Renal colic Flashcards

1
Q

What is renal colic?

A

Pain usually caused by renal calculi.

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2
Q

What are the most common sites for stones to get stuck at?

A

Pelvi-ureteric junction
Pelvic brim
Vesico-ureteric junction
(PTS)

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3
Q

Give 3 risk factors for renal colic

A
  1. Male (3:1)
  2. 30-50 years old
  3. Family history
  4. Anatomical abnormalities
  5. Hypertension
  6. Gout
  7. Immobilisation
  8. Dehydration
    (PTS)
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4
Q

Give 3 things can renal calculi be composed of.

A

Calcium oxalate/ phosphate (80%)
Struvite (infection) (10%)
Uric acid (usually lucent on KUBXR) (5-10%)

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5
Q

Describe the pathophysiology of renal calculi.

A

Nucleation theory states that renal calculi form from supersaturation of urine with salt/minerals. (PTS)
Anatomical factors, eg spina bifida, horseshoe kidney (embryological fusion of kidneys)
Infection - changes acid-base balance.

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6
Q

Give 3 symptoms of renal calculi.

A

Can be asymptomatic, picked up on a CT for bowel disease.
1. RENAL COLIC sudden severe unilateral loin pain radiating to groin
2.. UTI symptoms: Dysuria, strangury (desire to urinate + severe pain), urgency, frequency.
3. Nausea and vomiting
4. Rigors
(PTS, lecture 19.2.18)

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7
Q

Give 3 signs of renal calculi.

A
  1. Haematuria, usually non-visible
  2. Patient writhes around in agony
  3. recurrent UTIs
    (lecture 19.2.18, PTS)
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8
Q

Describe the prevention of renal calculi recurrence.

A
Prevention of another stone forming:
1. Overhydration
2. Dietary modification - low-salt diet
3. reduce BMI
4. Check calcium - PTH.
5. deacidification of urine to prevent uric acid stones.
Always think about sepsis
(lecture 19.2.18)
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9
Q

Give 3 diseases that may be in your differential diagnosis if you suspect renal calculi.

A
  1. Ruptured abdominal aortic aneurysm
  2. Diverticulitis
  3. Appendicitis
  4. Acute pancreatitis
  5. Testicular torsion
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10
Q

What investigations would you do if you suspect renal calculi?

A
  1. Bloods - FBC, U&E, calcium, phosphate, urate
  2. Urinalysis
  3. If urinalysis positive, MSU
  4. Imaging: NCCT-KUB (99% sensitive), KUBXR (70% sensitive)
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11
Q

Describe the management of renal calculi.

A
  1. ABC, anti-emetic, analgesic eg diclofenac
  2. Focussed history and examination
  3. Antibiotics if infection suspected
    Stones <5mm usually pass spontaneously
    Stones >5mm removed using tamsulosin, lithotripsy or nephrolithotomy.
    If infection + obstruction, urinary stent may be needed.
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