Flank pain

2015 ◽  
Author(s):  
Hugo Farne ◽  
Edward Norris-Cervetto ◽  
James Warbrick-Smith
Keyword(s):  
Musculoskeletal Pain ◽  
Kidney Stones ◽  
Perforated Peptic Ulcer ◽  
Flank Pain ◽  
Constant Pain ◽  
Surgical Emergencies ◽  
Abdominal Aortic ◽  
Internal Bleeding ◽  
Lumbar Nerve Root ◽  
Nerve Root Pain

The diagnoses shown in bold in Figure 18.1 are all surgical emergencies that you must exclude as you clerk the patient. In women, you should consider gynaecological causes, e.g. ectopic pregnancy, ovarian torsion (you can of course narrow these down depending on whether the woman is of childbearing age or not). Also, bear in mind that other abdominal pathology can occasionally present as flank pain (e.g. pancreatitis, diverticulitis, appendicitis). You should ask the standard array of questions about the pain—remember the mnemonic SOCRATES: Site: Where is the pain, and has it always been there? Is it unilateral or bilateral? Kidney stones are almost always unilateral, but the location of the pain may radiate from loin to groin. Often they start with a vague discomfort that is ignored until it becomes a severe pain. Onset: Any trauma or other trigger, or spontaneous? Gradual or sudden? Trauma may lead to musculoskeletal pain or internal bleeding. Character: Is the pain colicky or constant? Is it sharp or dull? Ureteric stones give a colicky (waxing and waning) pain because of periodic spasms of the ureteric smooth muscle walls trying to dislodge the blockage. A constant pain is more consistent with a stone lodged in the kidney, which does not periodically contract (‘vermiculate’) like the ureters, or an inflammatory cause. Musculoskeletal pain is more typically an ache, while nerve impingement causes shooting pains. Radiation: Does the pain radiate to the groin (typical of ureteric pain)? Does it radiate down the leg (typical of lumbar nerve root pain)? Alleviating factors: Does anything make the pain better, e.g. a given posture, eating/drinking, any medications, etc.? Timing: How long has the pain been present? Musculoskeletal back pain can last many weeks, whereas a leaking abdominal aortic aneurysm (AAA) is unlikely to persist for more than a day without resolution, one way or another. Exacerbating factors: Does anything make the pain worse? Patients with peritonitis (e.g. due to a perforated peptic ulcer) are very sensitive to movement. Severity: How severe is the pain (e.g. on a scale of 1–10)? Kidney stones are said to be excruciatingly painful, comparable to childbirth.

scholarly journals Visceral obesity: A new risk factor for stone disease

2015 ◽  
Vol 9 (11-12) ◽  
pp. 795 ◽  
Author(s):  
Ilker Akarken ◽  
Hüseyin Tarhan ◽  
Rahmi Gökhan Ekin ◽  
Özgür Çakmak ◽  
Gökhan Koç ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Adipose Tissue ◽  
Kidney Stones ◽  
Visceral Fat ◽  
Subcutaneous Adipose Tissue ◽  
Subcutaneous Fat ◽  
Stone Disease ◽  
Flank Pain ◽  
Fat Tissue ◽  
Subcutaneous Adipose

Introduction: We examined the relationship between stone disease and the amount of visceral adipose tissue measured with unenhanced computed tomography (CT).Methods: We included 149 patients with complaints of flank pain and kidney stones detected by CT, from August 2012 to April 2013. In addition, as the control group we included 139 healthy individuals, with flank pain within the same time period, with no previous history of urological disease and no current kidney stones identified by CT. Patients were analyzed for age, gender, body mass index, amount of visceral and subcutaneous adipose tissue, and serum level of low-density lipoprotein and triglyceride.Results: There were no differences between groups in terms of gender and age (p = 0.27 and 0.06, respectively). Respective measurements for the stone and control groups for body mass index were 29.1 and 27.6 kg/m2; for visceral fat measurement 186.0 and 120.2 cm2; and for subcutaneous fat measurements 275.9 and 261.9 cm2 (p = 0.01; 0.01 and 0.36, respectively). Using multivariate analysis, the following factors were identified as increasing the risk of kidney stone formation: hyperlipidemia (p = 0.003), hypertension (p = 0.001), and ratio of visceral fat tissue to subcutaneous fat tissue (p = 0.01). Our study has its limitations, including its retrospective nature, its small sample size, possible selection bias, and missing data. The lack of stone composition data is another major limitation of our study.Conclusion: The ratio of visceral to subcutaneous adipose tissue, in addition to obesity, hyperlipidemia, and hypertension, was identified as an emerging factor in the formation of kidney stones.

