Monday, October 18, 2021


emDocs - October 18, 2021 - By Eriny Hanna and Aaron Lacy
Reviewed by: Michael J. Yoo, Alex Koyfman and Brit Long
  • 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”