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Renal Colic Flashcards

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1
Q

What is renal colic?

A

Pain experienced due to ureteric obstruction.

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2
Q

What causes renal colic?

A

Ureteral obstruction leading to acute distention of the renal capsule, resulting in colicky pain.

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3
Q

What is the typical onset of pain in renal colic?

A

Sudden onset of severe pain.

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4
Q

How is the pain in renal colic typically described?

A

The pain “comes and goes” (colicky pain).

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5
Q

Where is renal pain typically located?

A

At the costovertebral angle, lateral to the sacrospinalis muscle, below the 12th rib.

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6
Q

How does renal colic pain radiate?

A

From the loin to the groin, across the flank, and may extend to the inguinal region, testis, or labium majorum.

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7
Q

What are common associated symptoms of renal colic?

A

Nausea and vomiting.

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8
Q

What symptoms suggest distal ureteral obstruction?

A

Frequency, urgency, and suprapubic discomfort.

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9
Q

What is the most common cause of renal colic?

A

Ureteric stone.

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10
Q

What patient history increases suspicion for ureteric stones?

A

Previous stones and risk factors for stone formation.

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11
Q

What findings suggest a possible upper tract tumor?

A

Pain with haematuria, history of smoking, or presence of a renal mass.

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12
Q

How can sloughed papilla cause renal colic?

A

In diabetics with poor glycemic control, renal papillae may slough off and obstruct the ureter.

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13
Q

What are red flags for sepsis in a patient with renal colic?

A

Pyuria, rigors, and confusion.

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14
Q

What gynecological conditions can mimic renal colic?

A

Vaginal discharge and a positive pregnancy test.

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15
Q

What vascular condition must be ruled out in patients with suspected renal colic?

A

Abdominal aortic aneurysm (AAA), especially with a relevant history or suggestive exam findings.

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16
Q

What are the urological causes of renal colic?

A

Calculus, blood clot, sloughed papilla, tumor (though slow-growing tumors rarely cause pain).

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17
Q

What surgical conditions can mimic renal colic?

A

Appendicitis (retrocecal), acute pancreatitis, biliary colic, perforated peptic ulcer (PUD), bowel obstruction, diverticulitis.

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18
Q

How can acute inflammatory abdominal conditions be differentiated from renal colic?

A

Pyrexia and sweating are usually absent in renal colic. If peritonitis is present, the patient lies still rather than moving frequently in discomfort.

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19
Q

What vascular conditions can present similarly to renal colic?

A

Leaking abdominal aortic aneurysm (AAA), acute renal artery occlusion, renal vein thrombosis, ischemic bowel.

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20
Q

In which patient group should vascular causes be strongly considered?

A

Older patients (>60 years) with a history of vascular disease.

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21
Q

What gynecological conditions can mimic renal colic?

A

Pelvic inflammatory disease (PID), ovarian torsion, ruptured ectopic pregnancy.

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22
Q

What investigations should be done for female patients with suspected renal colic?

A

A pregnancy test and a thorough gynecological history.

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23
Q

What orthopedic condition can mimic renal colic?

A

Prolapsed intervertebral disc.

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24
Q

What other conditions can present similarly to renal colic?

A

Musculoskeletal conditions and Herpes Zoster (shingles).

