous urography in
patients with acute flank pain:
accuracy and economic impact
in a randomized prospective
trial. Eur Radiol. 2003 Nov;
13(11):2513–2520. PubMed
PMID: 12898174. Epub 2003/
08/05. eng.
26. Preminger G, Tiselius H,
Assimos D. 2007 Guideline for
the management of ureteral
calculi. J Urol. 2007;178(6):
2418–2434.
27. Holdgate A, Oh CM. Is there a
role for antimuscarinics in
renal colic? A randomized
controlled trial. J Urol. 2005
Aug;174(2):572–575;
discussion 5. PubMed PMID:
16006900. Epub 2005/07/12.
eng.
28. Safdar B, Degutis LC, Landry
K, Vedere SR, Moscovitz HC,
D'Onofrio G. Intravenous
morphine plus ketorolac is
superior to either drug alone
for treatment of acute renal
colic. Ann Emerg Med. 2006
Aug;48(2):173–181, 81 e1.
PubMed PMID: 16953530.
Epub 2006/09/06. eng.
29. Worster A, Richards C. Fluids
and diuretics for acute ureteric
colic. Cochrane Database Syst
Rev. 2005 (3):CD004926.
PubMed PMID: 16034958.
Epub 2005/07/22. eng.
30. Lifshitz DA, Lingeman JE.
Ureteroscopy as a first-line
intervention for ureteral calculi
in pregnancy.
J Endourol. 2002
Feb;16(1):19–22. PubMed
PMID: 11890444. Epub 2002/
03/14. eng.
31. Manohar P, McCahy P.
Repeated radiological radiation
exposure in patients
undergoing surgery for urinary
tract stone disease in Victoria,
Australia. BJU Int. 2011
Nov;108 Suppl 2:34–37.
PubMed PMID: 22085124.
Epub 2011/12/07. eng.
Claire Pearson and Robert D. Welch
052
21:14:43
Соседние файлы в папке Библиотека им академика М.И. Перельмана