STUDY - Technical - New Dacian's Medicine
Flank
pain (Classical / Allopathic Medicine)
Pain in the flank,
the area extending from the ribs to the ilium, is a leading
indicator of renal and upper urinary tract disease or trauma.
Depending on the cause, this symptom may vary from a dull ache
to a severe stabbing or throbbing pain and may be unilateral
or bilateral and constant or intermittent. It's aggravated by
costovertebral angle percussion and, in patients with renal or
urinary tract obstruction, by increased fluid intake and
ingestion of alcohol, caffeine, or diuretic drugs. Unaffected
by position changes, flank pain typically responds only to an
analgesic or to the treatment of the underlying disorder.
ALERT:
If the patient has suffered trauma:
- quickly look for a visible or palpable flank mass, associated injuries, costovertebral angle pain, hematuria, Turner's sign, and signs of shock (such as tachycardia and cool, clammy skin)
- take the patient's vital signs.
If the patient's condition permits, perform a thorough assessment.
If the patient has suffered trauma:
- quickly look for a visible or palpable flank mass, associated injuries, costovertebral angle pain, hematuria, Turner's sign, and signs of shock (such as tachycardia and cool, clammy skin)
- take the patient's vital signs.
If the patient's condition permits, perform a thorough assessment.
HISTORY:
Ask the patient about the pain's onset and apparent precipitating events.
Ask the patient to describe the pain's location, intensity, pattern, and duration. Does anything aggravate or alleviate it?
Ask the patient about changes in his normal pattern of fluid intake and urine output. Explore his history of urinary tract infection or obstruction, renal disease, or recent streptococcal infection.
Ask the patient about the pain's onset and apparent precipitating events.
Ask the patient to describe the pain's location, intensity, pattern, and duration. Does anything aggravate or alleviate it?
Ask the patient about changes in his normal pattern of fluid intake and urine output. Explore his history of urinary tract infection or obstruction, renal disease, or recent streptococcal infection.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs.
Inspect the flank area for bruising or obvious injury.
Palpate the flank area, and percuss the costovertebral angle to determine the extent of pain.
Obtain a urine specimen, and inspect for color and odor. Send the specimen for testing, as appropriate.
Take the patient's vital signs.
Inspect the flank area for bruising or obvious injury.
Palpate the flank area, and percuss the costovertebral angle to determine the extent of pain.
Obtain a urine specimen, and inspect for color and odor. Send the specimen for testing, as appropriate.
SPECIAL
CONSIDERATIONS:
Administer pain medication. Continue to monitor the patient's vital signs, and maintain precise records of intake and output.
Administer pain medication. Continue to monitor the patient's vital signs, and maintain precise records of intake and output.
PEDIATRIC
POINTERS:
Assessment of flank pain can be difficult if a child can't describe the pain. In such cases, transillumination of the abdomen and flanks may help in assessing bladder distention and identifying masses.
Common causes of flank pain in a child include obstructive uropathy, acute post-streptococcal glomerulonephritis, infantile polycystic kidney disease, and nephroblastoma.
Assessment of flank pain can be difficult if a child can't describe the pain. In such cases, transillumination of the abdomen and flanks may help in assessing bladder distention and identifying masses.
Common causes of flank pain in a child include obstructive uropathy, acute post-streptococcal glomerulonephritis, infantile polycystic kidney disease, and nephroblastoma.
PATIENT
COUNSELING:
Instruct the patient on what to expect from diagnostic testing, which may include excretory urography, flank ultrasonography, computed tomography scan, voiding cystourethrography, cystoscopy, and retrograde ureteropyelography, urethrography, or cystography.
Instruct the patient on what to expect from diagnostic testing, which may include excretory urography, flank ultrasonography, computed tomography scan, voiding cystourethrography, cystoscopy, and retrograde ureteropyelography, urethrography, or cystography.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)