Flank pain
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Flank pain' is a discomfort that occurs in a region of the posterior torso (lower back) beneath the ribs and above the ilium
Symptoms
Characterization of the symptoms associated with flank pain may help in pinpointing the underlying etiology. Obviously, a thorough genitourinary history should be obtained since kidney disease is a common cause of flank pain. Care should be taken to characterize the exact location of the pain as well as if there is any radiation of the pain. Care should be taken to understand if the pain represents a form of colic in which case a diagnosis of either renal colic or biliary colic might be suggested. A history of other recent illnesses should be obtained as well.
Signs
Physical examination
A careful examination of the patient's flank should be undertaken.
Common Causes of Flank Pain
- Disc disease
- Herpes zoster or shingles
- Muscle spasm
- Nephrolithiasis (kidney stone)
- Pyelonephritis
- Urinary tract infection (UTI)
Complete Differential Diagnosis of Flank Pain
In alphabetical order. [1] [1]
- Abdominal aortic aneurysm (leaking or ruptured)
- Acute Pancreatitis
- Acute Pyelonephritis
- Adnexitis
- Adrenal hemorrhage
- Appendicitis
- Cystitis
- Bilharziosis
- Biliary Colic
- Bladder carcinoma
- Calculi or nephrolithiasis
- Calix Diverticulum
- Cervicitis
- Cholecystitis
- Cholecystolithiasis
- Disc disease
- Duodenal ulcer
- Echinococcosis
- Ectopic Pregnancy
- Glomerulonephritis
- Hepatitis
- Herpes Zoster
- Herniated disc
- Ileus
- Inguinal hernia
- Kidney abscess
- Megaureter
- Muscle spasm
- Nephrolithiasis
- Nephroptosis
- Neuralgia
- Obstructive uropathy
- Ormond's disease
- Papillary Necrosis
- Pelvic inflammatory disease
- Perforation of a viscus
- Peritonitis
- Pneumonia
- Polycystic kidney disease
- Pyelonephritis
- Renal artery aneurysm
- Renal artery embolism
- Renal cell carcinoma
- Renal dystopia
- Renal vein thrombosis
- Renal trauma
- Retroperitoneal abscess
- Retroperitoneal fibrosis
- Retroperitoneal hematoma or bleed
- Shingles
- Spinal Arthritis
- Splenomegaly
- Trauma
- Ureterocele
- Urinary retention
- Urogenital Tuberculosis
- Vesicoureteral reflux
Laboratory studies
- Initial laboratory evaluation of flank pain should include an evaluation of common causes such as those originating in the genitourinary system. Thus a urinanalysis and urine culture and sensitivity are appropriate starting points. An appropriate imaging evaluation would include a renal ultrasound.
- If musculoskeletal or disc disease is thought to be likely, then a lumbosacral x-ray or a lumbosacral MRI would be appropriate.
- More extensive laboratory evaluation should be directed at the most likely underlying cause. If a gastrointestinal causes is suspected, then liver function tests and a serum amylase or lipase should be ordered.
- If an infectious etiology is suspected, then a complete blood count and blood cultures should be ordered.
- In a young woman of childbearing potential, a pregnancy test should be ordered.
- In an elderly man or woman in whom bladder cancer is suspected then urine cytology may be an appropriate starting point as well.
References
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
