ملاحظات العملي Metabolic block
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regular acting insulin
long acting insulin(glargine)
rapid acting insulin(aspart)
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شرح للـ insulin و شلون نحسب الـ dose
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ملاحظات الاستشارية :
What is the differential diagnosis of radio opaque shadow in loin area?
Stone , forign body , gall bladder stone , calcified lymph node ,fecolith

Pylonephritis cause tenderness when palpating the kidney angle

Struvite stone has other names , include :
1-Ammonium , megnesium , phosphat ( الاسم العلمي )

2-infectious stone
لان المريضة (غالبا بالfemale ) يكون عدها اكثر من attack of UTI
3-Triple phosphate

Stone can cause turbid urine appearance
Imaging:
In US we can see size and site of kidney , kidney number ,hydronephrosis , parynchymal thickness , stone , mass ,diltation of ureter

Ct is the golden standered imaging for stone
99% من الstone نشوفها بال CT عدى نوع نادر هو " triamterne stone "
هذا الدواء هو potassium sparing diuretic ويستعمل في علاج ال hypertension مع الthiazide
ولكن هو يعتبر nephrotoxin لا يسبب crystalluria and cast formation
وممكن يسبب stone ولكن نادرا
ESWL: extracorporeal shock wave lithotripsy ( مطلوب الاسم )
It is a procedure to break up stones inside the urinary tract, bile ducts or pancreatic duct with a series of shock waves generated by a machine called a lithotripter. The shock waves enter the body and are targeted using an X-ray

Used for stones that are too large to pass on their own (larger than 5 millimeters in diameter — about the size of a pencil eraser)

🔍Another source -> ESWL used for stones that are less than 2cm
الفرق بين ESWL & laser lithotripsy

ESWL as an outpatient procedure does not require analgesia or anesthesia; it remains the first line therapy for proximal ureteral stones while ureteroscopic laser lithotripsy as a surgical procedure requires general anesthesia, hospitalization and much more costs
Eswl is used for stone less than 2 cm
analysis found Laser Lithotripsy can treat larger stones (> 2 cm) with good stone-free and complication rates