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25
How does pyelonephritis differ from renal colic?
Pyelonephritis presents with pyrexia, sweating, and white blood cells/nitrates in urine, whereas renal colic usually does not unless there is concurrent infection.
26
Why is a testicular examination important in males presenting with acute abdominal pain?
Testicular torsion and epididymitis can mimic renal colic and must be ruled out.
27
Why is it important to consider serious conditions that may masquerade as renal colic?
Conditions like ruptured AAA, ischemic bowel, and ectopic pregnancy are life-threatening and require urgent recognition and management.
28
What vital signs should be assessed in a patient with suspected renal colic?
Heart rate, blood pressure, temperature, and signs of shock or sepsis.
29
What does tachycardia in renal colic suggest?
Pain or possible underlying sepsis.
30
What blood pressure findings may raise concern?
Hypotension may suggest shock due to sepsis, leaking AAA, or ruptured ectopic pregnancy.
31
When should sepsis be suspected in a patient with renal colic?
Presence of pyrexia, tachycardia, rigors, and confusion, especially if there is an obstructed urinary tract.
32
Why is an infected, obstructed urinary system a urological emergency?
It can lead to severe sepsis and requires urgent intervention.
33
What areas should be assessed for tenderness in renal colic?
Renal angle and iliac fossa tenderness.
34
What findings may suggest an alternative diagnosis?
Peritonism (guarding/rigidity) suggests surgical causes, pulsatile abdominal mass suggests leaking AAA, and adnexal tenderness suggests a gynecological cause.
35
What is the most important bedside test for all female patients with suspected renal colic?
Pregnancy test (to rule out ectopic pregnancy).
36
What is the role of a urine dipstick in renal colic?
It helps detect haematuria, leukocytes, nitrates, glucosuria, and ketonuria.
37
Why is haematuria significant in renal colic?
It usually indicates renal calculi or other ureteric pathology but can also result from conditions like appendicitis affecting the ureter.
38
What urine findings may suggest a urinary tract infection (UTI)?
Presence of leukocytes and nitrates.
39
What blood tests should be ordered in suspected renal colic?
Full blood count (FBC), creatinine, and inflammatory markers.
40
Why is haemoglobin (Hb) important in renal colic evaluation?
Low Hb may indicate chronic bleeding or other pathology.
41
Why should white cell count (WCC) be checked?
Elevated WCC may indicate infection (urosepsis or pyelonephritis).
42
Why is creatinine measured in renal colic?
To assess kidney function, especially if there is concern about obstruction or infection.
43
What is the role of an abdominal X-ray (AXR) in renal colic?
It can detect some calculi but may miss radiolucent stones.
44
What are the limitations of an AXR in diagnosing renal calculi?
It is not useful in obese patients, those with a faeces-loaded colon, or when calculi are over the sacrum.
45
What is the role of ultrasound in renal colic?
It helps identify hydronephrosis, renal stones, renal abscess, and perinephric collections.
46
What are the limitations of ultrasound in renal colic?
It is not useful in obese patients, is poor at detecting ureteric stones, and does not reliably exclude other differential diagnoses.
47
Why is a non0 contrast CT KUB the gold standard for renal colic?
It is the best test for renal calculi, excludes most severe differential diagnoses, and identifies complications such as perinephric collections.
48
When is a CT KUB especially useful?
In severely ill patients, as it expedites an accurate diagnosis.
49
Why is Intravenous pyelogram (IVP) no longer commonly used for acute renal colic?
It does not provide good visualization of an obstructed kidney because contrast is poorly excreted.
50
What are the limitations of IVP in diagnosing renal colic?
It is not useful for detecting alternative diagnoses and has largely been replaced by CT KUB.
51
What are the three most critical steps in managing renal colic?
1. Make a diagnosis (confirm renal colic vs. other serious conditions). 2. Treat shock and infection if present. 3. Relieve obstruction if necessary.
52
When should obstruction be urgently relieved?
If the patient has infection or severe renal dysfunction.
53
What procedures are used to relieve obstruction in renal colic?
DJ stent placement or percutaneous nephrostomy.
54
What are the key supportive measures for renal colic?
1. Analgesia (pain control). 2. IV fluids for rehydration. 3. Renal support (monitor kidney function).
55
Why is hydration important in renal colic?
Patients are often dehydrated, which can worsen stone formation and pain.
56
What are the two main approaches to stone management?
Medical Expulsive Therapy (MET) – for small stones. Surgical intervention – for larger or obstructing stones.
57
What medications are used for Medical Expulsive Therapy (MET)?
Alpha-blockers (e.g., tamsulosin) or calcium channel blockers.
58
When is surgical management required?
If the stone is too large, obstructing, or causing complications.
59
What imaging is preferred for pregnant patients or if gynecologic/biliary pathology is suspected?
Ultrasound
60
If a patient has a history of radiopaque calculi, what imaging should be performed?
Plain-film radiography (X-ray)
61
What is the preferred imaging for most patients with suspected renal colic?
Noncontrast helical CT (CT KUB)
62
If CT is unavailable, what alternative imaging can be considered?
Intravenous pyelography (IVP)
63
When is conservative management appropriate for renal colic?
- Small, distal ureteric stone likely to pass spontaneously. - No infection (urosepsis risk). - No renal impairment (normal renal function, no CKD, no solitary kidney). - Pain is manageable with medication. - Patient is willing to try conservative treatment.
64
What is Medical Expulsive Therapy (MET)?
he use of medications to help pass ureteric stones naturally.
65
Q: What drug is used for MET?
Tamsulosin (alpha-blocker).
66
What size and location of stones are most suitable for MET?
Stones <1 cm in the distal ureter.
67
What are the preferred pain relief options in conservative management?
NSAIDs (if tolerated, e.g., ibuprofen, diclofenac). Opioids (if severe pain and NSAIDs are contraindicated). Paracetamol (adjunctive pain relief).
68
Why are NSAIDs preferred over opioids in renal colic?
They reduce ureteric inflammation and lower renal pelvic pressure.
69
When is intervention required for renal colic?
1. Sepsis (infected obstructed system = urological emergency). 2. Renal dysfunction (AKI, CKD, solitary kidney). 3. Stone unlikely to pass (large >1 cm, proximal, anatomical obstruction). 4. Intractable pain despite medication. 5. Patient request (e.g., due to occupation – pilots, sailors).
70
What are the options for relieving obstruction in renal colic?
Percutaneous nephrostomy – urgent decompression in infected, obstructed systems. Double J (DJ) stent – internal drainage of urine past the obstruction.
71
What procedures are used for stone removal?
Ureteroscopic laser lithotripsy – laser fragmentation of stones. Basket stone extraction – endoscopic removal of stones.

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