Differential Diagnosis
- Single most likely diagnosis
- Nephrolithiasis (kidney stones): The patient's sudden-onset cramps in the right lower abdomen, sweating, nausea, vomiting, and mild tenderness to palpation over the right flank are consistent with nephrolithiasis. The presence of moderate blood in the urinalysis without evidence of infection (negative for white blood cells, leukocyte esterase, and nitrites) further supports this diagnosis.
- Other Likely diagnoses
- Appendicitis: Although the patient's symptoms could be consistent with appendicitis, the location of the pain (right flank) and the absence of rebound tenderness make this diagnosis less likely. However, it is still a possible cause of the patient's symptoms.
- Placental abruption: The patient's abdominal cramps and vomiting could be indicative of placental abruption, but the absence of vaginal bleeding and the normal fetal heart rate tracing make this diagnosis less likely.
- Pyelonephritis: The patient's symptoms and urinalysis results could be consistent with pyelonephritis, but the absence of white blood cells, leukocyte esterase, and nitrites in the urinalysis makes this diagnosis less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Eclampsia: Although the patient's blood pressure is not significantly elevated, eclampsia is a life-threatening condition that can occur without warning. The patient's symptoms, such as abdominal cramps and vomiting, could be indicative of eclampsia, and it is essential to monitor her blood pressure and fetal heart rate closely.
- Uterine rupture: The patient's abdominal cramps and vomiting could be indicative of uterine rupture, especially if she has a history of uterine surgery or other risk factors. Although this diagnosis is unlikely, it is essential to consider it due to its potential severity.
- Pulmonary embolism: The patient's symptoms, such as sudden-onset pain and vomiting, could be indicative of pulmonary embolism, which is a life-threatening condition that requires immediate attention.
- Rare diagnoses
- Ovarian torsion: The patient's symptoms, such as sudden-onset abdominal pain, could be indicative of ovarian torsion, although this diagnosis is rare in pregnancy.
- Adrenal crisis: The patient's symptoms, such as abdominal pain and vomiting, could be indicative of adrenal crisis, although this diagnosis is rare and would require further evaluation.