Urolithiasis

BMI

Calculation of the body mass index

The body mass index (BMI) is a simple, dimensionless index for classifying body weight in relation to height. It is calculated by dividing body weight in kilograms by the square of height in meters. The BMI serves as a rough guide to the relationship of mass to height, but does not take body composition or fat distribution into account.

colicky

Colicky pain quality

Colicky describes pain that occurs in waves: phases of high intensity alternate with phases of relative relief. Typical are sudden, cramp-like pain episodes that vary markedly in intensity and often show high but not constantly sustained intensity.

Flank

Flank

The flank refers to the lateral region of the abdomen between the lower margin of the thorax (rib area) and the pelvic brim. This region contains, among other structures, the kidneys and retroperitoneal structures as well as soft tissues of the abdominal wall. Clinically, flank pain is an important localized symptom that may indicate renal, retroperitoneal, or musculoskeletal causes.

Vagina

Vagina (vagina)

The vagina is a muscular and elastic tube that extends from the external genitalia (vestibulum) to the cervix. It serves as a connection between the external body surface and the uterus and fulfills functions during sexual intercourse, menstruation and as a birth canal, among others.

Inguinal region

Inguinal region

The inguinal region (groin) is located on both sides at the transition between the lower abdomen and the thigh. Important structures include the inguinal ligament, the inguinal canal running above it with the spermatic cord in men or the round ligament of the uterus in women, as well as nerves and inguinal lymph nodes. Below the inguinal ligament run, among others, the A. and V. femoralis and the N. femoralis. Clinically the region is particularly relevant for inguinal and femoral hernias, enlarged lymph nodes, palpation of the femoral pulse and vascular access.

Hematuria

Hematuria

Refers to the presence of blood in the urine. A distinction is made between macroscopic hematuria, in which the blood is visible to the naked eye, and microscopic hematuria, which is detectable only in the laboratory.

Dysuria

Dysuria

Describes difficult or painful bladder emptying. Affected individuals often report burning, a feeling of pressure or an increased urinary urge during micturition.

Alguria

Alguria

Refers to pain associated with urination. The complaints can be perceived as burning, stabbing or pressing and often occur together with dysuria or hematuria.

Nausea

Nausea

Subjective sensation of nausea and urge to vomit without mandatory evacuation of stomach contents. It is often accompanied by upper abdominal discomfort and loss of appetite and can precede vomiting.

Emesis

Emesis

Acute process of expulsion of stomach contents via the mouth and esophagus, medically termed vomiting. Clinically this can occur once or repeatedly; in the present report a single episode with food remnants was stated.

Pollakiuria

Pollakiuria

Increased frequency of bladder emptying, usually associated with only small urine volumes each time. Typically affected individuals feel the need to urinate more frequently; in the present case a subjective low urine volume and five micturitions since the morning were also reported.

Hyperhidrosis

Hyperhidrosis

Excessive sweating that exceeds the amount expected for temperature regulation. It can be localized or generalized and was described in the report as increased general sweating.

Urgency

Urgency (strong urinary urge)
Short description: Sudden, hardly suppressible need to urinate.

Incontinence

Incontinence
Definition: Involuntary loss of urine in varying degrees.
Causes and differential diagnoses: Causes include urgency-related incontinence in overactive bladder or urinary tract infections, sphincter-related disorders, neurogenic causes as well as functional or anatomical problems. The specific classification (stress, urge, overflow or functional incontinence) depends on history and findings.

Weakened or interrupted urinary stream

Weakened or interrupted urinary stream
Description: Reduced force or intermittent urinary stream during micturition.
Key causes: Such symptoms often indicate urinary outflow obstruction; benign prostatic hyperplasia is a common cause in older men, and urethral strictures or bladder emptying disorders may also underlie it.

New onset change in bowel habits

New onset change in bowel habits
Definition: Any recent change in frequency, consistency, color or accompanying symptoms of bowel movements.
Possible causes and significance: Such changes can indicate various diseases, including colorectal neoplasms, chronic inflammatory bowel diseases, functional disorders like irritable bowel syndrome or infectious enteritides; the prioritization of differential diagnoses depends on accompanying symptoms and risk factors.
Approach: For relevant changes, initiate targeted history, physical examination and, if necessary, further diagnostics.

