You are seeing Ms. Hamilton, a 64 year old man, for left sided back pain. She says it began three days ago and isn’t getting any better. Take a focused history of her complaint and perform a physical examination.
History
- Onset and duration of pain
- Progression of pain
- Location of pain (unilateral)
- Frequency of pain (intermittent)
- Quality of pain (sharp)
- Radiation (to abdomen and groin)
- Flank pain (yes)
- Changes in amount of urine
- Dysuria
- Urgency
- Hematura (some darkening)
- Post-void dribbling
- Fever (recently)
- Nausea/vomiting
- Diarrhea (none)
- Diaphoresis
- Current Medications
- Diet history (focusing on calcium and oxalate intake)
- Personal history of renal stones
- Personal history of urinary tract infections
- Family history of renal stones
- Past medical history
Physical Examination
Inspection/Vitals
- Comments on general appearance of patient (uncomfortable, diaphoretic)
- Measures heart rate (elevated) and states that temperature should also be measured
Renal Examination
- Palpates location of back in which pain is located
- Assesses for CVA percussion tenderness
- Attempts to palpates for kidneys with patient supine
- Auscultates for renal bruits bilaterally
Abdominal Examination
- Inspects abdomen for masses, scars
- Auscultates in all four quadrants of the abdomen
- Palpates all quadrants for tenderness, commenting on absence/presence of guarding
- Assesses for rebound tenderness in the left and right lower quadrants
- States that they would perform a digital rectal examination as part of the abdominal examination
Special Maneuvers
- Examines for signs of appendicitis: McBurney’s point tenderness, Rovsing’s sign, Psoas sign
Case 4 – Renal Colic