Flank pain (oxford clin cases) Flashcards
What are some differentials when someone presents with acute flank pain?
Muscle sprain Ureteric colic Pyelonephritis Testicular torsion Leaking or ruptured AAA
What 3 surgical emergencies do you need to rule out when someone presents with acute flank pain?
Pyelonephritis
Ruptured AAA
Testicular torsion
Where will pain from kidney stones be?
Unilateral and radiating from loin to groin
What will be the character of pain if there is a stone in the kidney vs the ureter?
Kidney= constant Ureter= colicky
How severe is pain for kidney stones?
Extremely severe, comparable to childbirth
What other symptoms should you ask about when someone presents with flank pain and why?
Is there any fever- suggests infection
Is there dehydration- predisposes them to kidney stones
Is there any change in urination- dysuria, frequency, urinary obstruction, heamaturia etc
Is there nausea or vomiting- if yes rules out muscle strain, nerve root causes etc
Cloudy urine?- infection
What should you ask about in pmx in someone with flank pain? Explain why
Have they has previous kidney stones- recurrence is not uncommon
Have they had recurrent UTIs- increases risk of stones
Have they had any kidney operations- if one kidney has been removed obstruction of the remaining ureter is a medical emergency
Do they have polycystic kidney disease- increases risk of stones
Do they have atherosclerotic disease- all increase risk of AAA leak/rupture
What should you look for in the drug hx when someone has flank pain and why?
Are they on any drugs that crystallise the urine?- increases risk of blockage
Are they on diuretics- increases dehydration which increases risk of kidney stones
What should you look for on examination of someone with flank pain and why?
Position- if its ureteric colic they won’t be able to lie still and will writhe, if its peritonitis they will lie completely still
Tenderness- flank tenderness in ureteric colic
Mass- expansile AAA
Temperature- indicates infection eg pyelonephritis
Lower limbs- an easily felt popliteal pulse might indicate AAA
Can an AAA be ruled on via clinical examination?
No, you have to image it too
What does acidic urine suggest?
Urate stones
What does alkaline urine suggest?
Presence of bacteria that produce urease which can cause stones
What do red or white cell casts in the urine suggest?
Red or white cells are coming from the kidney
What do red cell casts in urinalysis indicate?
Glomerular damage
What do white cell casts in urinalysis indicate?
Pyelonpehritis