Chapter -94 Urologic stone disease- part 2 TARGET TINTINALLI

🎯 Target Tintinalli | Chapter 94: Urologic Stone Disease (Part 2)
Welcome to the conclusion of Chapter 94! In this video, we move from pathophysiology into the clinical management of urologic stones in the Emergency Department. We discuss how to identify "stony" pain, what life-threatening conditions mimic it, and how to treat it based on current Tintinalli guidelines.

🏥 Clinical Features & "The Big Miss"

Pain Patterns: Understanding how pain radiates based on stone location (Upper Ureter vs. VUJ).

Systemic Signs: Why nausea and vomiting are almost always present.

AAA Warning: Why new-onset flank pain in a male over 60 years old is a "red flag" for Abdominal Aortic Aneurysm (AAA) until proven otherwise.

🔍 Imaging & Diagnostics

We compare the three main tools in the ER:

Plain X-ray: Good for tracking, poor for initial diagnosis.

Ultrasound: Best for pregnancy/children, but often misses stones smaller than 5mm.

NCCT KUB: The gold standard for sensitivity, though it carries a radiation risk.

💊 Management Myths & Reality

The IV Fluid Myth: Why "rushing" IV fluids does not help stone passage and can actually cause false-positive results on an ultrasound.

Pain Management: Why NSAIDs are often the first choice over opioids due to their direct effect on the ureter.

Lidocaine: A surprising Tintinalli alternative for rapid pain relief.

📋 Who Needs Admission?


We break down the absolute vs. relative indications for admitting a patient, including:

Intractable pain or vomiting.

Signs of Urosepsis.

Obstructions in a solitary or transplanted kidney.

Significant comorbidities like Diabetes or AKI.

Wrapping up: We touch on Medical Expulsion Therapy (Tamsulosin) and when to involve your urology colleagues.

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