Flank pain

Flank pain

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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.

• Turner's sign
• Cullen's sign

Causes

Common Causes

• Disc disease
• Herpes zoster or shingles
• Muscle spasm
• Nephrolithiasis (kidney stone)
• Pyelonephritis
• Urinary tract infection (UTI)

Causes by Organ System

Cardiovascular	No underlying causes
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	No underlying causes
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	No underlying causes

Differential Diagnosis of Flank Pain

In alphabetical order.

• 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

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