Flank Pain

HISTORY:

‍RightLeft flank pain for ‍ ‍hoursdays

Onset: ‍gradualsudden, following ‍

Radiation: ‍none

Severity: ‍mildmoderatesevere, ‍012345678910 / 10

Type: ‍crampingburning

Pattern: ‍constantintermittent

Worsening factors: ‍none

Treatments tried: ‍none, ‍effectiveineffective

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍diarrhea, ‍ episodes ‍per day, ‍

‍constipation

‍changes in bowel habits

‍bloating

‍hematuria

‍dysuria

‍urinary frequency

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍weight loss

‍loss of appetite



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

CVA tenderness: ‍negativepositive on Rpositive on L

Pelvic: vulva ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍no cervical motion tenderness

Genital: ‍normal, testicles ‍normal, penis ‍normal

Skin: ‍no rash

Thoracic

Lumbar spine: ‍no tenderness on ‍, range of motion ‍fulllimited



ASSESSMENT:

‍Kidney stones ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍glucose, ‍LFTs, ‍lipase, ‍CRP, ‍β-HCG

- Urine: ‍urinalysis, ‍urine culture

- Abdominal X-ray

- Abdominal ultrasound

- CT scan of abdomen and pelvis

- Cystoscopy

- ‍Analgesics

- ‍Antibiotics

- ‍Tamsulosin

- Referral to urologist

- Referral to nephrologist

- Follow-up in ‍ ‍daysweeks

- Return if pain worsens, if new symptoms develop such as fever, hematuria, or vomiting, or if symptoms do not improve with treatment

- Go to ER if severe pain or sudden onset of symptoms occurs