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

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.

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

1. Urology consult
2. Neurology consult
3. CBC
4. Chemistry panel (uremia, renal calculi)
5. CT scan of the abdomen and pelvis (neoplasms, stones, hemorrhage abscess)
6. X-rays of the thoracolumbar spine (bone metastasis, herniated disc)
7. MRI of the thoracic spine (neoplasms, herniated disc)
8. Sonogram (renal cyst)
9. Urine for AFB smear and culture (tuberculosis)
10. Cystoscopy and retrograde pyelography (malformations, neoplasm)
11. Protein electrophoresis (multiple myeloma)

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Abdominal rigidity: Introduction (review 47 causes)
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More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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