Kidney, Liver and Gallbladder Referral and When to Refer On

Kidneys can refer to the loin, lateral lumbar spine, buttock and lateral thigh, overlapping with greater trochanteric pain syndrome, so the speaker asks about urinary changes and signs of infection, which are more common in women. Renal colic comes and goes severely rather than behaving mechanically. Liver dysfunction shows through skin itching, dark circles under the eyes, body odor, dark urine, pale stools, weight loss and fatigue, signs patients will not link to right shoulder pain unless asked. Gallbladder pain relates to fatty or spicy food and alcohol and can be colicky. The speaker stresses not forcing symptoms to fit. When a presentation does not fit, think about which organ refers there, what it does and which questions test that function. Physical examination can include observation for masses and bloating, auscultation of bowel sounds and abdominal palpation for tenderness, guarding or masses. Being unable to reproduce symptoms in a full regional exam strengthens the case for referral, and the findings make referral letters more useful.