Problem: A 45 y/o female underwent surgical removal of the uterus (total hysterectomy) for symptomatic endometriosis 2 days previously. She now complains of right back and flank tenderness. On examination, her temperature is 102°F, heart rate is 100 beats/minute, and blood pressure is 130/90 mm of Hg. The heart and lung examinations are normal. Her abdomen is slightly tender diffusely, but bowel sounds are normal. The surgical incision is uncomplicated. There is exquisite right costovertebral angle tenderness on palpation. An ultrasound of the kidneys was performed and showed marked dilation of the right renal collecting system and right ureter. Need Assignment Help?