Editing Stones: Diagnosis and Evaluation (section)

===History and Physical Exam===
====History====
*'''Signs and Symptoms'''
**Flank pain
**Hematuria
**Lower urinary tract symptoms
*'''Risk factors'''
**'''<span style="color:#ff0000">Conditions associated with stone disease (8):</span>'''
**#'''<span style="color:#ff0000">Obesity</span>'''
**#'''<span style="color:#ff0000">Hyperthyroidism</span>'''
**#'''<span style="color:#ff0000">Gout</span>'''
**#'''<span style="color:#ff0000">Renal tubular acidosis (RTA) type 1</span>'''
**#'''<span style="color:#ff0000">Diabetes mellitus type 2</span>'''
**#'''<span style="color:#ff0000">Bone disease</span>'''
**#'''<span style="color:#ff0000">Primary hyperparathyroidism</span>'''
**#'''<span style="color:#ff0000">Malabsorptive gastrointestinal states</span>''' due to bowel resection, bariatric surgery or bowel or pancreatic disease
**##Chronic diarrhea that could be caused by inflammatory bowel disease (Crohn disease, ulcerative colitis) or irritable bowel syndrome
**##Gout may predispose the patient to hyperuricosuria or gouty diathesis with either uric acid calculi or calcium oxalate stone formers
**##Surgical history should be obtained focusing particularly on bariatric surgery and surgeries of the intestinal tract.
**###Roux-en-Y-gastric bypass surgery may significantly increase the overall risk for stone formation
**###'''In contrast to gastric bypass surgery, restrictive bariatric surgeries such as gastric sleeve or gastric band do not seem to increase the risk for kidney stones'''
**'''<span style="color:#ff0000">Dietary history</span>'''
***'''Should include average daily intake of fluids (amount and specific beverages), protein (types and amounts), calcium, sodium, high oxalate-containing foods, fruits and vegetables and over-the-counter supplements.'''
****'''Nutritional factors associated with stone disease, depending on stone type and risk factors, include'''
*****Calcium intake below or significantly above the recommended dietary allowance (RDA)
*****Low fluid intake
*****High sodium intake
*****Limited intake of fruits and vegetables
*****High intake of animal-derived purines
**'''<span style="color:#ff0000">Medications</span>'''
***'''<span style="color:#ff0000">Stone-provoking medications or supplements (9):'''
***#'''<span style="color:#ff0000">Triamterene'''
***#'''<span style="color:#ff0000">Carbonic anhydrase inhibitors such as topiramate, acetazolamide, zonisamide'''
***#'''<span style="color:#ff0000">Probenecid'''
***#'''<span style="color:#ff0000">Some protease inhibitors'''
***#'''<span style="color:#ff0000">Lipase inhibitors'''
***#'''<span style="color:#ff0000">Chemotherapy'''
***#'''<span style="color:#ff0000">Vitamin C'''
***#'''<span style="color:#ff0000">Vitamin D'''
***#'''<span style="color:#ff0000">Calcium'''
====Physical Exam====
*'''General'''
**'''Body mass index'''
***'''Increased BMI, larger waist size, and weight gain are correlated with an increased risk for stone episodes'''
****'''The association of obesity and uric acid stone formation is primarily due to change in urinary pH'''
****'''The association of obesity with calcium oxalate stone formation is primarily due to increased excretion of promoters of stone formation''' (oxalate, uric acid, sodium, and phosphorus)
*'''Flank'''
**'''Costovertebral tenderness'''