Page 227 - Medicine and Surgery

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Genitourinary system 6

Clinical, 223 Urinary tract infections, 265 Genitourinary oncology, 275
Disorders of the kidney, 233 Urinary stones, 270
Disorders of the bladder and Disorders of the male genital
prostate, 261 system, 272

Clinical Alleviating factors: Nothing relieves the pain until ei-
ther the stone is passed (which may be felt as ‘gravelly’
urine), or strong analgesia is given.
Symptoms Associated symptoms include nausea, vomiting, frank
haematuria (blood in the urine).
Loin pain Loin pain is associated with fever, and loin tender-
ness is strongly suggestive of infection of the kidney
Definition
(pyelonephritis).Theremaybenauseaandvomiting,but
Loin pain or flank pain is pain felt unilaterally or bilat-
lower urinary tract symptoms (such as stinging, burning
erally in the back, below the twelfth rib. It has two main
onpassingurineorurinaryfrequencymaybeminimalor
causes: obstruction and inflammation. Most kidney dis-
absent). Pain felt in the loin may also result from other
eases do not cause loin pain.
abdominal organs (see under Gastrointestinal System
On taking the history of any pain consider the Site,
and Liver Biliary Pancreas), and musculoskeletal pain.
Onset,Character,Radiation,Alleviatingfactors,Timing,
Rarer causes include psoas haematoma and abscess.
Exacerbating factors and Symptoms associated with the
pain (SOCRATES).
Theclassicformof loinpainisfromobstructiontothe Dysuria
outflow of urine, usually caused by a renal stone (often
called renal colic, although the pain may not always be Definition
colicky). Dysuriaisthesensationofburningorstingingonpassing
Site:The pain is usually unilateral, as bilateral renal urine.

obstruction is uncommon without there being blad- This is usually caused by a urinary tract infection
der obstruction as well. and is frequently accompanied by increased urinary fre-
Onset tends to be sudden. quency and increased urgency (a sudden urge to pass

Character: The pain can be dull, but is usually severe urine). There may be accompanying fever, and systemic

and constant if the stone has obstructed the kidney, upset such as nausea and vomiting, although these are
or may come in spasms (colicky) if the stone is in the less common with simple cystitis, compared to cysti-
ureter, and the patient will often walk around, or roll tis complicated by prostatitis, pyelonephritis or obs-
around, trying to get comfortable. truction.
Radiation occurs down towards the symphysis pubis, It can also be caused after instrumentation of the

groin or into the testis. urinary tract, e.g. by a catheter or cystoscopy, and by

223