Flank Pain/CVA Tenderness
Flank Pain/CVA Tenderness: Excerpt from In a Page: Signs and Symptoms
Pain and/or tenderness on the side of the trunk from the ribs to the ileum is often associated with renal disease; however, nonrenal etiologies are very common. Of course, renal disease should be strongly suspected in the case of costovertebral angle tenderness and concurrent urinary complaints.
Differential Diagnosis
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Degenerative disk disease and/or disk herniation is the most frequent cause of pain
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Muscle spasm or cramping
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Trauma
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Nephrolithiasis/urolithiasis (renal or ureteral calculi or stones) is the most common urinary tract etiology
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Pyelonephritis (acute or chronic)
–E. coli is the most common cause of upper and lower urinary infections, followed by
Staphylococcus saprophyticus
–Acute pyelonephritis is usually a
complication of a lower UTI
–Chronic pyelonephritis is usually associated with obstruction
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Perirenal (kidney) abscess
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Acute pancreatitis
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Glomerulonephritis
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Herpes zoster
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Bacterial cystitis
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Polycystic kidney disease
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Renal infarction or trauma
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Papillary necrosis
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Duodenal ulcer
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Cholecystitis or biliary colic
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Pneumonia
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Appendicitis
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Obstructive uropathy
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Ectopic pregnancy
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Cervicitis
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Renal or bladder cancer
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Leaking or ruptured abdominal aortic aneurysm
Workup and Diagnosis
- History should include onset, duration, quality, intensity, and location of pain; radiation; associated symptoms (e.g., nausea/vomiting, fever, dysuria, hematuria, rash); history of recent trauma or illness; and family history of renal disease or cancer
- Exam should include complete cardiovascular, pulmonary, abdominal, and genitourinary exam, and pelvic exam if suspect cervicitis or ectopic pregnancy
–Turner's sign (bluish discoloration at flank) and/or Cullen's sign (bluish discoloration at the umbilicus) indicate retroperitoneal hemorrhage and may be present in cases of pancreatitis or ruptured AAA
–Initial labs may include CBC, ESR, electrolytes, BUN/creatinine, calcium, amylase/lipase, liver function tests, pregnancy test, blood cultures, urinalysis, and urine culture
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Urine cytology, cystoscopy, and biopsy may be indicated if renal or bladder cancer is suspected
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Renal or abdominal ultrasound or abdominal CT scan
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Spiral CT scan without contrast is the gold standard to diagnose stones and urinary tract obstruction
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Intravenous pyelography has high sensitivity/specificity for stones, urinary tract obstruction, and renal cysts
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Voiding cystourethrography
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Lumbosacral X-ray may be indicated to evaluate for degenerative joint disease
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Lumbosacral MRI may be indicated to evaluate for disk disease
Treatment
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Disk disease: NSAIDs and physical therapy; surgery is rarely indicated
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Muscle spasm: Rest, physical therapy, analgesics
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Renal calculi: Increased fluid intake, analgesics, consider surgery
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Pyelonephritis, cystitis, and perirenal abscess: Antibiotics and increased fluid intake
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Pancreatitis: Analgesics, antibiotics, consider surgery
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Glomerulonephritis: Antibiotics (if poststreptococcal), loop diuretics, antihypertensive agents
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Polycystic kidney disease: Manage blood pressure
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Renal infarction: Surgery, antihypertensive, streptokinase
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Papillary necrosis: Dialysis, treat underlying cause
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Cholelithiasis: Cholecystectomy, analgesics
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Appendicitis and ectopic pregnancy: Surgery
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Renal and bladder cancer: Surgical resection, chemotherapy, and radiation
Book Source Details
- Book Title: In a Page: Signs and Symptoms
- Author(s): Scott Kahan, Ellen G. Smith
- Year of Publication: 2004
- Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: In a Page: Signs and Symptoms
Authors: Scott Kahan, Ellen G. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2004
ISBN: 1-4051-0368-X
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» Next page: Cerebrovascular Disease (A Pocket Manual of Differential Diagnosis)
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