Flank Pain

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍rightleft flank pain

Onset was ‍gradualsudden, started ‍whileafter ‍

Radiation ‍none to ‍

Rated at ‍012345678910 / 10 ‍

Described as ‍crampingburning

Pattern ‍persistentintermittent

Episodes last for ‍ ‍, recur ‍ times per ‍

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍diarrhea, ‍ episodes ‍per day, ‍

‍constipation

‍changes in bowel habits

‍bloating

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍loss of appetite

‍hematuria

‍dysuria

‍urinary frequency



Contributing factors:

‍heavy alcohol consumption

‍recent strenuous physical activity

no history of: ‍kidney stones, ‍pyelonephritis, ‍chronic back pain, ‍urinary tract infections, ‍cancer

no family history of: ‍kidney stones





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Pelvic: external genitalia ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍cervical motion tenderness

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia

Skin: ‍rashlesions on ‍

Thoracic

Lumbar spine: ‍tenderness on ‍, range of motion ‍fulllimited





ASSESSMENT:

‍Kidney stones ‍likelysuspectedpossible

DDx: kidney stones, pyelonephritis, musculoskeletal pain, renal colic, ureteropelvic junction obstruction, renal cell carcinoma, referred pain from thoracic spine, psoas abscess, retroperitoneal hematoma, renal artery stenosis, renal vein thrombosis, pancreatitis, hepatic abscess, diverticulitis, appendicitis, ovarian pathology, ectopic pregnancy, herpes zoster, aortic aneurysm





PLAN:

Investigations:

- 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

Treatments:

- ‍Analgesics

- ‍Antibiotics

- ‍Tamsulosin

Further care:

- 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

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