I. Concept
Renal colic is a sudden and severe colic caused by the obstruction of the ureter by stones, clots, or detached necrotic tumor tissue, which causes spasm of the smooth muscle of the renal pelvis or ureteral wall, resulting in an acute increase in the pressure of the renal pelvis, and is one of the common clinical acute abdominal conditions.
Second, the etiology
Any lesion that can lead to ureteral obstruction may cause the occurrence of renal colic. The common causes of renal colic are as follows.
1, kidney, ureteral stones: is the most common cause of renal colic, due to the downward movement of stones caused by spasm of the renal pelvis, ureteral smooth muscle.
2, renal pelvis, ureteral inflammation: due to the stimulation of inflammation or the production of pus blocking the ureter. It is more common in women.
3, kidney, renal pelvis or ureteral tumor: acute obstruction of ureter caused by tumor necrosis, hemorrhage formation of blood clots and/or dislodged tissue can induce renal colic.
4.Celiac disease: When the celiac mass in urine causes obstruction of renal pelvis and ureter, it can cause colic.
5.Dietl crisis: It is a special case of renal colic, which is induced by the acute obstruction of ureter caused by the acute obstruction of ureter caused by the sudden dropping of kidney after standing or running and jumping of patients with renal prolapse, and the pain can be relieved after lying down.
Clinical manifestations
1. Symptoms: Sudden onset of severe colic in the affected lumbar region, radiating downward to the lower abdomen, groin, inner thighs and perineum along the ureteral route, with unbearable pain, nausea, vomiting, and even pallor, profuse sweating, fine pulse and decreased blood pressure. The pain is paroxysmal, lasting from a few minutes to several hours, and is relieved with the release of the obstruction, and can last for several days after the colic turns into pure pain. Occasionally, the obstruction is on one side and the pain is on the opposite side, that is, “renal reflex pain”, which should be noted during diagnosis and treatment.
2.Signs: There is obvious pressure pain and percussion pain in the kidney area on the affected side, and there is pressure pain along the ureteral travel area, but there is no pressure pain and percussion pain in the kidney area on the opposite side. Sometimes the urine is hematuria in the naked eye.
IV. Diagnosis
According to the medical history and typical clinical manifestations, the diagnosis of renal colic is not difficult, the key lies in defining the cause and making a good differential diagnosis. In clinical practice, symptomatic treatment is usually given first, and then relevant examinations are performed to clarify the cause after the symptoms are relieved.
The past and present history of the patient can help to find the cause of renal colic.
1. If hematuria occurs after colic, it may be a kidney or ureteral stone; if renal colic is accompanied by urinary frequency, urinary urgency and difficulty in urination, it may be a stone at the end of the ureter.
2. If there is painless hematuria first, followed by colic attack, it may be kidney tumor, renal pelvis tumor or ureteral tumor.
3.Kidney colic with pus urine may be inflammation of renal pelvis and ureter.
4.Kidney colic after activity, pain relief when lying down, and discharge of large amount of urine, may be renal prolapse.
5.Kidney colic with celiac mass may be due to celiac disease.
Some auxiliary tests can also help to find the cause of renal colic.
1.X-ray examination KUB+IVU examination is performed 3-4 weeks after the complete relief of colic, which can detect kidney or ureteral stones, tumor, renal prolapse, etc., and help to understand the kidney function and whether the kidney and ureter have dilated fluid.
2.B ultrasound examination It is a convenient, effective and non-invasive examination, which is generally preferred. It can find out whether there are kidney or ureteral stones, tumors, renal prolapse, pyelonephritis and hydronephrosis, etc.
3.CT and retrograde ureterogram are helpful to detect small kidney and ureter negative stones.
4.Celiac test can confirm the diagnosis of celiac disease.
V. Differential diagnosis should be done when diagnosing renal colic, and the diseases that need to be differentiated from renal colic are.
1, acute appendicitis Typical abdominal pain attack starts in the upper abdomen, and then shifts to the right lower abdomen after 6-8 hours, with persistent pain; there is pressure pain and rebound pain in the right lower abdomen, and abdominal muscle tension. Urinalysis is usually normal, with elevated leukocytes in the blood count. In a few cases of posterior appendicitis involving the ureter, there may be red and white blood cells in the urine, but there is no image of urinary stones on X-ray.
2, biliary ascariasis Sudden subxiphoid paroxysmal drill-top-like severe colic, intermittent as normal, no obvious positive signs on examination, urine routine is generally normal.
3, acute cholecystitis Often after eating greasy food, severe colic in the right upper abdomen, radiating to the back of the right shoulder. On physical examination, there is pressure pain, rebound pain and muscle tension in the right upper abdomen, and Murphy’s sign is positive; ultrasound examination shows an enlarged gallbladder, and routine blood tests show an increase in white blood cells, but routine urine is negative.
4, acute pancreatitis History of overeating or alcoholism, persistent severe pain in the upper abdomen to the left, radiating to the shoulder or lower back, accompanied by nausea and vomiting. The examination has epigastric pressure pain. Routine urine examination is usually negative, blood and urine amylase are often increased.
5. Ovarian cyst torsion Sudden onset of severe colic in the left or right lower abdomen, accompanied by nausea and vomiting. There is mostly a history of lower abdominal masses. The lower abdomen and vagina can be identified by double examination and pelvic ultrasound.
6. Ectopic pregnancy Sudden severe tearing pain in the lower abdomen, accompanied by vaginal bleeding and shock. Most of them have a history of menopause. On physical examination, there is pressure pain and rebound pain in the lower abdomen or the whole abdomen, with positive mobile turbid sounds. The gynecological examination shows fullness of the posterior fornix, painful cervical lifting, and non-coagulated blood can be extracted by posterior fornix puncture.
The treatment principle of renal colic is to relieve spasm and pain, prevent infection and remove the cause of the disease.
1, antispasmodic and analgesic treatment Commonly used drugs are atropine, 654-2, diclofenac sodium, prednisolone, dulcolax, etc. Calcium antagonists such as cardiac pain can inhibit the spasmodic contractility of ureteral smooth muscle, which is often used in clinical practice.
2, the application of antibiotics to prevent infection, intravenous fluids to maintain adequate urine volume to promote the discharge of stones.
3.Remove the cause After the symptoms of renal colic are relieved, after further examination to clarify the diagnosis, carry out relevant treatment for the cause.