Pathological vaginal bleeding

Pathological vaginal bleeding

Abnormal bleeding from the vagina that occurs outside the normal menstruation or in unusual intensity or duration. Such bleeding can have various gynecological causes. Common relevant differential diagnoses include benign uterine muscle tumors (uterine fibroids), the presence of endometrial tissue outside the uterus (endometriosis) and ectopic pregnancy. When it occurs, the clinic must investigate these and other causes.

Genital discharge

Genital discharge

Refers to abnormal vaginal discharge that differs from normal vaginal secretion in color, odor or quantity. Common causes are inflammatory diseases of the vagina (vaginitis), inflammation of the cervix (cervicitis) and inflammatory processes of the adnexal structures (adnexitis). Characteristics of the discharge can provide clues to the underlying disease and should be considered in the clinical assessment.

Dyspnea

Dyspnea

Describes the subjective experience of shortness of breath or difficult breathing. Dyspnea can indicate problems of the lungs, heart, circulation or metabolic disturbances and is an important parameter for assessing the general condition. When present, attention should be paid to severity, accompanying symptoms and possible systemic complications.

Tachycardia

Tachycardia

Refers to an increased heart rate above the expected resting value. Tachycardia can be a sign of circulatory disturbance, a compensatory response or a systemic disease and provides information about the hemodynamic situation. Clinical evaluation should assess heart rate in the context of symptoms and possible systemic complications.

Edema

Edema — definition and clinical features

An edema arises from a pathological accumulation of fluid in the interstitium or extracellular space of the tissue, not inside the blood vessels. Causes can be increased hydrostatic pressure, decreased colloid osmotic pressure, lymphatic drainage disorders or increased vascular permeability. Clinically an edema appears as visible and palpable swelling, possibly with pitting and a typical distribution (e.g., peripheral, generalized, sacral). In the present context an edema was denied.

Insomnia

Insomnia — features and context

Insomnia describes persistent problems falling asleep, staying asleep or early awakening with impairment of daytime functioning. Causes are varied and include psychological stress. In the present history there are stress-related sleep disturbances affecting both sleep onset and maintenance and described in connection with family stress due to a divorce. The rest of the autonomic history: unremarkable.

Complications

Complications of diabetes — overview

In diabetes mellitus, micro- and macrovascular complications are typically distinguished. Microangiopathic complications include diabetic retinopathy, diabetic nephropathy and diabetic polyneuropathy. Macrovascular consequences include, for example, coronary heart disease, cerebrovascular disease and peripheral arterial occlusive disease.

mmHg

mmHg — meaning of the unit

The abbreviation mmHg stands for “millimeter of mercury column”.

Tenosynovitis

Tenosynovitis

Definition and cause: Tenosynovitis refers to inflammation of the tendon sheath that surrounds the tendon and ensures its gliding ability. Common triggers are repetitive strain, monotonous movements or local overuse.

Therapy and course: Treatment is primarily based on rest of the affected structures, targeted physiotherapy to normalize tendon function and local measures for pain relief. If needed, orthopedic splints or braces are used for offloading. In selected cases further interventional measures such as local corticosteroid injections may be considered. For purely symptomatic analgesia it should be noted that metamizole is primarily analgesic and antipyretic but does not have pronounced anti-inflammatory effects like NSAIDs.

Herpes zoster

Herpes zoster (shingles)

Cause and development:
Reactivation of the varicella-zoster virus, which remained dormant in the ganglia of the spinal or cranial nerves after a prior chickenpox infection. Upon reactivation the virus spreads along a nerve to the overlying skin.

Clinical picture:
Typical are unilateral, dermatomal pain and sensory disturbances followed by grouped vesicles on an erythematous base. Thoracic dermatomes are among the most common locations. Burning or stabbing pain may occur before or concurrently with the skin rash.

