emDocs
emDocs - October 18, 2021 - By Eriny Hanna and Aaron Lacy
Reviewed by: Michael J. Yoo, Alex Koyfman and Brit Long
“Pearls
- Do not forget to consider complications (infection, AKI, obstruction) as well as serious alternative diagnosesin every patient with flank pain.
- When needing to evaluate for other etiologies of flank pain, a contrasted CT has adequate sensitivity for obstructive stones. Otherwise, low dose and even ultra-low dose non-contrast CT will detect clinically significant (>3mm) stones. Do start with renal ultrasound first if there is low suspicion of complication or serious alternative
- Disposition bottom line:
- Infection or AKI due to obstruction: urgent urology consult for drainage + broad spectrum antibiotics + admission (floor vs ICU depending on hemodynamics).
- Moderate/severe hydronephrosis or >10mm stone: urology consult (or very urgent outpatient urology follow up if young, healthy, uncomplicated). Disposition can vary depending on urology’s plan for intervention.
- Intractable pain/vomiting/dehydration/revisit for worsening symptoms: admit to floor for symptom control.
- Presence of risk factors for developing complications/needing intervention: arrange a very urgent urology clinic follow up if discharging. Admit any patient with concerns for loss to follow up or clinical deterioration.
- Uncomplicated, small, distal stone: Discharge with pain control +/- MET, close PCP follown up and non-urgent urology clinic follow up”