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    Appendicitis is the inflammation of the vermiform appendix (D’souza & Nugent, 2016), the clinical presentation of appendicitis includes central abdominal pain that radiates to the right side of the abdomen and worst on palpation. In addition to feeling hungry, nauseous, and vomiting, and having a fever are other common signs and symptoms (Livingston, 2015). There are no clinical signs which could have reliably diagnose appendicitis, as the patient was mildly nauseous and complained of aching sensation in the flank area worst on palpation.  2.    Kidney stones or urolithiasis can often remain asymptomatic, kidney stone pain is often characterised as spasmodic that begins at the loin area and radiates to the ipsilateral flank, iliac fossa and inguinal region (Strittmatter, Gratzke & Stief, 2015).  However, the most common presenting symptoms are renal colic that was not evident in this case. Renal colic is triggered by tension in the renal capsule, collecting system, or ureter and can radiate with the sympathetic nerves along the subcostal, iliohypogastric, ilioinguinal, or genitofemoral nerves.

The patient may also have intermittent and paroxysmal attacks with associated nausea and vomiting, and fever when the stone causes uropathy obstruction in addition to haematuria and urinary retention (Al-mamari, 2017). 3.    According to Dean (2017), the most common clinical presentations of patient with renal cancer include haematuria, mass or lump in the kidney area, sudden weight loss, fever, diaphoresis, persistent loin area pain, lethargy, loss of appetite, and general feeling of poor health. The differential diagnosis of renal cancer was disproven in the patient assessment, this was due to lack of symptoms suggesting this condition. 4.    Renal vein thrombosis is the formation of a blood clot in the renal vein; the clinical presentation varies with the degree and speed of venous occlusion. Renal vein thrombosis can sometimes remain asymptomatic, some patients may present with symptoms of nausea, vomiting and weakness (Jou, Jong, Hsieh & Kang, 2014).

Other specific symptoms in severe cases include upper abdominal and flank pain, offensive smelling urine, fever or haematuria. Additionally, scrotal pain in male caused by thrombosis induced varicocele (Yildiz, Nieuwenhove, Doyen & Tombi, 2016). Although this patient did complain of flank pain and nausea, no other clinical manifestation strongly suggested renal vein thrombosis. 

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