EMERGENCIES ALL SHOULD KNOW:RENAL COLIC

RENAL COLIC


The renal colic is a pain related to stones in urinary tract, comes in waves due to ureteric peristalsis. It may come in two varieties: dull and acute; the acute variation is particularly unpleasant and is often described as one of the strongest pain sensations felt by humans (being worse than childbirth, broken bones, gunshot wounds, burns, or surgery).

Passing kidney stones can be quite painful, the experience is said to be traumatizing due to pain, and the experience of passing blood, blood clots, and pieces of the stone. The majority of renal calculi contain calcium. The pain generated by renal colic is primarily caused by dilation, stretching, and spasm because of the acute ureteral obstruction.

Depending on the sufferer's situation, surgery may be needed to remove the stone which is impacted in the  urinary passage anywhere between kidney and urethra in both males and females.One may have kidney stones in one or both  kidneys or ureters. Blood clots, ureter spasms (tightening and relaxing), and dead tissue may also block the urinary tract.The pain may start quickly, come and go, and may become worse over time. One may have any of the following:

• Severe low back, abdominal, or groin pain. The pain may be so bad that you are not able to sit still. You may have pain when you urinate. The pain may also cause you to sweat and feel like your heart is beating faster than usual.
• Nausea and vomiting.
• Feeling the need to urinate often, or right away.
• Urinating less than what is normal for you, or not at all.

Most small stones are passed spontaneously and only pain killers and anti-spasmodics are required.There is typically no antalgic position for the patient (lying down on the non-aching side etc).

Medical treatment of nephrolithiasis involves supportive care and administration of agents, such as the following:

• IV hydration
• IV narcotic analgesics
• NSAIDS 
• Uricosuric agents (eg, allopurinol)
• Antiemetics
• Antibiotics 
• Alkalinizing agents (eg, potassium citrate, sodium bicarbonate): For uric acid and cysteine calculi
• Alpha blockers (eg, tamsulosin, terazosin)
  
  
  
  
  
  The reason why kidney stones are formed is still not known in many cases. Many waste chemicals are dissolved in the urine. The chemicals sometimes form tiny crystals in the concentrated urine which clump together to form a small stone.About half of the people who have a kidney stone develop another one at a later age in life.
  
  
  
  A stone that is stuck in a kidney may cause pain in the side of the abdomen.This is a severe pain which comes and goes and is caused by a stone that passes into the ureter (the tube that leads from the kidney to the bladder). The stone becomes stuck. The ureter squeezes the stone towards the bladder, which causes intense pain in the side of the abdomen. The pain may spread down into the lower abdomen or groin. The patient  may sweat or feel sick due to the pain.One may also see blood in  urine (urine turns red) caused by a stone rubbing against the inside of the ureter.Urine infections are more common in people with kidney stones. Infections can cause fever, pain on passing urine and increased frequency of passing urine.

 One is  more likely to form a stone if urine is concentrated. For example, if you exercise vigorously, if you live in a hot climate or if you work in a hot environment when you may lose more fluid as sweat and less as urine.

You are also more prone to develop kidney stones if you have:

• Recurrent urine or kidney infections.
• A kidney with scars or cysts on it.
• A close relative who has had a kidney stone.

The following are the battery of tests done if a person is having renal colic:

• Blood tests: routine blood tests,serum urea,creatinine  to know the function of kidneys,etc.
• Urine sample: A sample of your urine is collected and sent to a lab for tests for any infections.
• Renal ultrasound: A renal ultrasound is a test using sound waves to look at your kidneys. An ultrasound may show if you have a kidney stone or other problems that are causing your pain.
• Computed tomography scan: A computed tomography (CT) scan is a special x-ray using a computer to take pictures of your urinary tract. A CT scan may be done to check for stones and their size. A CT scan may also be done to check for other causes of your pain.
• KUB x-ray: A KUB  x-ray is a picture of your kidneys (K), ureters (U), and bladder (B).
• Intravenous pyelogram: An intravenous pyelogram (IVP) is an x-ray of your kidneys, ureters, and bladder. Dye is put into your IV before the pictures are taken.  People who are allergic to shellfish may be allergic to some dyes. You may need to have more than one x-ray over short periods of time during your IVP.
•    An analysis of the stone if you pass it out. To catch a stone, pass urine through gauze, a tea strainer or a filter    such as a coffee filter.

