18. Flank Pain Flashcards
Mr Kirk’s pain is unilateral. It is localised to his right flank, and has not moved. He says it came on spontaneously while he was watching TV. At first it was just a dull constant ache, but a couple of hours ago it became colicky and started radiating from his flank into his groin. There is nothing he can do to make it better or worse. Having characterised his pain, what further questions should you ask in the history?
- History of the presenting complaint?
- Past medical history?
- Drug history?
- Family history?
Mr Kirk is restless, consistent with the description of his pain. His flanks are not particularly tender. His abdomen is soft and non-tender with no masses. Bowel sounds are present and normal. He is apyrexial. Examination of his lower limbs is unremarkable. Judging from the way Mr Kirk is writhing on the bed, he has a full range of motion in his back, and although you are not able to assess his spine formally, you establish there is no tenderness to palpation over bony landmarks. What diagnosis do the history and examination suggest so far? What investigations wil you arrange? (8)
The CT-KUB report confirms a single 0.78cm stone in the right PUJ. More importantly, it shows a normal-diameter abdominal aorta and no hydronephrosis due to the kidney stone. How should Mr Kirk be managed during the acute episode? Does he require admission?
= 5 treatments
= 6
What is the diagnosis? How will you proceed?
What is the pathology?
What are the 4 types of kidney stones? How might you treat them?
A number of medical conditions can predispose to stone formation - can you name 10 of them?
6 Complications of Kidney stones? How are they managed?
5 Contraindications for NSAIDs?
3 Conditions they should you used with caution in?
Where along the renal tract are stones most likely to cause obstruction?
What is the ‘psoas sign’ on abdominal radiographs?
- 2 Immediate?
- 5 Within 1 week?
- 4 As soon as possible?
What medications would you prescribe for any patient in pain?
