RENAL COLIC.
Renal colic implies severe and often agonizing pain, which follows spasmodic contraction of the renal pelvis and ureter, in the effort to expel an obstructing object from one or the other. It may be produced by calculi, by clots of blood, clumps of pus and debris, by particles of sloughing tissue (as in breaking-down tuberculous or cancerous foci), by extrinsic pressure of various morbid products, or finally by kinking or alternating stricture and dilatation of the ureter. Pain is the constant and significant feature, marked by spasmodic exacerbation. It is usually well localized, and referred along the course of the ureter and the cord to the testicle in the male, with retraction of the scrotum, to the labium in the female, and down the thigh in both sexes. With it there usually occur more or less sympathetic disturbances, such as nausea, with most pronounced local tenderness and sometimes abdominal rigidity.
Treatment.
—Treatment, while palliative during the intensity of the attack, should be later made radical. For the former hot applications, morphine, and chloroform inhalations may be used. It may happen that an almost complete inversion of the patient will be followed by relief. Large does of glycerin, and sometimes of aspirin, will also occasionally prove beneficial. Meantime the case should be carefully studied and a skiagram be taken, in order that one may intelligently advise and carry out whatever indications may be revealed.
RENAL CALCULUS.
Renal and vesical calculi are the result of the precipitation of material previously held in solution by the urine as it escapes from the tubules, their nuclei or nidi being usually a clump of cells, particles of blood clot or of tissue. They are composed mainly of uric acid, urates or oxalates, less abundantly of phosphates, and rarely of cystin or xanthin. They vary in size from the smallest visible particle to those weighing ounces, and in number from one to hundreds. They occur more often in males, and usually late rather than early in life. They may be found in one or both kidneys. When the latter it may be assumed that some systemic defect underlies their formation. In shape they vary greatly, the small, sharp particles often causing as much pain as do large stones, or even more. Diathetic conditions produce them in some de novo, while in others they result from previous morbid processes.
Small calculi escaping into the bladder cause intense [renal colic] (see above), and, within the latter, unless they escape through the ureter, as they usually do when small or are not retained behind a large prostate, they increase in size, and become then the common vesical calculi, those with uric acid nuclei. Calculi long present in the kidney usually set up what is known as calculous nephritis or pyelonephritis. It is quite possible, however, for such a concretion to first form within the tubules or at the apex of one of the pyramids, so that it does not fall free into the renal cavity. In such locations it may produce great pain, with hematuria and tenderness, yet not for a long time escape into the renal pelvis. Such a stone may be shown by a good skiagram. Calculi long retained will cause other troubles, whose characteristics will be revealed by careful study of the urine, especially of that drawn from the affected kidney, albuminuria and pyuria often figuring. The symptoms include pain and tenderness, which may be referred; colic, hematuria, and pyuria. Symptoms of less frequency include thamuria (sometimes painful), nausea, and vomiting. The accompanying features include pyonephrosis, tuberculous or movable kidney, or possibly various neoplasms.
Symptoms.
—Stone in the ureter may cause symptoms likely to be mistaken for appendicitis, especially when lodged on the brim of the pelvis, or an inflamed appendix may hang over into the pelvis and cause bladder and rectal symptoms, while on palpation through the vagina the tenderness and thickening may be misleading. In such cases the urine offers the surest guide. Acute pancreatitis should hardly be mistaken for renal trouble, as there would be a history of former attacks of indigestion, probably associated with typical gallstone colic, while the location of pain and the presence of pancreatic enlargement would be significant. In pancreatitis, moreover, the urine might show sugar. Renal or ureteral colic is sometimes followed by such reflex paralysis of the bowel, with meteorism and tenesmus, perhaps even with nausea and vomiting, as to suggest intestinal obstruction. Again, the crises of Henoch’s purpura, and of angioneurotic edema, sometimes accompanied by hematuria, may mislead.
Inspection of the entire body will probably reveal purpuric spots or areas of edema.