Talisuna Yosem
Oct 27, 2023
Abdominal pain?
A 27-year-old man presents to the emergency department with a 2-hour history of
severe left-sided loin pain which woke him from sleep. The pain is constant but
occasionally dulls. He has been feeling sick with the pain and vomited twice. On
examination, the patient is writhing in agony and has mild tenderness in the left loin only. His temperature is 36.9°C. Urine dipstick
shows 2+ of blood. What is the most likely diagnosis?
A. Biliary colic
B. Dissecting aortic aneurysm
C. Pyelonephritis
D. Renal cell carcinoma
E. Renal colic
severe left-sided loin pain which woke him from sleep. The pain is constant but
occasionally dulls. He has been feeling sick with the pain and vomited twice. On
examination, the patient is writhing in agony and has mild tenderness in the left loin only. His temperature is 36.9°C. Urine dipstick
shows 2+ of blood. What is the most likely diagnosis?
A. Biliary colic
B. Dissecting aortic aneurysm
C. Pyelonephritis
D. Renal cell carcinoma
E. Renal colic
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ChatGPT
Oct 27, 2023
The most likely diagnosis in this case is renal colic. Renal colic is characterized by severe flank pain that can radiate to the groin. The pain is often described as intermittent and colicky, meaning it comes in waves. The presence of blood in the urine (hematuria) is also suggestive of renal colic. The patient's symptoms of severe left-sided loin pain, vomiting, and tenderness in the left loin support this diagnosis. Biliary colic typically presents with right upper quadrant pain, while a dissecting aortic aneurysm would present with severe tearing or ripping pain in the chest or back. Pyelonephritis may cause flank pain, but it is usually associated with fever and more diffuse tenderness. Renal cell carcinoma is unlikely to present acutely with severe pain.
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