Calculi in kidney / ureter causing colic and obstruction.
History taking
- • Severe loin-to-groin colicky pain, haematuria, nausea
Examination
- • General: vitals, pallor, icterus, oedema, lymphadenopathy
- • Focused system examination
- • Look for red-flag findings
Red flags
- • Haemodynamic instability
- • Rapid deterioration
- • Severe pain or new neurological deficit
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • Urinalysis (haematuria), MCS
- • Non-contrast CT KUB (gold standard), USS in pregnancy
- • U&E, calcium, urate
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Treat underlying cause
- • Symptomatic relief
- • Patient education
Drug therapy
- • Diclofenac 75 mg IM for acute pain
- • Tamsulosin 400 µg OD for distal ureteric stones ≤10 mm
- • Hydration
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Fluid intake 2.5 L/day, reduce salt, moderate animal protein
Referral criteria
- • Urology if stone >10 mm, infection + obstruction (emergency), AKI
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
