Assessing the Patient with Flank Pain

Additional Questions

1. Timing of onset: When did the pain start? Was it sudden or gradual?
2. Character of pain: Is the pain sharp, dull, aching, or cramping?
3. Radiation of pain: Does the pain radiate to the groin, abdomen, or back?
4. Associated symptoms: Besides nausea, are there other symptoms like fever, chills, vomiting, or difficulty urinating?
5. Medical history: Any history of kidney stones, infections, or abdominal surgeries?
6. Family history: Any family history of kidney stones or other kidney disorders?
7. Medications: Are there any medications she is currently taking?
8. Recent activities: Any recent physical exertion, trauma, or changes in diet?

These questions will help to narrow down the differential diagnosis and guide the physical examination and diagnostic tests.

Physical Examination

• Vital signs: Blood pressure, heart rate, respiratory rate, temperature
• Abdominal examination: Palpation of the abdomen, focusing on the right flank area. Check for tenderness, guarding, and rebound tenderness.
• Renal examination: Percuss the costovertebral angle (CVA) tenderness.
• Genitourinary examination: Check for any signs of infection or abnormalities.

Differential Diagnoses

• Kidney Stones: A common cause of severe flank pain, often associated with nausea and vomiting.
• Pyelonephritis: A kidney infection that can cause severe flank pain, fever, chills, and dysuria.
• Renal Colic: Severe pain caused by obstruction of the urinary tract, often due to kidney stones.
• Appendicitis: Although less common in adults, it can present with flank pain, especially in atypical presentations.
• Pancreatitis: Can cause severe abdominal pain, often radiating to the back.
• Aortic Aneurysm: While less likely, it can present with back pain, especially in older individuals.

Diagnostic Tests

• Urinalysis: To check for blood, infection, or crystals.
• Blood tests: Complete blood count (CBC), basic metabolic panel (BMP), and renal function tests.
• Imaging studies:
  • Kidney, ureter, and bladder (KUB) X-ray: To identify kidney stones.
  • Computed tomography (CT) scan: To visualize kidney stones, hydronephrosis, or other abnormalities.
  • Ultrasound: To assess kidney size, shape, and presence of hydronephrosis.

Management

• Pain management: Administer pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids, as needed.
• Hydration: Encourage oral hydration or administer intravenous fluids if necessary.
• Treatment of underlying cause: If kidney stones are diagnosed, medical management or surgical intervention may be required. For pyelonephritis, antibiotics are necessary.
• Follow-up: Schedule a follow-up appointment to assess the patient’s recovery and address any underlying issues.

It is important to note that this is a general approach, and the specific management plan will depend on the patient’s individual presentation and diagnostic findings.