Flank Pain Flashcards
DDx of flank pain (12, in women 2 more, and 3 more abdominal pathologies)
Muscular sprain
Nephrolithiasis/ureteric colic
Leaking/ruptured abdominal aortic aneurysm (AAA)
Spinal pathology (fractures, metastases, disc prolapse) Testicular torsion (very unusual in an elderly person)
Pyelonephritis (unusual in a man)
Perforated peptic ulcer
Renal cancer
Abscess (perinephric, renal) Basal pneumonia
Ectopic pregnancy
Ovarian torsion
Pancreatitis
Diverticulitis
Appendicitis
Site of kidney stone pain?
Unilateral
May radiate from loin to groin
Character of ureteric stone pain?
Ureteric stones give a colicky (waxing and waning) pain because of periodic spasms of the ureteric smooth muscle walls trying to dislodge the blockage.
How to differentiate ureteric vs kidney stones?
Constant = kidney Colicky = ureteric
What is an achey pain in the flank suggestive of?
Musculoskeletal
What is a sharp shooting pain in the flank suggestive of?
Nerve impingement
What pain typically radiates to the groin
Ureteric
What pain typically radiates down the leg
Lumbar nerve root pain
Typical radiation of ureteric pain
To the groin
Typical radiation of lumbar nerve root pain
Down the leg
If flank pain is said to be excruciatingly painful what is it suggestive of?
Kidney stones
What questions should you ask in the when checking the history of the flank pain? (After socrates, 17)
Fevers, rigors, night sweats Dehydration Nausea and vomiting Haematuria Lower UTI symptoms (FUN HIIPS - frequency, urgency, nocturne, hesitancy, intermittency, ) Cloudy or offensive smelling urine Leg weakness
What does leg weakness suggest in flank pain?
Spinal pathology
What does cloudy or offensive-smelling urine suggest in flank pain?
Infection
What does nausea and vomiting suggest in flank pain? (3)
This is more typical of visceral organ pathology (e.g. ureteric stones, biliary colic, appendicitis)
What dehydration indicate?
Concentrated urine and therefore kidney stones
What do fevers, rigors and night sweats suggest in flank pain? (3)
A markedly raised fever indicates an inflammatory process, potentially pyelonephritis or sepsis. The fever of malignancies (e.g. renal cell carcinoma) is typically intermittent, unlike in infection.
Difference between fever in inflammatory processes vs malignancy?
Malignancies is intermittent
What PMHx should you inquire about in flank pain? (5)
Previous kidney stones Recurrent cystitis Atherosclerotic disease Long-standing back pain Kidney disease
What type of stone does recurrent cystitis predispose to?
Struvite
What drugs can lead to kidney stone formation? (3)
Indinavir, aciclovir, and acetazolamid
What does FHx of kidney stones suggest in someone presenting with kidney stones?
This may indicate a (rare) inherited condition such as cystinuria.