A Comprehensive Evaluation And Evidence-Based Management Of Acute

A COMPREHENSIVE EVALUATION AND EVIDENCE-BASED MANAGEMENT OF ACUTE RIGHT-SIDED FLANK PAIN, HEMATURIA, AND URINARY SYMPTOMS IN A 33-YEAR-OLD FEMALE: DIAGNOSTIC REASONING LEADING TO URETERAL NEPHROLITHIASIS Chief Complaint (CC): Severe right-side back pain and blood in my urine for the past 6 hours.History of Present Illness (HPI): A 32-year-old female presents to the Emergency Department with the acute onset of severe, colicky right flank pain that began 6 hours prior. She describes the pain as waxing and waning in intensity, starting in her right costovertebral angle and radiating anteriorly to her right lower quadrant and groin. It is associated with multiple episodes of nausea and one episode of non-bilious vomiting. She noticed her urine was pink-tinged (gross hematuria) shortly after the pain began. She reports urinary frequency and a persistent sensation of needing to urinate, but only passes small volumes. She denies fever, chills, or vaginal discharge. A heating pad and over-the-counter ibuprofen (400mg) provided minimal relief. Explanation: The classic description of colicky (intermittent, severe) pain radiating from the flank to the groin is highly suggestive of ureteral colic, as the stone migrates and causes peristaltic spasms of the ureter. Radiation to the labia is common in females. Associated nausea/vomiting are