InvestigationsPotential resultsClinical management plan: abnormal results
Neurological examination (including perianal sensation)Abnormal examination (eg, suspected spinal cord compression)This is an emergency
Discuss immediately with an oncology or neurology team.
Symptom assessmentPain over the renal angle
  1. Consider pyelonephritis kidney infection/stone/urinary tract infection.

  2. Urine dip stick and urine sample for culture and sensitivity.

  3. Consider renal ultrasound.

Pain in the lower flankConsider constipation, faecal loading and faecal impaction (page 6).
Pain in the lower back
  1. Consider lower back fracture.

  2. Request a spinal (thoracic/lumbar) X-ray.

  3. Consider MRI.

Bone painConsider a bone scan and myeloma screen.
Routine blood screen and additional blood screenAbnormal results suggesting cancer relapseDiscuss immediately with supervising clinician.
CT/MRI/PET scan abdomen and pelvisColonic faecal loadingSee ‘constipation’ (page 6).
Acute bowel obstructionThis is an emergency
Discuss immediately with a GI surgeon.
Spinal fractureDiscuss immediately with supervising clinician.
  • GI, gastrointestinal; PET, position emission tomography.