Flank pain Flashcards
What are the ddx for acute flank pain
Muscular sprain Nephrolithiasis/ureteric colic Spinal pathology Leaking/ruptured AAA* Testicular torsion Pyelonephritis Perforated peptic ulcer
also consider gynaecological causes in women e.g. ectopic pregnancy or ovarian torsion
Unilateral “loin to groin” pain indicates?
Kidney stones
Colicky flank pain may suggest what?
What about constant flank pain?
Colicky pain = ureteric stones(as periodic spasms of ureteric smooth muscle)
Constant pain = kidney stones
What may a fever indicate?
Pyelonephritis
Or also psoas abscess or malignancy
Dehydration may indicate?
Kidney stones
N&V may indicate which pathologies
Ureteric stones, biliary colic, appendicitis
Haematuria (unreliable) can indicate what
Kidney or ureteric stones but don’t rely on this. But ask
Urinary frequency, urgency and dysuria are common in what?
UTI
Hesitancy, reduced flow, dribbling and incomplete voiding are signs of?
Ureteric obstruction - e.g. due to enlarged prostate or less commonly stones/tumours
Recurrent episodes of UTI predispose to what?
Struvite (bacterial origin) stones
Polycystic kidney disease predisposes to?
Pyelonephritis
Aciclovir, indinavir crystallise in urine. Acetazolomide can cause what?
Stones potentially as acetazolomide can cause diuresis and dehydration
Patients that are unable to sit still and write in pain probably have?
Ureteric colic
Flank and loin tenderness suggests what?
Ureteric/kidney stones
A high temperature indicates an inflammatory process, such as?
Pyelonephritis
What urine investigations should be done in someone with flank pain?
- Urinalysis - haematuria, pyuria, leucocyte esterase and nitrites. Acidic urine pH indicates stones. Alkali pH suggests bacteria that predispose to stones.
- Urine microscopy/culture/sensitivity - if urinalysis abnormal.
What blood tests should be done in someone with flank pain
- FBC and CRP
- Urea, creatinine and electrolytes. Obstruction by renal stone can cause renal failure (medical emergency)
- Serum calcium, phosphate and urate
What imaging is done in someone with flank pain
- Bedside US- AAA? Do CT abdomen if AAA evidence
2. Non contrast CT-KUB
How should kidney stone be managed
- Multimodal analgesia
- Fluid intake
- Tamsulosin or nifedipine - they relax SMC in ureter - may allow spontaneous passage of renal tract stone.
- Consider stone removal
How may the kidney stone be removed
- Lithotriopsy
- Ureterenoscopic removal
- Percutaneous nephrolithotomy
- Stenting
- Abx cover if invasive procedure used
Dull flank pain, high fever and urinalysis suggestive of UTI indicates what diagnosis
Acute pyelonephritis - most commonly caused by e coli
Treat with IV fluid, oxygen, blood cultures, VBG, Abx for 2 weeks, monitoring
How is leaking AAA managed
Cross match 10 units blood
Urinary catheter
Notify senior