• The location and characteristics of pain in is related to site of stone in urinary tract:
  • Stones obstructing ureteropelvic junction: Mild to severe deep flank pain without radiation to the groin; irritative voiding symptoms (eg, frequency, dysuria); suprapubic pain, urinary frequency/urgency, dysuria, stranguria, bowel symptoms
  • Stones within ureter: Abrupt, severe, colicky pain in the flank and ipsilateral lower abdomen; radiation to testicles or vulvar area; intense nausea with or without vomiting
  • Upper ureteral stones: Radiate to flank or lumbar areas
  • Midureteral calculi: Radiate anteriorly and caudally
  • Distal ureteral stones: Radiate into groin or testicle (men) or labia majora (women)
  • Stones passed into bladder: Mostly asymptomatic; rarely, positional urinary retention

• Management:
• Some stones that form and stick in the kidney do not cause symptoms or any harm. They can just be left if they are small. Sometimes you may be offered medicines to help the small stone pass through, such as  tamsulosin.
• The size of the stone is an important predictor of spontaneous passage. A stone less than 4 mm in diameter has an 80% chance of spontaneous passage; this falls to 20% for stones larger than 8 mm in diameter. However, stone passage also depends on the exact shape and location of the stone and the specific anatomy of the upper urinary tract in the particular individual.

       

Some stones become stuck in a ureter or kidney and cause persistent symptoms or problems. In these cases, the pain usually becomes severe and you may need to be admitted to hospital. There are various treatment options which include the following:

• Ureteroscopy is another treatment that may be used. In this procedure, a thin telescope either (flexible or rigid) is passed up into the ureter via the urethra and bladder. Once the stone is seen, a laser (or other form of energy) is used to break up the stone. This technique is suitable for most types of stone. The stone removal is followed by the  placement of DJ(Internal ureteral) stents which form a coil at either end, One coil forms in the renal pelvis and the other in the bladder. Stents are available in lengths from 20-30 cm and in 3 widths from 4.6F to 8.5F. The stents allow proper functioning of kidneys and are later removed usually after 4 weeks by a minor procedure.

• Extracorporeal shock wave lithotripsy (ESWL). This uses high-energy shock waves which are focused on to the stones from a machine outside the body to break up stones. You then pass out the tiny broken fragments when you pass urine.

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• Percutaneous nephrolithotomy (PCNL) is used for some select stones not suitable for ESWL. A nephroscope (a thin telescope-like instrument) is passed through the skin and into the kidney. The stone is broken up and the fragments of stone are removed via the nephroscope. This procedure is usually done under general anaesthetic.

About half of people who have a kidney stone develop another one within 10 years. Sometimes stones can be prevented from forming.f you have had one stone, you are less likely to have a recurrence if you drink plenty of fluid, mainly water, throughout the day (and night). The aim is to keep the urine dilute. (Your urine is more dilute if it is clear of colour rather than a dark yellow colour.) To do this, you should drink between two and three litres a day (unless your doctor advises otherwise if you have other medical problems). If you work or live in a hot environment, you should drink even more.

• A dietitian may advise people with calcium oxalate stones to reduce the oxalate content of their diet. This may include reducing rhubarb, coffee and spinach.
• Uric acid stones can be prevented with a medicine.

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PRIAPISM

ACUTE URINE RETENTION

SEVERE PALLOR

ABSCESS

ANIMAL BITES

POISONING

BURNS

SEIZURES

PARALYTIC STROKE

ANY PREGNANCY RELATED EVENT

SUDDEN LOSS OR IMPAIRMENT OF VISION

SUDDEN HEAD ACHE AND VOMITING

HIGH GRADE FEVER

NON-RESPONSIVENESS

VIOLENT BEHAVIOUR

SUDDEN CALF PAIN

SEVERE BREATHLESSNESS