Diagnosis of Stones
Physical Examination

When a patient is evaluated for a suspected urinary calculus, a thorough and complete physical examination is essential. Most patients with stone disease present to the Emergency Room or physician's office with severe renal colic and will be obvious distress. A patient with ureteral colic tosses about and is unable to find comfort in a single position. This patient usually exhibits diaphoresis, tachycardia and tachypnea. Hypertension may be seen and is usually resulting from discomfort. The stone patient is usually not febrile unless infection is associated with obstruction.

The patient's abdomen should be carefully examined, especially the flank area, where an early obstructed, hydronephrotic kidney may be palpable. Tenderness on palpation of the kidney or in the costovertebral angle is frequently present. It is not unusual for the bowel sounds to be hypoactive and an ileus to be present clinically and radiographically. The bladder should be palpated, as urinary retention not infrequently occurs with acute ureteral colic, especially when the stone is positioned in the intramural ureter.

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