Loin pain Flashcards
What are differentials for loin pain?
Muscular sprain Nephrolithiasis/Ureteric colic Spinal pathology Ruptured AAA Pyelonephritis
Testicular/Ovarian torsion
Acute pancreatitis
What is almost always the case with ureteric colic?
Unilateral
Why do you get colicky pain with ureteric stones?
Periodic spasms of the ureteric smooth muscle walls trying to dislodge the blockage
Where can loin pain radiate?
to groin - stones
to legs - lumbar nerve root pain
What patients are very sensitive to movement?
Peritonitis e.g. due to perforated peptic ulcer
In unilateral, right flank pain what would a fever be indicative of?
Pyelonephritis
OR
Renal cell carcinoma
What could cause N+V to accompany the loin pain?
Ureteric stones
Biliary colic
Appendicitis
unlikely MSK pain
What might haematuria indicate?
Kidney/Ureteric stones although usually microscopic
What LUTS are associated with UTI?
Increased frequency
Urgency
Dysuria
What LUTS are associated with ureteric obstruction?
Hesitancy
Reduced flow
Dribbling
Incomplete voiding
e.g. prostate enlargement
What does cloud, offensive smelling urine indicate?
Infection
What would urinalysis show in suspected renal or uretric colic?
haematuria
Increased WCC
Nitrites
Urine pH (urate stones - acidic)
When would you perform urine microscopy, culture and sensitivity?
If urinalysis is abnormal and shows blood, leucocytes or nitrites
What imaging is important for loin pain?
CT-KUB
Will show kidney/ureteric stones
Retroperitoneal tumours
AAAs
What investigations must be done is acute pancreatitis is suspected?
Lipase and amylase
