Assessing the Patient with Flank Pain

Additional Questions:

1. Character of the pain: Is the pain sharp, stabbing, dull, or aching? Does it radiate to other areas?
2. Aggravators and alleviators: What makes the pain worse or better?
3. Associated symptoms: Are there any other symptoms, such as fever, chills, hematuria, or changes in urinary frequency or urgency?
4. Medical history: Are there any previous medical conditions, surgeries, or medications that might be relevant?
5. Family history: Is there a family history of kidney stones or other kidney diseases?
6. Risk factors: Are there any risk factors for kidney stones, such as dehydration, diet, or certain medical conditions?

Physical Examination:

1. Vital signs: Measure blood pressure, heart rate, respiratory rate, temperature, and oxygen saturation.
2. Abdominal examination: Examine the abdomen for tenderness, guarding, rebound tenderness, and masses.
3. Flank examination: Palpate the flanks for tenderness and costovertebral angle (CVA) tenderness.
4. Genitourinary examination: Examine the external genitalia and assess for any abnormalities.

Possible Differential Diagnoses:

1. Renal colic (kidney stone): This is the most likely diagnosis given the sudden onset of severe flank pain and nausea.
2. Pyelonephritis: Inflammation of the kidney, often caused by a bacterial infection.
3. Ureteral stone: A stone that has passed from the kidney into the ureter, causing severe pain.
4. Pancreatitis: Inflammation of the pancreas, which can cause severe abdominal pain.
5. Aortic aneurysm: A rupture of the aorta can cause sudden, severe back pain.

Tests:

1. Urinalysis: To check for blood, infection, and crystals.
2. Blood tests: To assess kidney function and rule out other causes of abdominal pain.
3. Imaging studies: CT scan or ultrasound to visualize the kidneys and urinary tract and identify any stones or abnormalities.

Management:

• Pain management: Administer pain medication, such as opioids or nonsteroidal anti-inflammatory drugs (NSAIDs), as needed.
• Hydration: Encourage the patient to drink plenty of fluids to help pass the stone.
• Antibiotics: If a urinary tract infection is suspected, prescribe antibiotics.
• Refer to urologist: If a kidney stone is confirmed, refer the patient to a urologist for further evaluation and treatment.

It is important to note that this is a preliminary assessment, and further evaluation may be necessary to confirm the diagnosis and determine the appropriate treatment.