2. IntroductionIntroduction
• T10-12, L1 roots innervate the renal
capsule and ureter.
• Pain from these structures is felt in these
dermatomes.
• Urinary tract & GIT share the same
autonomic innervation, that’s why renal
colic is usually associated with GI
symptoms.
5. • Course:Course: constant.
• ProgressionProgression: progressive.
• Relieving & Exacerbating factors:Relieving & Exacerbating factors: patient
tries changing his position in bed, or walking,
but usually fails to relieve the pain. Relieved
by analgesics.
• AssociatedAssociated Hematuria, urinary frequency,
dysuria, fever, sweating, nausea & vomiting.
7. • Patient usually describesdescribes the pain by
spreading his hand around his waist with
his fingers covering the renal angle & his
thumb above the anterior superior iliac
spine.
• Acute Pyelonephritis and acute
ureteral obstruction both cause
this typical pain.
8. Ureteral ColicUreteral Colic
• Site:Site: Originates at the costo-vertebral
angle.
• Radiation:Radiation: Lower quadrant of abdomen,
upper thigh and ipsilateral testicle or
labium.
• Onset:Onset: Sudden.
• Duration:Duration: variable.
• Nature:Nature: colicky, gripping.
• Intensity:Intensity: Severe.
9. • Course:Course: attacks, pain is less severe in
between, but never disappears
completely.
• ProgressionProgression: progressive.
• Relieving & Exacerbating factors:Relieving & Exacerbating factors:
patient tries changing his position in bed,
or walking, but usually fails to relieve the
pain. Relieved by analgesics.
• AssociatedAssociated Hematuria, urinary frequency,
dysuria, fever, sweating, nausea &
vomiting.
10.
11. Ureteral ColicUreteral Colic
• Typical of sudden ureteric distension &
associated distension of the renal pelvis.
• Most commonly due to calculi.
• Less commonly due to tumor, or blood
clot.
12. • Ureteral colic caused by stone in the
upper ureter may be associated with
severe pain in the ipsilateral testicle; due
to the common innervation of these
structures (T11–12).
• Stone in the lower ureter may cause pain
referred to the scrotal wall.
13. • Stones in mid-ureter on the right side,
causes pain referred to McBurney’s point
and may therefore simulate appendicitis.
• On left side it may resemble diverticulitis
or other diseases of the descending or
sigmoid colon (T12, L1).
14. On ExaminationOn Examination
• General examination: Agitated, in pain,
pallor, fever, tachycardia.
• Abdomen tense & rigid.
• Loin tenderness.
• Kidney enlargement.
18. IVU Vs. CT scanIVU Vs. CT scan
IVUIVU::
• More readily available.
• Less irradiation.
• Easy to interpret.
• More economical.
• Kidney function.
19. CT scanCT scan::
• Quick.
• No risk of contrast allergy.
• High specificity.
• Detailed anatomy.
• Shows other pathology.
20. ManagementManagement
• Bed rest.
• Hydration.
• Analgesia: Morphine I.M. (10-20 mg),
Pethidine I.M. (100 mg).
• Anti-emetic.
• Further management according to the
cause.
21. Renal Stones ManagementRenal Stones Management
• On this conservative regime 60% of all
stones pass spontaneously.
• However 30% of stones do require
surgical removal whilst the remaining 10%
may be followed expectantly.
22. • >90% of kidney stones are treated by
Extracorporeal Shock Wave Lithotripsy.
• For Staghorn calculi: Percutaneous
Nephrolithotomy or conventional open
surgery (Pyelolithotomy) are still indicated
on occasion.
24. Surgery indicated ifSurgery indicated if::
1.Large stone.
2.Infection with severe obstruction.
3.Failure of conservative measures.
4.To correct anatomical abnormalities.
25. Ureteric Stones ManagementUreteric Stones Management
• 60% of all ureteric calculi will pass within a
week to a month of onset of symptoms.
• Only 30% will require surgical removal.
• Most ureteric calculi are treated by ESWL.
• Push-bang treatment.
26. • Rigid or flexible Ureteroscopes can be
used if ESWL fail.
• Stone fragmentation using laser, EHL and
Ultrasound probes.
27. Surgery indicated ifSurgery indicated if::
1.Stone is too large to pass spontaneously
(>7 mm).
2.Causing obstruction & impairing renal
function.
3.Proximal infection combined with
obstruction.
28. ReferencesReferences::
1. Smith’s General Urology, 17th
edition, Chapter 3,
Page 30-34.
2. Davidsons’s principles & practice of medicine.
3. Oxford handbook of urology.
4. Bates’ guide to physical examination and history
taking, 10th
edition, Chapter 11, Page 428-429.
5. Textbook of medicine, Das.
5. Browse’s introduction to the symptoms & signs of
surgical disease, Chapter 16, Page 435-436.
6. Hutchinson’s clinical methods, 22nd
edition, Chapter
14, Page 293.
Editor's Notes
Nausea & vomiting
(T10–12, L1)
Usually present early due to pain severity.
Both Stomach & Kidney supplied by celiac ganglion hence Nausea & vomiting common in renal colic
Due to distension of renal capsule.
Patients even describe it as worst pain they have ever experienced.
