Urinary Colic due to Calculus Flashcards
Cause of pain in urinary colic due to stone?
Pain due to prostaglandins released
What are stones made of?
Calcium phosphate
-Calcium oxalate
Initial investigations for colic due to stone?
- Urine dipstick and culture
- Serum creatinine and electrolytes
- FBC/CRP
- Calcium/urate
- Also: clotting if percutaneous intervention planned and blood cultures if pyrexial or other signs of sepsis
Investigations for urinary colic caused by calculus?
CT KUB: all patients with 14h of admission
USS sensitivity is much lower than CT KUB
Management for urinary colic caused by stones?
- Start with diclofenac 75mg IM
- NSAID as analgesia of choice
Treatment if stone burden of less than 2cm in aggregate?
Lithotripsy(shock waves)
Treatment of stone with burden of less than 2cm in pregnant females?
Ureteroscopy
Management of complex renal calculi and staghorn calculi?
Percutaneous nephrolithotomy
Stone in pregnancy treatment?
Ureteroscopy
Management in colic if there is hydronephrosis?
Insert nephrostomy ASAP
What do patients with obstructive urinary calculi and signs of infection require?
Urgent renal decompression and IV ABs due to risk of sepsis
NICE Guidelines for renal stones <5mm?
Conservative: will usually pass spontaneously
Diclofenac
NICE Guidelines for renal stones 5-10mm?
Conservative or alpha blockers | Shock wave lithotripsy | Uteroscopy
NICE Guidelines for renal stones 10-20mm?
Shockwave lithotripsy/uteroscopy
|
Percutaneous nephrolithotomy
What is shockwave lithortripsy?
Shock wave is generated external to patient, internally cavitation bubbles and mechanical stress lead to stone fragmentation
Passage of shock waves can result in development of solid organ injury
Analgesia is required
