Flank Pain and Kidney Stones

Kidney Stones are a Diagnosis of Exclusion!!! Step 1: Consider the Differential Diagnosis for Flank Pain * Appendicitis* Abdominal Aortic Aneurysm* Ectopic Pregnancy* Testicular/Ovarian Torsion* Kidney Stone Step 2: Diagnose the Kidney Stone * Option 1- Renal Ultrasound* Findings consistent with kidney stone diagnosis* Hydronephrosis* Lack of ureteral jets (in bladder)* Kidney stones (poor sensitivity for this)* Benefits* Can be performed at bedside* No radiation* Option 2- Non-contrast CT scan* Great for identifying alternative diagnoses Step 3: Rule Out Infection * Fevers* Urinalysis with nitrites or bacteria* If present, patient needs antibiotics Step 4: Control Symptoms * Analgesics* NSAIDS (such as ketorolac)* Opiates* Antiemetics* Zofran Step 5: Rule Out Kidney Injury * Elevated creatinine* Solitary kidney Admission Criteria for Kidney Stones * Coexisting Urinary Tract Infection* Unable to Control Symptoms* Renal Injury/Solitary Kidney Additional Reading * How to Interpret a Urinalysis (EM Clerkship)