Ureteric colic

Question 1

Features

Answer 1

Kidney (renal) colic is not a true colic but a constant pain due to blood clots or a stone lodged at the pelvic ureteric junction;

Ureteric colic, however, presents as severe true colicky pain due to stone movement, dilatation and spasm.

Question 2

typical radiation of pain in left ureteric colic

Answer 2

Question 3

Diagnosis

Answer 3

Plain X-ray: most stones (75%) are radio-opaque (calcium oxalate and phosphate). Stones <5 mm usually pass

Intravenous pyelogram: confirms opacity and indicates kidney function (limited value)

US: may locate calculus and exclude obstruction

Non-contrast spiral KUB-CT is the gold standard

Question 4

Management (average size adult)

Answer 4

Morphine 5 mg (IV) or fentanyl 50–100 mcg IV ± metoclopramide 10 mg IM or IV or hyoscine 20 mg IM if vomiting

Avoid high fluid intake

Indomethacin suppositories for further pain (limited to 2/d)

Options: diclofenac 75 mg IM; ketoralac 10–30 mg IM