Recognition and treatment of renal colic pain

The article was written by MSc Vu Ngoc Thang - General Surgery Department, Vinmec Times City International Hospital

Hepatic colic pain, common in people with a history of gallstones, pain is usually in the liver region towards the right shoulder, normal people have a specific hunched position in pain, palpable gallbladder, yellow skin... The patient may or may not have a fever.
The rupture of the abdominal aortic aneurysm also causes sudden pain, mainly pain in the back, the patient may be in a state of shock, tachycardia. Ultrasound can make the initial diagnosis. Depending on the clinical situation that decides to choose a diagnostic technique, in an emergency, the patient should be admitted to the hospital for monitoring and treatment with a cardiologist.
Retroperitoneal hematoma, common in anticoagulant users, or of unknown etiology, is easily diagnosed by ultrasound.
Renal infarction is diagnosed initially by Doppler ultrasound, later diagnosed by computed tomography or magnetic resonance.
The bleeding in the tumor or bleeding in the kidney cyst, the ruptured kidney tumor... the ultrasound diagnosis is relatively easy. - The acute pyelonephritis sometimes also manifests as renal colic but does not progress suddenly, gradually dull, cloudy urine sometimes with pyuria. Diagnosis is based on clinical, laboratory, and imaging techniques for poor signs.

Acute appendicitis, especially the appendix in the posterior cecum, has many clinical signs that are difficult to distinguish from ureteral stones, but pain is usually localized to the right iliac fossa, with clinical signs of infection (disorder) Digestive diarrhea, dry lips, dirty tongue, high white blood cell count). Enteritis, spastic colitis, and diverticulitis also have some suggestive gastrointestinal findings.
Fitz - Hugh - Curtis syndrome: the patient has right upper quadrant pain due to inflammation around the liver originating from appendicitis (bacteria from inflammatory foci in the pelvic region - ovaries, fallopian tubes...) along the mesentery. The ovary spreads along the peritoneum, along the right colonic groove to the perihepatic area.
ruptured ectopic pregnancy, pain is often in the lower pelvic region, there may be signs of internal bleeding, blood loss shock, there are localized signs. Adnexal torsion, ovarian tumor also have specific signs.
Some other pain may appear suddenly, moderate, patient can tolerate, no fever. Common back pain caused by exertion, patients often relieve pain when immobilized in a certain position.
The radiculitis, sciatica... In some cases of lower lobe pneumonia, acute pleural effusion also has some signs that are easily confused with acute obstruction of the urinary tract [5].

Do not drink a lot of water. Initial treatment with analgesia, antispasmodic: The typical renal colic pain will reduce clinical signs after a few minutes, can give the drug again after a few hours. After the pain is over, you can drink water normally and proceed to find the cause in unclear cases.

Management of some emergency cases: the goal of preserving kidney function by acute excretory drainage (upstream ureteral catheterization, percutaneous drainage, endoscopic lithotripsy...) can be achieved with the following indications. to determine the pain of anuria, analgesia, ineffective analgesia, bilateral ureteral stones, single kidney, transplanted kidney.

Urinary tractography and ultrasonography are the initial tests of choice, of which ultrasound is used first and is most effective for the differential diagnosis of renal colic from other causes.
Non-enhanced multislice computed tomography is usually applied at the outset for some complex cases. When renal function is needed to be assessed, a combination of UIV or contrast-enhanced computed tomography may be used. Urine and blood tests are also essential for diagnosis.
Currently, Vinmec International General Hospital is equipped with a 640-slice CT scanner TSX - 301C manufactured by Toshiba capable of supporting diagnosis on an area up to 16 cm wide, fast speed allows one rotation of the image. The whole heart can be detected, helping to optimally diagnose coronary, vascular and systemic arteries. In particular, this machine can reduce up to 90% of radiation dose, so it can be taken for pregnant women when indicated.