18. Flank Pain Flashcards Preview

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Flashcards in 18. Flank Pain Deck (16)
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1

What are the 6 main differentials for flank pain?

Muscular sprain
Nephrolithiasis
Spinal pathology
Ruptured AAA
Testicular torsion
Pyelonephritis

2

What is the nature of the pain from kidney stones?

Unilateral colicky pain that radiates from loin to groin
Starts with vague discomfort + progresses to very severe pain

3

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

FLAWS
Dehydration: predisposes to kidney stones
Nausea + vomiting
Haematuria
LUT symptoms: FUNDHIPS
Leg weakness: suggests spinal pathology

4

What PMHx is important to ask about in someone who presented with flank pain? What does each carry risk of?

previous kidney stones: recurrence
recurrent cystitis: stones
athersclerotic disease: AAA
longstanding back pain: msk
kidney disease: pyelonephritis

5

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

AAA

6

What is the best imaging to look for kidney stones?

Non contrast CT KUB

7

How would you manage kidney stones in the acute phase?

Analgesia
Encourage fluid intake
Tamsulosin/ Nifedipine: relax smooth muscle in the ureters + increase chance of the stone passing
Active stone removal if the stone >5mm

8

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

Lithotripsy: shock waves
Ureterorenoscopic removal: via urethra
Percutaneous nephrolithotomy: invasive, rare
Stenting

9

What acronym is used for red flags?

FLAWS
Fever
Lethargy
Appetite loss
Weight loss
Night sweats

10

What acronym is used for urinary screening?

FUNDHIPS
Frequency
Urgency
Nocturia
Dysuria
Hesitancy

11

What is indicated by a palpable popliteal pulse?

Popliteal aneurysm
50% also have AAA

12

What do red cell casts ins MC+S suggest?

Glomerular damage

13

What do white cell casts in MC+S suggest?

Pyelonephritis

14

What action must you take on finding a ruptured AAA?

Insert 2 large bore IV access cannulae
Cross match 10 units of blood
Insert urinary catheter
Surgery

15

In order of decreasing occurrence, list the 4 types of renal stone

Calcium
Struvite
Urate
Cystine

16

What are the 3 broad components of the pain pathway? Which drugs address these?

Inflammation: NSAIDs
Pain transmission through nerves: Opiods
Pain perception in the brain: Paracetemol