Renal Colic Approach

– History –

  • CC: most likely will present as LUTS\flank pain:
    • Site (of pain, if any): where? Bi\uni-lateral? Radiates anywhere else (groin)?
    • Onset: first time? When? Sudden\gradual? Continues\intermittent? Worse\better?
    • Timing and frequency: day\night? How frequent?
    • Aggravating\relieving factors: position, medications?
    • Severity: 1-10 scale? Wakes you up from sleep? Interfering w\ ADL?
  • Associated sx:
    • Constitutional: fever, chills, wt loss, loss of appetite, night sweats?
    • Urine: color, bloody (if yes; beginning\end\throughout, dark\fresh\mixed, clots), frothy, pneumaturia, fecaluria? Urethral discharge?
    • Voiding: hesitancy, straining, weak flow, intermittency, post-void dribbling, sensation of incomplete voiding?
    • Storage: frequency, urgency, urge incontinence, dysuria, nocturia?
    • GI: abdominal\flank\groin, N\V, diarrhea\constipation?
  • PMHx:
    • Diseases:
      • Chronic ds (HTN, DM, DLP)
      • Kidney ds
      • Prev kidney stones
      • BPH
      • Malignancy
    • Medications
    • Surgery, hospitalization, trauma
    • Procedures, catheterization
    • Blood transfusions, IV drug use, tattoos
    • Allergies
  • FMHx:
    • Similar complaint?
    • Same diseases as in PMHx?
  • Social Hx:
    • Occupation, marital status, children?
    • Smoking, alcohol, recreational drugs?
    • Travel Hx
    • Diet, exercise

  


– Abdominal Physical Exam –

  • WIPE, blah blah 🙂
  • “Take vital signs”
  • Position: flat, arms on the side, pillow below the head
  • Proper exposure: from xiphoid to mid-thigh
  • General inspection of the pt and surroundings

1. Inspection: (stand at the end of the bed)

  • Symmetry and contous
  • Abdominal distention + flank fullness
  • Scars, skin changes\discoloration, rashes, striae
  • Obvious masses or swelling
  • Dilated veins\caput medusa
  • Visible pulsations
  • Umbilicus (inverted\everted?}
  • Hernia (ask pt to cough)

2. Palpation + percussion: (ask pt if they have any pain?)

  • Superficial and deep: “abdomen soft and lax, no tenderness, no masses, no peritoneal signs”
    • Tenderness
    • Guarding\rigidity
    • Masses
    • Rebound tenderness
    • CVA tenderness

3, Auscultation:

  • Bowel sounds
  • Bruits: Aortic, renal, femoral

4. To complete:

  • Digital rectal exam (PR)
  • Genital exam
  • Fecal occult blood test 

 

– Investigations –

  1. Labs:
    • U\A
    • Serum electrolytes
    • Kidney function
  2. Imaging:
    • KUB or US for initial imaging
    • CT (no contrast): gold standard

 

– Management –

  1. IVF
  2. Pain management (ketorolac)
  3. If < 5 mm -> might pass spontaneously
  4. Surgical therapy:
    • Size < 2 cm + upper ureter -> ESWL (extracorporeal shockwave lithotripsy)
    • Size < 2 cm + lower ureter -> ureteroscopy
    • Size > 2cm, staghorn, cysteine -> percutaneous removal or lithotripsy
  5. Medical therapy:
    1. Potassium citrate -> alkalizing urine -> prevents stone recurrence
    2. Thiazides -> prevents calcium stones

 


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