FLANK PAIN
Most cases of flank pain are associated with inflammation of the
kidney. As is shown in Table 29, however, jumping to that
conclusion in any given case may be hazardous.
FLANK PAIN
|
| V
| I
| N
| D |
|
| Vascular
| Inflammatory
| Neoplasm
| Degenerative |
|
| | | | |
|
Skin
| | Cellulitis Herpes zoster |
Muscle and Fascia
| | Trichinosis |
Colon
| Mesenteric thrombosis
| Colitis
| Carcinoma |
| |
Gallbladder
| | Cholecystitis Cholangitis
| Carcinoma |
Adrenal Gland |
| |
| |
Kidney
| Embolism Thrombosis
| Pyelonephritis Perinephric abscess
| Wilms tumor Hypernephroma |
| |
Aorta
| Aneurysm
| | | Atheroma Dissecting aneurysm |
Vena Cava
| Thrombosis |
Spine
| | Osteomyelitis Tuberculosis
| Metastatic carcinoma
| Osteoarthritis |
Spinal Cord and Nerves
| Anterior spinal artery occlusion
| Tabes dorsalis Myelitis Epidural abscess
| Spinal cord tumor |
|
In addition to the kidney (pyelonephritis and perinephric abscess),
inflammation of the skin (herpes zoster), the colon
(diverticulitis and colitis), the gallbladder (cholecystitis), and the
spine (epidural abscess and Pott disease) may also cause flank pain.
The mnemonic VINDICATE also suggests several vascular disorders that
are significant causes of flank pain such as aortic aneurysms, embolic
nephritis, and mesenteric thrombosis. Neoplasms of the kidney and colon are
less likely to produce pain unless they are complicated by infection.
However, trauma of the kidney and spine and renal calculi—whether due to
hyperparathyroidism, idiopathic etiologies, or hyperuricemia—are important
causes. Neoplasms of the spinal cord and tabes dorsalis must also be
considered.
-4pc
FLANK PAIN
|
| I
| C
| A
| T
| E |
| Intoxication
| Congenital Acquired
| Autoimmune
| Trauma
| Endocrine |
| Idiopathic
| Malformation
|
|
| |
|
|
| | | Contusion Laceration | |
|
| Hernia
| Dermatomyositis
| Contusion
| |
|
| Diverticulitis Appendix
| Ulcerative colitis Granulomatous colitis
| Contusion Laceration
| |
|
| | | | |
| |
|
| | | | Hemorrhage Infarction Tumor |
Gout Toxic nephritis Crush syndrome
| Obstruction Infection due to malformation
| Periarteritis nodosa Vasculitis of other cause
| Contusion Laceration
| Calculus due to hyperparathyroidism |
|
| | | Rupture | |
| |
|
| | | | |
|
| | Marie–Strümpell disease
| Fracture Herniated disc
| |
Arsenic poisoning Porphyria
| Syringomyelia
| Guillain–Barré syndrome
| Hematoma
| |
| |
|
Approach to the Diagnosis
The diagnosis of flank pain usually involves careful examination of the
urine and a urine culture, an IVP, and plain films of the abdomen and spine.
If these are negative, bone scans, arteriogram, and other tests listed below
may be required. CT has eliminated the need for exploratory laparotomy in
many cases.
Other Useful Tests
-
Urology consult
-
Neurology consult
-
CBC
-
Chemistry panel (uremia, renal calculi)
-
CT scan of the abdomen and pelvis (neoplasms, stones, hemorrhage
abscess)
-
X-rays of the thoracolumbar spine (bone metastasis, herniated disc)
-
MRI of the thoracic spine (neoplasms, herniated disc)
-
Sonogram (renal cyst)
-
Urine for acid-fast bacillus (AFB) smear and culture (tuberculosis)
-
Cystoscopy and retrograde pyelography (malformations, neoplasm)
-
Protein electrophoresis (multiple myeloma)
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Abdominal rigidity
Read excerpts from these other book chapters related to Abdominal rigidity:
Medical Books Excerpts
- FLANK PAIN
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Flank pain
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Flank pain
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Abdominal Pain
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Abdominal pain
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Flank pain
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Abdominal rigidity
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Flank pain
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Abdominal Pain
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
- [ read ]
Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
More About Causes of Abdominal rigidity
» Next page: Abdominal Mass, Generalized (Differential Diagnosis in Primary Care)
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