Acute treatment:
Therapy includes early antiviral treatment, analgesic measures and local skin care. Involvement of the eye or severe courses require immediate specialist care.

Complications and course:
Major complications are persistent neuropathic pain (post-zoster neuralgia) as well as secondary skin infections or, depending on location, neurological manifestations. Risk and severity can increase with advancing age or immunosuppression.

Prevention:
A vaccine is available for risk groups that can reduce the occurrence of zoster and severe courses.

Note on context:
The statement that a thoracic zoster was treated with aciclovir about six months ago is consistent with usual acute antiviral therapy; further management depends on the current symptom picture.

Measles infection

Measles infection (morbilli)

Pathogen and transmission: Measles are transmitted by a highly contagious RNA virus, mainly via droplet infection when coughing or sneezing.

Clinical picture: The disease often begins with fever, cough, runny nose and conjunctival irritation; characteristic is a subsequent generalized exanthem, usually appearing first on the face. In severe courses, respiratory involvement such as pneumonia can occur.

Complications and prevention: Possible complications include otitis media, pneumonia and, in rare cases, meningitis or encephalitis. The most effective prevention is vaccination against measles (part of the MMR vaccine). In light of the history of missing childhood vaccinations and a severe measles infection with pneumonia, a pronounced early course is plausible.

Comminuted fracture

Comminuted fracture

Definition: A comminuted fracture occurs when a bone shatters into several fragments at the fracture site.

Olecranon

Anatomy:
The olecranon is the posterior bony prominence of the ulna at the elbow joint and serves as the attachment point for the triceps tendon.

Injuries and treatment:
A comminuted fracture of the olecranon often requires open reduction and internal fixation, for example with plate-and-screw osteosynthesis, to reconstruct the joint surfaces and extension function. This is usually followed by a limited period of immobilization and subsequent physiotherapeutic mobilization and functional training.

Long-term course:
After uncomplicated healing, pain relief and recovery of elbow function can be expected. In individual cases the implant is removed after completed bone healing.

Atacand

Class and mechanism of action:
Atacand contains candesartan, an angiotensin II receptor antagonist that blocks the effect of angiotensin II at AT1 receptors, thereby reducing vascular tone and blood pressure.

Indications:
Candesartan is primarily used to treat arterial hypertension and in certain situations of heart failure to reduce hemodynamic load.

Important risks and contraindications:
Possible side effects include dizziness, headache and hypotension; increases in potassium levels and impaired renal function may occur. Use is contraindicated in pregnancy. Caution is advised in severe liver disease, biliary obstruction, known intolerance to the active substance and bilateral renal artery stenosis.

Wasp venom allergy

Definition
IgE-mediated hypersensitivity to wasp venom (a wasp is a flying insect notable for its black-and-yellow coloring. It can sting).

Clinical manifestations
The spectrum ranges from locally limited reactions to generalized urticaria and systemic symptoms such as shortness of breath, bronchospasm, circulatory compromise and potentially life-threatening anaphylaxis.

Care aspects
Systemic reactions require immediate emergency medical treatment; affected individuals with a systemic history should have an emergency plan and carry an adrenaline autoinjector. Specific immunotherapy against wasp sting allergy can be considered for long-term risk reduction.

Pack years

Definition
Pack years = (number of cigarettes smoked per day ÷ 20) × number of years of regular smoking.

Explanation
One pack year corresponds to the daily consumption of one pack (20 cigarettes) over one year. Example: 5 cigarettes per day over 10 years equals (5/20) × 10 = 2.5 pack years.

Anorexia

Anorexia nervosa is an eating disorder characterized by severely restricted food intake, an intense fear of weight gain and a distorted perception of one’s body. Some affected individuals additionally attempt to control their weight through excessive exercise, self-induced vomiting or misuse of laxatives.
Treatment includes psychotherapy, nutritional therapy and medical care. In adults, cognitive behavioral therapy is an appropriate psychotherapeutic approach; in children and adolescents, family-based approaches play an important role.

ADHD

Attention-deficit/hyperactivity disorder (ADHD)

Core feature: Persistent inattention, increased activity and/or impulsive behavior that impair daily functioning and typically begin in childhood.

