A patient with right/left loin pain.

A 25 years old male presented with severe colicky pain in the left loin for 2 hours.

What are the diagnoses striking in your mind?

Renal colic due to

• Nephrolithiasis (renal stone)
• Blood clot
• Sloughed papillae

 

What key questions would you ask?

Pain-

colicky loin pain radiates to groin, testis and inner side of thigh.

Vomiting, dysuria and haematuria– ureteric stone

What would you examine?

General examination– distressed with pain.

Abdominal examination– normal.

Clinical diagnosis–

Typical loin pain with radiation as above and haematuria suggest the diagnosis of renal colic.

 

Investigation-

• Urine for R/M/E- red cells may suggest renal stone.
• Plain X-ray KUB- to confirm the presence of a stone, and to identify the site of the stone. About 90% of stones contain calcium and are seen on a plain abdominal X-ray except uric acid stones.
• USG of KUB- Ultrasound may show dilatation of the ureter if the stone is obstructing urine flow. The stone may also cast an acoustic shadow.
• Further investigations- IVU, Spiral CT scan- not usually available at primary and secondary level.

 

Treatment-

Relieve of pain-

• Bed rest
• Application of warmth to the site of pain.
• Analgesia, e.g. morphine (10-20 mg), pethidine (100 mg) intramuscularly or diclofenac as a suppository (100 mg).
• Patients are advised to drink 2 L per day.

 

(Around 90% of stones < 4 mm in diameter will pass spontaneously, but   only 10% of stones of > 6 mm will pass and these may require endoscopic / surgical intervention.)

• Referral to urologist for further management.