approach to flank pain

flankpain

With flank pain we often jump to renal causes like nephrolithiasis or pyelonephritis, but there are other causes to consider as well. Using the systems-based approach we can be more thorough

A

B: CHEST

  • Effusion
  • Sick pneumonia
  • Tumour

C: CARDIOVASCULAR

  • DV strain: PE
  • Outflow: dissection into renal artery
  • Soft tissue bleed: AAA, retroperitoneal bleed
  • Lactate: septic from pyelo

D: NEUROLOGIC

  • Origin (root) compression

E

F: CREATININE

  • Renal artery/vein thrombosis
  • Impacted stone

G: ABDOMINAL

  • Ammonia: liver pathology
  • Biliary disease
  • Organomegaly: splenic
  • Appy retrocecal

H

I

Joint, skin, bone

  • zoster, muscle strain

 

Putting this together,

  • B: ask about cough/dyspnea and listen to chest
  • C: as if it’s pleuritic or if there PE risk factors; if elderly consider aortic, assess for sepsis
  • D: assess risk factors for bony pathology
  • F: assess risk factors for thrombosis; bedside ultrasound for hydro
  • G: examine abdomen, consider ultrasound +/- CT
  • J: examine skin for rash

flankpain

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  1. Pingback: missed AAA |

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