Differential Diagnosis for Left Side Colicky Abdominal Pain, Hematuria, and Nausea

Single Most Likely Diagnosis

• Kidney Stone (Nephrolithiasis): This condition is characterized by the formation of stones in the kidneys, which can cause severe, colicky pain, typically radiating from the flank to the groin. The presence of hematuria (blood in the urine) and nausea supports this diagnosis, as stones can cause bleeding and irritate the urinary tract, leading to nausea.

Other Likely Diagnoses

• Pyelonephritis: An infection of the kidney, which can cause flank pain, nausea, and sometimes hematuria. The pain might not always be colicky but can be severe and persistent.
• Urinary Tract Infection (UTI): While more common in women, UTIs can cause significant discomfort, including pain, nausea, and sometimes hematuria, especially if the infection involves the upper urinary tract.
• Diverticulitis: Inflammation of a diverticulum in the digestive tract, which can cause abdominal pain, typically on the left side, nausea, and changes in bowel habits. Hematuria is less common but can occur if the diverticulum erodes into the urinary tract.

Do Not Miss Diagnoses

• Appendicitis: Although appendicitis typically presents with right lower quadrant pain, it can occasionally present atypically, especially if the appendix is retrocecal. Missing this diagnosis can lead to perforation and severe complications.
• Ectopic Pregnancy: A pregnancy that develops outside the uterus, which can cause severe abdominal pain, nausea, and sometimes hematuria if the ectopic pregnancy ruptures and involves the urinary tract. This is a medical emergency.
• Ruptured Aneurysm or Aortic Dissection: These are life-threatening conditions that can cause severe, tearing abdominal or back pain and can sometimes present with hematuria if there is retroperitoneal bleeding. Immediate diagnosis and treatment are crucial.

Rare Diagnoses

• Renal Infarction: A condition where the blood supply to the kidney is interrupted, leading to tissue death. It can cause severe flank pain and hematuria.
• Papillary Necrosis: A condition where part of the kidney tissue dies due to lack of blood supply, often associated with diabetes, analgesic abuse, or sickle cell disease. It can cause severe pain and hematuria.
• Malrotation with Volvulus: A condition where the intestine twists around its base, cutting off its blood supply. It's more common in children but can occur in adults, causing severe abdominal pain, nausea, and potentially hematuria if there's significant ischemia affecting the urinary tract indirectly.