Renal colic

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Editor-In-Chief: Steven C. Campbell, M.D., Ph.D., Professor of Surgery, Residency Program Director, Section of Urologic Oncology, Glickman Urological and Kidney Institute, Cleveland Clinic. You can email Dr. Campbell by clicking here. Office phone: 216-444-5595.Soumya Sachdeva Luke Rusowicz-Orazem, B.S.

Overview

Renal colic is a type of pain commonly caused by kidney stones or accumulation of crystals. These kidney stones cause interference with the flow of urine and the kidney may swell up causing pain (colic).

The pain typically begins in the kidney area or below it and radiates through the flank until it reaches the bladder. The pain is colicky in nature, meaning that it comes on in spasmodic waves as opposed to being a steady continuous pain. It may come in two varieties: dull and acute; the acute variation is particularly unpleasant and has been described as one of the strongest pain sensations felt by humans.[2]

Depending on the type and sizes of the kidney stones moving through the urinal tract the pain may be stronger in the renal or bladder area or equally strong in both.

Differential diagnosis

Classification of acute abdomen based

on etiology

Presentation Clinical findings Diagnosis Comments
Fever Rigors and Chills Abdominal Pain Jaundice Hypotension Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging
Common causes of

Peritonitis

Spontaneous bacterial peritonitis + Diffuse Hypoactive
  • Ascitic fluid PMN>250 cells/mm³
  • Culture: Positive for single organism
Ultrasound for evaluation of liver cirrhosis -
Perforated gastric and duodenal ulcer + Diffuse + + + N
  • Ascitic fluid
    • LDH > serum LDH
    • Glucose < 50mg/dl
    • Total protein > 1g/dl
Air under diaphragm in upright CXR Upper GI endoscopy for diagnosis
Acute suppurative cholangitis + + RUQ + + + + ±
Acute cholangitis + RUQ + N Abnormal LFT Ultrasound shows biliary dilatation Biliary drainage (ERCP) + IV antibiotics
Acute cholecystitis + RUQ + Hypoactive Ultrasound shows gallstone and evidence of inflammation Murphy’s sign
Acute pancreatitis + Epigastric ± N Increased amylase / lipase Ultrasound shows evidence of inflammation Pain radiation to back
Acute appendicitis + RLQ + + Hypoactive Leukocytosis Ultrasound shows evidence of inflammation Nausea & vomiting, decreased appetite
Acute diverticulitis + LLQ ± + Hypoactive Leukocytosis CT scan and ultrasound shows evidence of inflammation
Hollow Viscous Obstruction Small intestine obstruction Diffuse + ± Hyperactive then absent Leukocytosis Abdominal X ray Nausea & vomiting associated with constipation, abdominal distention
Gall stone disease/Cholelithiasis ±
Volvulus - Diffuse - + - Hypoactive Leukocytosis CT scan and abdominal X ray Nausea & vomiting associated with constipation, abdominal distention
Biliary colic - RUQ + - - N Increased bilirubin and alkaline phosphatase Ultrasound Nausea & vomiting
Renal colic - Flank pain - - - N Hematuria CT scan and ultrasound Colicky abdominal pain associated with nausea & vomiting
Vascular Disorders Ischemic causes Mesenteric ischemia ± Periumbilical - - - Hyperactive Leukocytosis and lactic acidosis CT scan Nausea & vomiting, normal physical examination
Acute ischemic colitis ± Diffuse - + + Hyperactive then absent Leukocytosis CT scan Nausea & vomiting
Hemorrhagic causes Ruptured abdominal aortic aneurysm - Diffuse - - - N Normal CT scan Unstable hemodynamics
Intra-abdominal or retroperitoneal hemorrhage - Diffuse - - - N Anemia CT scan History of trauma
Gynaecological Causes Fallopian tube Acute salpingitis + LLQ/ RLQ ± ± N Leukocytosis Pelvic ultrasound Vaginal discharge
Ovarian cyst complications and endometrial disease Torsion of the cyst - RLQ / LLQ - ± ± N Increased ESR and CRP Ultrasound Sudden onset sever pain with nausea and vomiting
Endometriosis - RLQ/LLQ - +/- +/- N Normal Laproscopy Menstrual-associated symptoms, pelvic

symptoms

Cyst rupture - RLQ / LLQ - +/- +/- N Increased ESR and CRP Ultrasound Sudden onset sever pain with nausea and vomiting
Pregnancy Ruptured ectopic pregnancy - RLQ / LLQ - - - N Positive pregnancy test Ultrasound History of missed period and vaginal bleeding
Functional Irritable Bowel Syndrome - Diffuse - - - - N

Clinical diagnosis

-

Causes

Common Causes

Causes by Organ System

Cardiovascular Renal artery embolism
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Probenecid
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic Chilaiditi syndrome, Wilson's disease
Genetic No underlying causes
Hematologic Papillary necrosis
Iatrogenic No underlying causes
Infectious Disease No underlying causes
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic Endometriosis, Müllerianosis
Oncologic No underlying causes
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte Analgesic nephropathy syndrome, Chronic interstitial nephritis, Cystinuria, Danubian endemic familial nephropathy, Hydatiduria, Medullary sponge kidney, Nephrocalcinosis, Nephrolithiasis, Oxalosis, Papillary necrosis, Pyelocalyceal diverticulum, Renal artery embolism, The primary hyperoxalurias, Urinary blockage
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

Treatment and Prognosis

Most small stones are passed spontaneously and only pain management is required. For this type of pain, strong Non-steroidal anti-inflammatory drugs (NSAID) such as Diclofenac provide better pain relief than opiates. Lying down on the non-aching side and applying a hot bottle or towel to the area affected may help. If the pain is not too intense, a more speedy release of the stones may be achieved by walking.

Larger stones may require intervention for their removal.

See Also



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