Flank Pain Flashcards Preview

Oxford Clinical Cases > Flank Pain > Flashcards

Flashcards in Flank Pain Deck (42):
1

List the differential diagnosis for flank pain.

Muscular sprain
Ureteric colic
Spinal pathologies (fractures, metastases, disc prolapse)
Leaking/ruptured AAA
Testicular torsion
Pyelonephritis

2

List some gynaecological diseases that could cause flank pain.

Ectopic pregnancy
Ovarian torsion

3

List some other abdominal pathology that could present atypically with flank pain.

Pancreatitis
Diverticulitis
Appendicitis

4

Describe the type of pain caused by ureteric colic.

Unilateral (almost always)
Waxing and waning (colicky)
Extremely severe
Loin to groin

5

Describe the type of pain caused by nerve impingement.

Shooting pain that radiates down the legs

6

What does pain that radiates down the leg suggest?

Lumbar nerve root compression

7

Which surgical emergency can present with acute flank pain?

Leaking AAA

8

What type of pathology tends to be associated with nausea and vomiting?

Visceral pathology (e.g. ureteric colic, biliary colic, appendicitis)

9

Why is it important to check for signs of persistent dehydration on examination?

Persistent dehydration predisposes to concentrated urine and the formation of kidney stones

10

Why is it important to perform a urine dipstick test in patients with ureteric colic?

70-90% of patients with ureteric colic have microscopic haematuria

11

List some symptoms of UTI.

Urgency
Frequency
Dysuria

12

List some common obstructive symptoms.

Hesitancy
Reduced flow
Dribbling
Incomplete emptying

13

What does cloudy, offensive-smelling urine suggest?

Infection

14

State another symptom that may indicate that spinal pathology is the cause of the flank pain.

Leg weakness

15

List some key features of the past medical history.

Previous kidney stones
Recurrent cystitis
Atherosclerotic disease
Longstanding back pain
Kidney disease (e.g. polycystic kidney disease predisposes to pyelonephritis)

16

List some drugs that predispose to the formation of kidney stones.

Aciclovir
Indinavir
Acetazolamide

17

Name an inherited condition that increases the risk of forming kidney stones.

Cystinuria

18

Describe the appearance of a patient with:
Ureteric Colic
Peritonitis

- Ureteric Colic
Writhing in pain and unable to stay still
- Peritonitis
Rigid and motionless

19

What can you do during the examination to figure out whether spinal pathology is the cause of the flank pain?

Test range of movement and feel for tenderness over the vertebrae

20

What examination should be performed if spinal pathology is suspected?

Lower limb neurological examination

21

What examination should be performed if AAA is suspected?

Peripheral vascular examination

22

Why is the finding of a popliteal artery aneurysm significant?

50% of patients with popliteal artery aneurysms also have AAA

23

Why is it important to perform urinalysis in patients with flank pain?

Microscopic haematuria is a common feature of kidney stones

24

What clues may the pH of the urine suggest?

Acidic – urate stones can cause urine to be acidic
Alkaline – suggests the presence of urease-producing bacteria (e.g. Proteus, Pseudomonas)

25

What are red cell casts and what do they suggest?

Sausage-shaped clumps of red cells found on urine MC&S
They suggest that the red cells are coming from the kidneys rather then the ureters/bladder)
The presence of red cell casts suggests that there has been glomerular damage

26

What do white cell casts suggest?

Pyelonephritis

27

Why should patients be told to try and retain the stones if they pass them?

They can be send for analysis, which could reveal clues about the aetiology of the kidney stones

28

List some blood tests that would be performed in a patient with suspected ureteric colic.

FBC
CRP
U&Es
Creatinine
Serum calcium, phosphate and urate

29

Why is it important to check the serum calcium, phosphate and urate levels in a patient with ureteric colic?

It can give information about the aetiology of kidney stones

30

List two types of imaging that are useful for investigating patients with flank pain.

Bedside ultrasound
Non-contrast CT-KUB

31

What is a disadvantage of using bedside ultrasound to investigate flank pain?

It shows AAA but it does not show whether the AAA is leaking or not

32

List some reasons for admitting patients with kidney/ureteric stones.

Evidence of upper urinary tract infection
Evidence of renal impairment/failure
Refractory pain
Bilateral obstructing stones
Elderly/child

33

Which drugs can be used to ease the passage of kidney stones?

Tamsulosin
Nifedipine

34

Management of kidney stones is largely dependent on its size. What size kidney stones have a good chance of passing spontaneously?

< 5 mm

35

List some surgical methods of removing stones.

Ureteroscopic lithotripsy (URS)
Percutaneous nephrolithotomy (PCNL)
Extracorporeal shockwave lithotripsy (ESWL)
JJ Stenting

36

Describe the typical presentation of acute pyelonephritis.

Dull flank pain, high fever and urinalysis suggestive of UTI

37

Pyelonephritis can occur secondary to what other urinary tract pathology?

Secondary to obstruction caused by a kidney stone

38

What organism most commonly causes pyelonephritis?

Escherichia coli

39

List the sepsis 6 guidelines.

High-flow oxygen
Take blood cultures
Broad-spectrum antibiotics
IV fluid challenge
Measure serum lactate and haemoglobin
Monitor urine output

40

What symptoms and signs would suggest that an intrarenal or perinephric abscess has developed?

Persistently high fever, bacteraemia, very high WCC, severe tenderness on examination or failure to improve with therapy

41

Describe the typical presentation of an AAA.

Elderly with a past medical history of hypertension
Presents with sudden-onset, sharp flank pain

42

Describe the management of an AAA.

Urgent CT abdomen to confirm the bleed
Large bore IV access
X-match 10 units of blood
Insert a urinary catheter
Notify vascular surgeon