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| {{Infobox_Disease |
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| {{SI}}
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| {{CMG}} | | {{CMG}} |
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| {{Editor help}}
| | ==Overview== |
| | Flank pain is a discomfort that occurs in a region of the posterior [[torso]] (lower back) beneath the [[rib]]s and above the [[Ilium (bone)|ilium]] |
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| '''Flank pain'''' is a discomfort that occurs in a region of the posterior [[torso]] (lower back) beneath the [[rib]]s and above the [[Ilium (bone)|ilium]]
| | ==Classification== |
| | | ===[[Right flank pain|Right Flank Pain]]=== |
| ==Symptoms==
| | ===[[Left flank pain|Left Flank Pain]]=== |
| 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.
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| ==Signs== | |
| === Physical examination=== | |
| A careful examination of the patient's flank should be undertaken.
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| *[[Turner's sign]]
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| *[[Cullen's sign]]
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| ==Causes== | |
| ===Common Causes=== | |
| *Disc disease
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| *[[Herpes zoster]] or [[shingles]]
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| *Muscle spasm
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| *[[Nephrolithiasis]] (kidney stone)
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| *[[Pyelonephritis]]
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| *[[Urinary tract infection]] (UTI)
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| ===Causes by Organ System===
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| {|style="width:82%; height:100px" border="1"
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| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Chemical/Poisoning'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Dental'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Dermatologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Drug Side Effect'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Ear Nose Throat'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Endocrine'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Environmental'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Gastroenterologic'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Genetic'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Hematologic'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Iatrogenic'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Infectious Disease'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Musculoskeletal/Orthopedic'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Neurologic'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Nutritional/Metabolic'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Oncologic'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Ophthalmologic'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Overdose/Toxicity'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Psychiatric'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Pulmonary'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Renal/Electrolyte'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Rheumatology/Immunology/Allergy'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Sexual'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Trauma'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Urologic'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |bgcolor="LightSteelBlue" | '''Miscellaneous'''
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| |bgcolor="Beige" | No underlying causes
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| |-
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| |} | |
| ===Causes in Alphabetical Order===
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| {{col-begin|width=84%}}
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| {{col-break|width=33%}}
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| {{col-break|width=33%}}
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| {{col-break|width=33%}}
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| {{col-end}}
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| == Differential Diagnosis of Flank Pain==
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| In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
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| * [[Abdominal aortic aneurysm]] (leaking or ruptured)
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| * [[Acute Pancreatitis]]
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| * [[Pyelonephritis|Acute Pyelonephritis]]
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| * [[Adnexitis]]
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| * [[Adrenal hemorrhage]]
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| * [[Appendicitis]]
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| * [[Cystitis]]
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| * [[Bilharziosis]]
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| * [[Biliary Colic]]
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| * [[Bladder carcinoma]]
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| * [[Calculi]] or [[nephrolithiasis]]
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| * [[Calix Diverticulum]]
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| * [[Cervicitis]]
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| * [[Cholecystitis]]
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| * [[Cholecystolithiasis]]
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| * [[Disc disease]]
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| * [[Duodenal ulcer]]
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| * [[Echinococcosis]]
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| * [[Ectopic Pregnancy]]
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| * [[Glomerulonephritis]]
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| * [[Hepatitis]]
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| * [[Herpes Zoster]]
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| * [[Herniated disc]]
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| * [[Ileus]]
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| * [[Inguinal hernia]]
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| * [[Kidney abscess]]
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| * Megaureter
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| * Muscle spasm
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| * [[Nephrolithiasis]]
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| * [[Nephroptosis]]
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| * [[Neuralgia]]
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| * Obstructive uropathy
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| * [[Ormond's disease]]
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| * [[Papillary Necrosis]]
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| * [[Pelvic inflammatory disease]]
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| * Perforation of a viscus
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| * [[Peritonitis]]
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| * [[Pneumonia]]
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| * [[Polycystic kidney disease]]
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| * [[Pyelonephritis]]
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| * Renal artery aneurysm
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| * Renal artery embolism
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| * [[Renal cell carcinoma]]
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| * Renal dystopia
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| * [[Renal vein thrombosis]]
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| * Renal [[trauma]]
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| * Retroperitoneal [[abscess]]
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| * [[Retroperitoneal fibrosis]]
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| * [[Retroperitoneal hematoma]] or bleed
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| * [[Shingles]]
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| * [[Spinal Arthritis]]
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| * [[Splenomegaly]]
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| * [[Trauma]]
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| * [[Ureterocele]]
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| * [[Urinary retention]]
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| * [[Urogenital Tuberculosis]]
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| * [[Vesicoureteral reflux]]
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| ==Laboratory studies== | |
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| *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.
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| *If musculoskeletal or disc disease is thought to be likely, then a lumbosacral x-ray or a lumbosacral MRI would be appropriate.
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| *More extensive laboratory evaluation should be directed at the most likely underlying cause. If a gastrointestinal causes is suspected, then [[liver function test]]s and a serum [[amylase]] or [[lipase]] should be ordered.
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| *If an infectious etiology is suspected, then a [[complete blood count]] and [[blood culture]]s should be ordered.
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| *In a young woman of childbearing potential, a [[pregnancy test]] should be ordered.
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| *In an elderly man or woman in whom [[bladder cancer]] is suspected then urine cytology may be an appropriate starting point as well.
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| ==References==
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| {{Reflist|2}}
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| [[Category:Nephrology]] | | [[Category:Nephrology]] |