18. Flank Pain

Question 1

What are the main differentials for flank pain?

Answer 1

Muscular sprain, nephrolithiasis, spinal apthology, leaking AAA, testicular torsion, pyelonephritis

Question 2

What is the nature of the pain from kidney stones?

Answer 2

Unilateral colicky pain that radiates from loin to groin, starting with vague discomfort and progresses to very severe pain

Question 3

Once you have characterised flank pain what else should you ask about?

Answer 3

FLAWS
Dehydration- predisposes to kidney stones
Nausea and vomiting
Haematuria
Lower urinary tract symptoms- FUNDHIPS
Leg weakness- suggests spinal pathology

Question 4

What PMHx is important to ask about in someone who presented with flank pain?

Answer 4

previous kidney stones
recurrent cystitis
athersclerotic disease
longstanding back pain
kidney disease

Question 5

What can an ultrasound be used to show in someone with flank pain?

Answer 5

AAA

Question 6

What is the best imaging to look for kidney stones?

Answer 6

Non contrast CT KUB

Question 7

How would you manage kidney stones in the acute phase?

Answer 7

Analgesia
Encourage fluid intake
Tamsulosin- relax smooth muscle in the ureters and increase chance of the stone passing
Active stone removal if the stone >5mm

Question 8

How may a large kidney stone be removed (>5mm)?

Answer 8

Lithotripsy
Ureterorenoscopic removal
Percutaneous nephrolithotomy
Stenting