Renal colic Flashcards
(30 cards)
What is the definition of renal colic?
Kidney pain typically begenning in the abdomen and often radiating to the hypochondrium or the groin.
Pain is often colicky (comes in waves) due to ureteric peristalsis, but may be constant.
Two varieties:
- dull
- acute: unpleasant = very strong pain
What percentage of patients with renal colic have haematuria?
85%
What are the risk factors of renal colic?
Previous stones
Recent travel to a hot climate
Low average fluid intake
Recent period of immobilisation (=> skeleteal Ca2+ resorption)
Recurrent infections
Urological conditions
Previous surgery (stasis/obstruction)
What are the comorbidities associated with renal colic?
Parathyroidism
Paraplegia
Gout
Cystinuria
…
What is the male female ratio of renal colic?
M:F = 3:1
What investigations should be done for suspected stones?
CT scan
IVU
- contrast may cause allergy
Renograms (function and obstruction)
- MAG3
- DTPA
DMSA (radionucleotide scan)
How should stones be treated?
NSAIDs and analgesia
Extracorpeal shock-wave lithotripsy
- very efficient for renal stones
Ureteroscopy
- ideal for ureteric stones
PCNL = percutaneous nephrolithomy (key hole approach)
- large staghorn calculo
- may scar kidney
- may choose to remove entire kidney
Stent for distal calculi => dilatation
Antibiotics if infection and obstruction => urgent nephrostomy or ureteric stent
Which antibiotics should be used for infection as a result of stones?
IV Ampicillin
IV Gentamycin
What should be used for recurrent stones?
24 hour urinary analysis and gamma analysis with gamma fluid and detector (DTPA / Mag-3)
What is cholecystitis?
Inflammation of the gallbladder incl. gallstones
What are the symptoms of cholecystitis?
Severe upper right quadrant pain
Elevation of bilirubin and alkaline phosphatase
What investigation should be done when looking for gallstones?
Abdominal USS
What investigation should be done when looking for appendicitis?
CT scan
What investigation should be done when looking for pyelonephritis?
Urine Dipstick
Urine cultures and antibody sensitivity
MAG3/DMTA
What is a abdominal aortic aneurysm?
Leaking or ruptured abdominal aorta
What investigation should be done when looking for a AAA?
CT scan
What treatment should be done for a AAA?
Surgery
What is acute diverticulitis?
Inflammation of the diverticula (small pouches which form with age on the colon, particularly the sigmoid)
Can become blocked and provide habitat for bacteria
What is the investigation of choice for acute diverticulitis?
Barium enema and abdominal USS
What is the treatment for acute diverticulitis?
Cephalosporin
Metranidazole
What is the investigation for a suspected ectopic pregnancy?
Pregnancy and USS
- must be ruled out in women of relevant age
What is the treatment for an ectopic pregnancy?
Salpingectomy (surgical removal of the fallopian tube)
What is salpingitis and how does it present?
Infection of fallopian tubes
Commonly present with:
- bilateral, low-abdo pain
- fever
- vaginal discharge
What is Mittelschmerz?
Unitaleral, low abdo pain as a result of mid cycle
