31 - renal colic

Question 1

Sx of colic

Answer 1

sudden onset unilateral flank pain

• radiates anteriorly and inferior
• writhe and cannot find a comfortable position

Question 2

Phx findings

Answer 2

• typically afebrile with normal vitals
• unilateral CVA tenderness
• no abdo tenderness

Question 3

5 common mimicers

Answer 3

uncommon in elderly

1. AAA
2. aortic dissection
3. renal art. thrombosis
4. append
5. pyelo

Question 4

what is best lab and findings

Answer 4

urine dip
- micro hema
- no WBCs
- no nitries
HCG for all women

Question 5

when to image

Answer 5

presumed first presentation

- low threshold for elderly

Question 6

5 imaging modalityes

Answer 6

1. CT - preferred
   - good and can pick up some mimickers
2. US
   - only modest sensitivity
   - good for hydronephrosis
3. MR
   - poor sensitivity for stones, but good for obst
4. IVP
5. KUB xray
   - only really good for follow up

Question 7

Tx steps for colic

Answer 7

1. IV morphine
2. naproxen
3. tamulosin
4. IV saline

Question 8

4 absolute indications for uro consult

Answer 8

1. intractable pain or vomiting
2. obstructed stone with infection
3. single kidney
4. transplanted with obstruction

Question 9

prognosis for stones

Answer 9

80% will pass

over 7mm unlikely to pass