Doctor, I have very severe pain on the left side of abdomen since 6 hours. It started suddenly in the morning.
1. Is the pain colicky & intermittent, or continuous? “Doctor, it is colicky.” (It could be ureteric colic or large bowel colic. Not appendicular colic as it is on left side) 2. Does it radiate to the penis or testis? Is there burning at miturition or difficulty? “Yes, and I have a continuous urge to pass urine.” (That’s a Ureteric colic). 3. Did you have loose motions, or mucus in stools? “No” (Amoebic or infective colitis can give severe colics or cramps) 4. Did you have fever? “No” (That rules out UTI) 5. Did you hae vomiting? “Yes” (Vomiting may be severe enough to cause dehydration and need IV fluids)
Palpate the abdomen gently. There is very mild tenderness in the left iliac fossa & renal angle. Tenderness is never seen in ureteric colic. If tenderness is significant, think of amoebic colitis or other causes of acute abdomen.
Whenever ureteric colic is suspected, test urine for RBCs. Tiny stones or crystals may not be seen on KUB X-ray or Ultrasonography, But RBCs in urine confirm the diagnosis.
In a female, menstrual history and a PV examination (and USG) is a must to rule out Ectopic pregnancy and twisted ovarian cyst.
Key points for colic in LIF : Left ureteric colic, amoebic colitis, In females – ruptured left ectopic, twisted left ovarian cyst. Action :
First make the patient comfortable with Inj. Anafortan (Anti-spasmodic) IM, Inj. Fortwin or Norphin IV, Inj. Diclofenac, And Inj. . Atropin.
IV Fluids and hydrotherapy to flush down the stone.
Urine routine, Xray KUB, and Ultrasonography. If stone is >5mm., or if there is hydronephrosis, refer the patent to urologist.
