The Patient History: Evidence-Based Approach (Tierney, The Patient History) by Henderson Mark & Tierney Lawrence & Smetana Gerald

Author:Henderson, Mark & Tierney, Lawrence & Smetana, Gerald [Henderson, Mark]
Language: eng
Format: epub
Publisher: McGraw-Hill
Published: 2012-06-13T00:00:00+00:00

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KEY TERMS

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ETIOLOGY

Unfortunately, few data exist on prevalence of the various causes of flank pain. Flank pain is often caused by sudden obstruction of a ureter by a renal calculus or renal colic. Renal colic tends to be sudden, severe, and debilitating. As the offending calculus descends through the collecting system, pain may also occur in the lower abdominal quadrants and genitalia, along with dysuria, frequency, urgency, and hematuria.2

Pyelonephritis commonly causes flank pain, particularly in women. Because women have shorter urethras than men, women have a greater incidence of lower urinary tract infections, which may ascend to one or both kidneys resulting in pyelonephritis. Pain is caused by inflammation of the kidney with stretching of the renal capsule; it may be less severe and more insidious than renal colic.3 A history of fever or dysuria suggests pyelonephritis, although dysuria may not occur in patients with indwelling urinary catheters.4,5 Occasionally, a kidney stone may obstruct the flow of urine, leading to the development of pyelonephritis.6 Such patients have both pyelonephritis and nephrolithiasis, the 2 most common causes of flank pain.

Musculoskeletal causes of flank pain are often clinically obvious. The patient usually describes a precipitating event, such as swinging a baseball bat or lifting a heavy object.

It is helpful to think about the most common diagnoses first and then consider the less common or rare causes.

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