Diagnostics: Assessment is based on the overall clinical evaluation, including history, collateral history and, if applicable, standardized instruments; other causes must be excluded.

Treatment approach: Multimodal therapy with behavioral interventions, psychoeducation and school-based measures; occupational therapy can support daily skills. If needed, pharmacological treatment with central stimulants (e.g., methylphenidate) or other approved substances is considered, with benefits and possible side effects monitored by a physician.

Scoliosis

Scoliosis

Definition: Lateral curvature of the spine often associated with rotation of the vertebral bodies.

Causes and course: Forms range from idiopathic variants (common in adolescents) to degenerative or neuromuscular causes in older age; course and symptoms vary depending on severity and cause.

Clinical consequences and treatment: Minor deformities can be observed and treated with physiotherapy. Orthoses are considered for growth-related progression; for pronounced or symptomatic deformities, surgical correction may be indicated. Pain management and functional rehabilitation are important components of care.

Cataract

Cataract (gray cataract)

Description: A clouding of the eye lens that can lead to blurred vision, increased sensitivity to glare and muted color perception; diplopia may occur in individual cases.

Causes and diagnosis: Most commonly age-related changes of the lens; other contributing factors are eye injuries, intense UV exposure, certain medications such as corticosteroids and metabolic diseases like diabetes. Assessment is performed by ophthalmologic examination, typically including slit lamp findings.

Therapy: Definitive treatment is surgical removal of the clouded lens with implantation of an artificial intraocular lens; the decision for surgery is based on functional limitation and subjective impairment.

Carotid dissection

Definition/pathology
A carotid dissection occurs when the vessel wall of the carotid artery tears or a split forms within the wall so that blood accumulates between the layers and an intramural hematoma or false lumen develops. This can impair normal blood flow and trigger thromboembolic events.
Causes
It can occur after trauma or arise spontaneously without prior injury; predisposing factors may include connective tissue disorders or vascular changes.
Clinical presentation
Typical complaints are sudden, usually unilateral headache or neck pain; focal neurological deficits and a Horner syndrome may also be observed.
Therapeutic note
Antithrombotic treatment is often used to reduce stroke risk; in selected cases endovascular or surgical procedures are considered.

Urolithiasis

Classification and types
Urolithiasis refers to the formation of urinary stones in the kidney or urinary tract. Four typical stone types with different pathophysiological mechanisms are often distinguished:
Calcium stones
The most common group includes predominantly calcium oxalate and calcium phosphate stones. Risk factors are increased calcium excretion (e.g., in hyperparathyroidism) and increased oxalate excretion; dietary oxalate sources can promote excretion.
Uric acid stones
These stones preferentially form in acidic urine; promoting factors are increased purine production or intake and metabolic disorders that lead to hyperuricemia.
Struvite stones
Struvite stones typically develop in association with urinary tract infections by urease-producing pathogens (e.g., Proteus spp., occasionally other bacterial germs).
Cystine stones
This rare form is due to a genetic metabolic disorder (cystinuria) in which increased cystine is excreted in the urine and can form crystals and stones.

Pyelonephritis

Definition
Pyelonephritis is a bacterial inflammation of the renal pelvis and renal parenchyma.
Clinical differentiation
Clinically, pyelonephritis can cause flank pain and thus mimic nephrolithiasis. Characteristically, however, there are more frequent systemic signs such as fever, chills and general malaise, which are less pronounced with uncomplicated urinary stones.
Diagnostic note
Urinalysis provides clues; definitive microbiological confirmation is obtained by urine culture.

Low back pain

Term and typical presentation
Lumbalgia refers to non-specific pain in the lumbar spine area, often dependent on strain and associated with a stressful activity or overuse.
Accompanying symptoms
Some affected individuals report radiating pain as well as sensory abnormalities such as paresthesias or hypoesthesias, particularly when nerve root involvement is present.
Diagnostics
Assessment is primarily based on the medical history and clinical examination; imaging procedures are used selectively when a specific cause is suspected or when red flags are present.

