18. Flank Pain Flashcards
What are the 6 main differentials for flank pain?
Muscular sprain Nephrolithiasis Spinal pathology Ruptured AAA Testicular torsion Pyelonephritis
What is the nature of the pain from kidney stones?
Unilateral colicky pain that radiates from loin to groin
Starts with vague discomfort + progresses to very severe pain
Once you have characterised flank pain what else should you ask about?
FLAWS Dehydration: predisposes to kidney stones Nausea + vomiting Haematuria LUT symptoms: FUNDHIPS Leg weakness: suggests spinal pathology
What PMHx is important to ask about in someone who presented with flank pain? What does each carry risk of?
previous kidney stones: recurrence recurrent cystitis: stones athersclerotic disease: AAA longstanding back pain: msk kidney disease: pyelonephritis
What can an ultrasound be used to show in someone with flank pain?
AAA
What is the best imaging to look for kidney stones?
Non contrast CT KUB
How would you manage kidney stones in the acute phase?
Analgesia
Encourage fluid intake
Tamsulosin/ Nifedipine: relax smooth muscle in the ureters + increase chance of the stone passing
Active stone removal if the stone >5mm
How may a large kidney stone be removed (>5mm)?
Lithotripsy: shock waves
Ureterorenoscopic removal: via urethra
Percutaneous nephrolithotomy: invasive, rare
Stenting
What acronym is used for red flags?
FLAWS Fever Lethargy Appetite loss Weight loss Night sweats
What acronym is used for urinary screening?
FUNDHIPS Frequency Urgency Nocturia Dysuria Hesitancy
What is indicated by a palpable popliteal pulse?
Popliteal aneurysm
50% also have AAA
What do red cell casts ins MC+S suggest?
Glomerular damage
What do white cell casts in MC+S suggest?
Pyelonephritis
What action must you take on finding a ruptured AAA?
Insert 2 large bore IV access cannulae
Cross match 10 units of blood
Insert urinary catheter
Surgery
In order of decreasing occurrence, list the 4 types of renal stone
Calcium
Struvite
Urate
Cystine
