Differential Diagnosis for Female Presenting with Nausea, Intense Pain on Right Rib and Hip, and Hematuria
- Single Most Likely Diagnosis
- Nephrolithiasis (Kidney Stones): The combination of intense pain, particularly if it radiates from the flank to the groin, nausea, and hematuria (blood in the urine) is highly suggestive of a kidney stone. The pain's location on the right rib and hip area aligns with the typical presentation of nephrolithiasis affecting the right kidney or ureter.
- Other Likely Diagnoses
- Pyelonephritis: An infection of the kidney, which can cause severe pain, nausea, and hematuria. The pain is usually flank pain but can radiate to the hip area.
- Musculoskeletal Injury or Strain: Although less likely given the hematuria, a severe musculoskeletal injury could cause intense pain and nausea, especially if there's associated trauma.
- Do Not Miss Diagnoses
- Ectopic Pregnancy: Although less common in presentations without clear obstetric symptoms, an ectopic pregnancy can cause severe abdominal or pelvic pain, nausea, and if there's associated bleeding, it might lead to hematuria. This diagnosis is critical to rule out due to its high mortality if missed.
- Appendicitis: If the appendix is located near the right ureter, an inflamed appendix could irritate the ureter, leading to hematuria and severe pain. The pain might start near the navel and then move to the lower right abdomen but can sometimes be felt in the flank or hip area.
- Ovarian Torsion or Rupture: These conditions can cause severe, sudden pain and nausea. Hematuria might not be a direct symptom but could occur if there's associated urinary tract injury or if the patient has a co-existing condition.
- Rare Diagnoses
- Renal Infarction: A blockage of the arteries supplying the kidney can cause severe flank pain, nausea, and potentially hematuria. It's less common but should be considered, especially in patients with risk factors for thromboembolic events.
- Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodes of severe pain, nausea, and other symptoms due to the release of catecholamines. Hematuria could be present if the tumor affects kidney function or causes hypertension-related kidney damage.