Ectopic pregnancy

In an ectopic pregnancy, vaginal bleeding often occurs. In addition, patients report a missed menstruation (amenorrhea). Diagnostic evaluation is performed by measuring β-hCG in the serum and by transvaginal sonography.
The treatment of an ectopic pregnancy depends on the symptoms, hemodynamic status, the course of β-hCG, and the sonographic findings. Depending on the findings, options include close monitoring, methotrexate, or usually laparoscopic surgery. If rupture is suspected, significant internal bleeding or hemodynamic instability is present, an immediate emergency operation is required.

Diverticulitis

Clinical features:
Typical complaints are pain in the left lower abdomen, often accompanied by fever and changes in bowel habits such as constipation or diarrhea.

Diagnostics:
The suspected diagnosis is based on history and physical examination. Imaging procedures such as abdominal ultrasound or abdominal computed tomography are used to confirm the diagnosis and assess possible complications.

Appendicitis

Clinical features:
Characteristic is pain that begins periombilically with later migration to the right lower abdomen (McBurney region). Accompanying complaints may include nausea, vomiting and loss of appetite; on palpation there are often tenderness and rebound pain.

Diagnostics:
The suspected diagnosis arises from history and clinical examination. Ultrasound or CT are used to confirm the diagnosis and to clarify possible complications.

Heart rate

Normal range:
In adults at rest, a heart rate of approximately 60 to 100 beats per minute is considered typical.

Blood pressure

Blood pressure measurement

For blood pressure determination, an inflatable cuff is used, which is inflated using a hand pump or an integrated pumping system. The manometer displays the pressure; with manual auscultation, Korotkoff sounds are heard with a stethoscope to determine systolic and diastolic values. There are also automatic devices that record the values electronically.

Respiratory rate

Respiratory rate

Respiratory rate denotes the number of breaths per minute at rest; in adults the normal range is typically about 12 to 20 breaths per minute. For measurement, observe thoracic or abdominal movements ideally for a full minute.

Oxygen saturation

Oxygen saturation

Oxygen saturation is measured noninvasively with a pulse oximeter on the finger, earlobe, or toe and gives the proportion of hemoglobin bound with oxygen as a percentage. Measurements can be affected by poor peripheral blood flow, movement, nail polish or certain hemoglobin variants; therefore interpretation in the clinical context is important.

Body temperature

Body temperature

Measured body temperature depends on the measurement site. Rectal measurements are considered an approximate reference value for core body temperature.
Axillary: add +0.5 °C,
Oral: add +0.3–0.5 °C
Rectal: considered the reference value

Shock wave lithotripsy

Procedure:
Extracorporeal shock wave lithotripsy (ESWL) is a non-invasive, externally applied procedure to fragment kidney and upper ureteral stones using focused shock waves.

Indication and effect:
The method is used for appropriately located and sized stones; the high-energy waves break the calculi into smaller fragments that can then be passed through the urinary tract.

Course:
The patient lies on a special table during the treatment; the actual treatment session usually lasts approximately half an hour to an hour but can vary. Pain management or sedation is provided depending on the condition and findings.

Preparation and aftercare:
Prior to the procedure, fasting for the time period recommended by the treating physician and weighing the discontinuation of anticoagulant medications are common. Adequate fluid intake after the procedure supports passage of the fragments. Further individually tailored measures are decided by the treating team.

Ureterorenoscopy

Procedure:
Ureterorenoscopy (URS) is an endoscopic, minimally invasive procedure for diagnosis and treatment of conditions of the upper urinary tract, often for the targeted removal of urinary stones.

Approach:
A thin optical instrument is advanced through the urethra and bladder into the ureter so that stones can be directly visualized and, if necessary, fragmented or retrieved.

Anesthesia and duration:
The examination is generally performed under regional or general anesthesia; the duration is typically about half an hour to one and a half hours, depending on the findings and the scope of the procedure.

Preparation:
Before the procedure, fasting according to the physician’s instructions and, if applicable, temporary discontinuation of anticoagulant medications should be considered. The treating team provides specific recommendations individually.