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Week 109 - Renal Colic and Haematuria > Renal colic > Flashcards

Renal colic Flashcards

1
Q

What is the definition of renal colic?

A

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
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2
Q

What percentage of patients with renal colic have haematuria?

A

85%

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3
Q

What are the risk factors of renal colic?

A

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)

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4
Q

What are the comorbidities associated with renal colic?

A

Parathyroidism

Paraplegia

Gout

Cystinuria
…

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5
Q

What is the male female ratio of renal colic?

A

M:F = 3:1

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6
Q

What investigations should be done for suspected stones?

A

CT scan

IVU
- contrast may cause allergy

Renograms (function and obstruction)

  • MAG3
  • DTPA

DMSA (radionucleotide scan)

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7
Q

How should stones be treated?

A

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

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8
Q

Which antibiotics should be used for infection as a result of stones?

A

IV Ampicillin

IV Gentamycin

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9
Q

What should be used for recurrent stones?

A

24 hour urinary analysis and gamma analysis with gamma fluid and detector (DTPA / Mag-3)

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10
Q

What is cholecystitis?

A

Inflammation of the gallbladder incl. gallstones

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11
Q

What are the symptoms of cholecystitis?

A

Severe upper right quadrant pain

Elevation of bilirubin and alkaline phosphatase

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12
Q

What investigation should be done when looking for gallstones?

A

Abdominal USS

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13
Q

What investigation should be done when looking for appendicitis?

A

CT scan

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14
Q

What investigation should be done when looking for pyelonephritis?

A

Urine Dipstick

Urine cultures and antibody sensitivity

MAG3/DMTA

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15
Q

What is a abdominal aortic aneurysm?

A

Leaking or ruptured abdominal aorta

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16
Q

What investigation should be done when looking for a AAA?

A

CT scan

17
Q

What treatment should be done for a AAA?

A

Surgery

18
Q

What is acute diverticulitis?

A

Inflammation of the diverticula (small pouches which form with age on the colon, particularly the sigmoid)

Can become blocked and provide habitat for bacteria

19
Q

What is the investigation of choice for acute diverticulitis?

A

Barium enema and abdominal USS

20
Q

What is the treatment for acute diverticulitis?

A

Cephalosporin

Metranidazole

21
Q

What is the investigation for a suspected ectopic pregnancy?

A

Pregnancy and USS

- must be ruled out in women of relevant age

22
Q

What is the treatment for an ectopic pregnancy?

A

Salpingectomy (surgical removal of the fallopian tube)

23
Q

What is salpingitis and how does it present?

A

Infection of fallopian tubes

Commonly present with:

  • bilateral, low-abdo pain
  • fever
  • vaginal discharge
24
Q

What is Mittelschmerz?

A

Unitaleral, low abdo pain as a result of mid cycle

25
Q

What is Schistosomiasis?

A

An infection acquired on foreign travel cause by a parasite from contaminated water.

26
Q

What are the common sites of stone obstruction?

A

Pelviureteric junction

Arching of ureter over iliac vessels near the pelvic brim

Vesicoureteric junction

27
Q

What are the damaging effects of stone obstruction?

A

Irreversible nephron decay

  • rate = *13 if infection present
  • simple obstruction = days for nephrons to die
28
Q

What is the typical presentation of stone obstruction?

A

Acute excruciating pain and can’t get comfortable

Peaks in 1-2 hours from onset

Radiates down dermatomes T10-L1

Level of pain => position of stone

Haematuria

Acute renal failure

Sepsis= pyrexia, rigors, tachycardia, hypotension

29
Q

What are the types of stones that can cause obstruction?

A

Calcium oxalate and phosphate (70%)

Struvite = Mg ammonium phophate (15-20%)
- cause large staghorn calculi

Uric acid (5-10%)

Cystine (1-2%)
- caused by genetic defects

30
Q

What is the process of stone formation?

A
  1. Urinary supersaturation
  2. Crystalisation
  3. Crystal growth in tubule
  4. Crystal erosion
  5. Exposure to urine and further stone formation

Week 109 - Renal Colic and Haematuria (3 decks)

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