A 34-year-old female presents with the complaint of sudden excruciating pain in her back and points to her flank area on the right side. She rates the pain as 10 on a scale of 1 to 10, with 10 being the worst. She also complains of nausea with the pain. She states that she has never had anything like this before, and the pain is subsiding a little now.
Struggling with where to start this assignment? Follow this guide to tackle your assignment easily!
Differential Diagnosis for Sudden Flank Pain
Given the patient’s sudden onset of excruciating right flank pain (10/10), nausea, and no prior history of similar pain, several conditions should be considered, with nephrolithiasis (kidney stones) being the most likely diagnosis.
Primary Suspected Diagnosis: Nephrolithiasis (Kidney Stones)
- Presentation: Sudden severe flank pain that can radiate to the lower abdomen or groin, often associated with nausea and restlessness.
- Supporting Features: The pain intensity (10/10) and its fluctuation (“subsiding a little now”) are classic for renal colic.
- Next Steps:
- Urinalysis – Look for hematuria (blood in urine)
- Non-contrast CT of the abdomen and pelvis – Gold standard for detecting kidney stones
- Ultrasound – Alternative imaging, especially in pregnancy
- Pain management – NSAIDs or opioids if severe
- Hydration – Encourage oral fluids if tolerated
Other Differential Diagnoses:
- Pyelonephritis (Kidney Infection)
- Flank pain with fever, chills, dysuria (painful urination), and malaise
- Diagnosis: Urinalysis (WBCs, bacteria), urine culture
- Musculoskeletal Pain (e.g., Lumbar Strain)
- Worsens with movement, no urinary symptoms
- Diagnosis: Clinical exam, no findings on imaging
- Ovarian Pathology (Ovarian Cyst Rupture or Torsion)
- Lower abdominal pain rather than flank pain, possible menstrual irregularities
- Diagnosis: Pelvic ultrasound
- Aortic Dissection (Less Likely but Serious Consideration)
- Sudden severe tearing pain, radiation to the back, hemodynamic instability
- Diagnosis: CT angiography
Initial Management:
- Pain control: NSAIDs (first-line) or opioids for severe pain
- Hydration: Encourage fluids but avoid excessive IV hydration if not needed
- Imaging: CT scan or ultrasound to confirm kidney stones
- Follow-up: Referral to urology if large stones (>5mm) or recurrent episodes
This patient should be evaluated urgently to confirm the diagnosis and initiate appropriate pain management.
Place this order or similar order and get an amazing discount. USE Discount code “GET20” for 20% discount