Can you make the diagnosis?

Doug is sitting in a meeting, when he notices a twinge of back pain.  He notices the pain seems worse on the left side.  He tries to ignore it.

Soon however the pain is much worse, and is radiating from his back to his groin.  He becomes nauseated and sweaty, and excuses himself from the meeting.   Doug makes it back to his office and tries to work.  He keeps shifting around in his chair to find a comfortable position, but the pain keeps getting worse.  Soon he is not sure he can even drive himself home because the pain is so bad.

What is causing Doug’s pain?

  1.  Muscular back pain
  2. A kidney stone
  3. Appendicitis
  4. A urinary tract infection




If you picked 2.  A kidney stone, you are correct!

Twelve percent of men and seven percent of women will get a kidney stone in their lifetime. Your chance of having a kidney stone doubles if you have a family member who has had one.  The average kidney stone is about 5 mm (0.2 inches).  Most kidney stones will pass on their own, but some need to be removed.

Patients who have kidney stones usually describe it as severe 10/10 pain that starts on the back on either the right or left side, and often radiates to the groin.  The pain is often associated with vomiting.

Muscular back pain usually has a subtle onset, and is more general low back pain though it can radiate to the legs.  It is not usually associated with nausea or vomiting.  Appendicitis pain usually starts in the mid-abdomen and then moves to the right lower side, and is often associated with vomiting.  Patients with appendicitis often want to lie very still however, and not writhe around like patients with a kidney stone.  A urinary tract infection usually starts with flu-like symptoms, and has burning with urination and fever.  A urinary infection that spreads to the kidney can also cause back pain.

Kidney stone:

kidney stone

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