DIFFERENTIAL DIAGNOSIS Flashcards
What is the pathophysiological cause of renal pain?
Distension of the renal capsule due to obstruction or inflammation.
How might renal pain differ in character between obstruction and inflammation?
Obstruction - colicky pain as ureteric peristalsis increases renal pelvic pressure
Inflammation - steady pain
What is the differential diagnosis for flank pain?
Obstructive:
Obstruction of ureteropelvic junction Renal stones Tumours Schistosomiasis Renal clots (iatrogenic) Papillary necrosis Retroperitoneal fibrosis
Inflammation:
Pyelonephritis Renal abscess Papillary necrosis Polycystic kidney disease Acute renal infarct
Non-renal:
AAA
Pneumonia
Musculoskeletal
How much fluid needs to build up in the bladder before pain is felt as a result of retention?
This is not dependent on volume but more on timescale. Slowly progressive obstruction causing chronic retention is painless despite residuals of over 1 litre.
What is the differential diagnosis for bladder pain?
Interstitial cystitis
UTI
Bladder cancer
Acute retention
Renal stones
What is the differential diagnosis for testicular pain?
Acute:
Epididymo-orchitis
Testicular torsion
Trauma
Mumps
Chronic:
Varicocele Spermatocele Testicular cancer Benign testicular masses Retractile testicle Cryptorchidism (undescended testicle) Hydrocele
How do we split up the causes of haematuria?
Innocent (pseudohaematuria)
Pre-renal
Renal
Post-renal - Ureteric / Bladder / Prostatic / Urethral
What are the innocent causes of apparent haematuria?
Haemoglobinuria
Myoglobinuria
Menstruation
Sexual intercourse
Acute intermittent porphyria
Beetroot, blackberries, rhubarb
Drugs: nitrofurantoin, senna, rifampicin, chloroquine and doxorubicin
What are the pre-renal causes of haematuria?
Bleeding diathesis
Atrial fibrillation - warfarin therapy and embolism
Infective endocarditis
Scurvy
Purpura
Leukaemia
Thrombocytopenia
Haemophilia
What are the renal causes of haematuria?
IgA nephropathy
Glomerulonephritis
Polyarteritis nodosa
Goodpasture’s syndrome
Acute pyelonephritis
Polycystic kidney disease
Haemolytic uremic syndrome
Alport’s syndrome
What are ureteric causes of haematuria?
Calculus
Carcinoma
Papilloma
Schistosomiasis
What are the bladder related causes of haematuria?
Cancer
Calculus
Cystitis
Injury
Purpura
Schistosomiasis
Ketamine
What are the prostatic causes of haematuria?
BPH
Cancer
What are the urethral causes of haematuria?
Acute urethritis
Calculus
Injury
Carcinoma
Papilloma
Urethral meatal ulcer
Foreign body
What is a good question to ask in the history to rule out organic causes of erectile dysfunction?
Early morning erections
