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Full Answer Section

Differential Diagnoses

• Renal colic: This is the most likely diagnosis given the sudden onset of severe flank pain and associated nausea. It is often caused by a kidney stone obstructing the ureter.
• Pyelonephritis: This is an infection of the kidney, which can cause severe flank pain, fever, chills, and nausea.
• Ureteral stricture: A narrowing of the ureter can cause obstruction and lead to flank pain.
• Appendicitis: While less likely, appendicitis can present with flank pain, especially in women.
• Pancreatitis: Acute pancreatitis can cause severe abdominal pain, including in the flank area.

Diagnostic Tests

• Urinalysis: To evaluate for hematuria, proteinuria, and other abnormalities.
• Blood tests: To assess renal function (BUN, creatinine), electrolytes, and inflammatory markers (C-reactive protein).
• CT scan of the abdomen and pelvis: To visualize the kidneys, ureters, and bladder for stones or other abnormalities.

Management

• Pain management: Administer analgesics, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids, to manage the pain.
• Hydration: Encourage the patient to drink plenty of fluids to help pass the stone.
• Antibiotics: If pyelonephritis is suspected, start appropriate antibiotic therapy.
• Observation: Monitor the patient's vital signs, pain levels, and urine output.
• Consult a urologist: If a kidney stone is confirmed, consult a urologist for further management, which may include lithotripsy (shock wave therapy) or endoscopic procedures to remove the stone.

References:

1. National Kidney Foundation. (2023). Kidney Stones. https://www.kidney.org/kidney-health/kidney-stones
2. American Family Physician. (2022). Acute Flank Pain: Diagnosis and Management. [invalid URL removed]

Sample Solution

Patient Assessment and Management

Initial Assessment

History of Present Illness:

• Location and severity: The patient describes a sudden, excruciating pain in the right flank, rated as 10/10.
• Onset and duration: The pain began abruptly and is subsiding slightly.
• Character: The pain is described as sharp and intense.
• Associated symptoms: The patient reports nausea.
• Aggravating/relieving factors: The patient has not identified any specific triggers or factors that alleviate the pain.
• Past medical history: It is important to inquire about the patient's past medical history, including any history of kidney stones, urinary tract infections, or other urological conditions.
• Family history: A family history of kidney stones or other urological disorders may increase the risk.
• Medications: Ask about any current medications, as some may increase the risk of kidney stones.
• Allergies: Inquire about any allergies to medications or contrast agents.

Physical Examination

• Vital signs: Measure blood pressure, heart rate, respiratory rate, temperature, and oxygen saturation.
• Abdominal examination: Palpate the abdomen for tenderness, guarding, or rebound tenderness. Assess for a palpable mass or distension.
• Costovertebral angle (CVA) tenderness: Percuss the CVA area to assess for kidney tenderness.
• Genitourinary examination: Examine the external genitalia for any abnormalities.