An Unusual Presentation of Acute Lumbar Nerve Root Pain

Spine ◽  
1996 ◽  
Vol 21 (20) ◽  
pp. 2387-2389 ◽  
Author(s):  
Cornelia S. Carr ◽  
Michael A. Edgar
Keyword(s):  
Nerve Root ◽  
Unusual Presentation ◽  
Lumbar Nerve Root ◽  
Nerve Root Pain

scholarly journals Laparoscopic Repair for Perforated Duodenal Ulcer

2015 ◽  
Vol 20 (3) ◽  
pp. 168-172
Author(s):  
Cotirleţ A. ◽  
Tincu E. ◽  
Coşa Raluca ◽  
Popa E. ◽  
Gavril Laura ◽  
...  
Keyword(s):  
Peptic Ulcer ◽  
Laparoscopic Repair ◽  
Perforated Peptic Ulcer ◽  
Gastric Surgery ◽  
High Morbidity ◽  
Ulcer Disease ◽  
Surgical Emergencies ◽  
Abdominal Disease ◽  
Laparoscopic Closure ◽  
Prolonged Surgery

Abstract Perforated peptic ulcer (PPU), despite antiulcer medication and Helicobacter eradication, is still the most common indication for emergency gastric surgery associated with high morbidity and mortality. Perforated peptic ulcer is a common abdominal disease that is treated by surgery. The development of laparoscopic surgery has changed the way to treat such abdominal surgical emergencies but there is no consensus on whether the benefits of laparoscopic closure of perforated peptic ulcer outweigh the disadvantages such as prolonged surgery time and greater expense. However we can say that laparoscopic repair is a viable and safe surgical option for patients with perforated peptic ulcer disease and should be considered with the necessary expertise available.

Vascular Disease and Kidney Stones: Abdominal Aortic Calcifications Are Associated with Low Urine pH and Hypocitraturia

2017 ◽  
Vol 31 (9) ◽  
pp. 956-961 ◽  
Author(s):  
Nishant D. Patel ◽  
Ryan D. Ward ◽  
Juan Calle ◽  
Erick M. Remer ◽  
Manoj Monga
Keyword(s):  
Vascular Disease ◽  
Kidney Stones ◽  
Urine Ph ◽  
Abdominal Aortic

scholarly journals The spectrum of pediatric amplified musculoskeletal pain syndrome

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
David D. Sherry ◽  
Maitry Sonagra ◽  
Sabrina Gmuca
Keyword(s):  
Musculoskeletal Pain ◽  
Pediatric Rheumatology ◽  
Functional Disability ◽  
Wide Spectrum ◽  
Pediatric Population ◽  
Pain Syndrome ◽  
Pain Clinic ◽  
Cross Sectional ◽  
Body Regions ◽  
Constant Pain

Abstract Background Children presenting with musculoskeletal pain to pediatric rheumatology clinics are very heterogeneous and on a continuum from those with localized pain to total body pain. Many report intermittent, rather than constant, pain. We examined clinical and psychological characteristics of these children at presentation and specifically those who fulfilled the criteria for fibromyalgia. Methods We performed a retrospective, cross-sectional cohort study of children under ≤18 years old presenting to the pediatric rheumatology pain clinic between January 2015 and July 2019 and enrolled in a patient registry. We included children diagnosed with amplified pain, excluding those fulfilling criteria for complex regional pain syndrome. Abstracted data included clinical characteristics, pain symptoms, functional disability inventory (FDI), widespread pain index, and symptom severity scale. Results We analyzed 636 subjects, predominantly non-Hispanic Caucasian females. Using median split method, 54% had diffuse pain (≥ 5 body regions involved), but, of these, only 58% met criteria for fibromyalgia. Subjects with diffuse pain, compared to those with localized pain had a longer duration of pain (24 vs 12 months, p < 0.01), reported greater pain intensity (6/10 vs 5/10, p < 0.001), greater mental health burden, and poorer function (FDI 25 vs 19, p < 0.0001). Subjects with limited pain more often reported a history of trigger event (34% vs 24%, p < 0.01) but not autonomic changes (14% vs 14%, p = 0.94). The presence of adverse childhood experiences did not differ among those with limited versus diffuse pain except for parental divorce (16% vs 23%, p = 0.03). Intermittent pain was reported in 117 children (18%) and, compared to subjects with constant pain, they reported less pain (0/10 vs 6/10) and were more functional (FDI 13 vs 25) (both p < 0.0001). Conclusions There exists a wide spectrum of pain manifestations among children with amplified pain including limited or diffuse and constant or intermittent pain. Most children who presented to our clinic did not fulfill criteria for fibromyalgia but nonetheless had significant symptoms and disability. Studies focusing on fibromyalgia may miss the full extent of childhood amplified pain. Additionally, research limited to those meeting the fibromyalgia criteria likely underestimate the significant impact of amplified pain among the pediatric population.

Innovative Design and Manufacturing Techniques for Patient Specific Abdominal Aortic Aneurysm Flexible Benchtop Models

2013 ◽  
Author(s):  
Florian Stefanov ◽  
Patrick Delassus ◽  
Tim McGloughlin ◽  
Liam Morris
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Patient Specific ◽  
Stent Grafts ◽  
Innovative Design ◽  
Abdominal Aortic ◽  
Internal Bleeding ◽  
Design And Manufacturing ◽  
Manufacturing Techniques ◽  
Elder People

Abdominal aortic aneurysm (AAA) represents an asymptomatic cardiovascular type of disease, that is diagnosed in elder people over 60 years old. It is characterised by a ballooning of the abdominal aorta, which grows, at different rates in different patients. If left untreated, it will rupture causing severe internal bleeding, which can lead to shock or death [1]. Medical devices such as bifurcated stent grafts (SG) are used for the treatment of this disease. To help improve SG performance, biomedical engineers design benchtop models for testing.

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