Renal Colic and Other Colicky Pain Syndromes
PAIN MANAGEMENT AND PROCEDURAL (CONSCIOUS) SEDATION IN THE EMERGENCY SETTING, Özgür Karcıoğlu,MD,Professor,Canan Akman,Associate Professor,Gökhan Yılmaz,Pınar Yeşim Akyol, Editör, Turkiye Klinikleri, Ankara, ss.177-193, 2026
- Yayın Türü: Kitapta Bölüm / Mesleki Kitap
- Basım Tarihi: 2026
- Doi Numarası: 10.5336/978-625-5439-05-5_p177
- Yayınevi: Turkiye Klinikleri
- Basıldığı Şehir: Ankara
- Sayfa Sayıları: ss.177-193
- Editörler: Özgür Karcıoğlu,MD,Professor,Canan Akman,Associate Professor,Gökhan Yılmaz,Pınar Yeşim Akyol, Editör
- Eskişehir Osmangazi Üniversitesi Adresli: Evet
Özet
RENAL COLIC AND OTHER COLICKY PAIN SYNDROMES
Colicky pain represents one of the most prevalent chief complaints encountered in emergency me-dicine, encompassing a spectrum of conditions arising from the urinary collecting system, biliary tract, gastrointestinal tract, and reproductive organs. The shared pathophysiological mechanism is the generation of visceral pain through smooth muscle spasm against an obstruction or inflammatory stimulus, mediated primarily through prostaglandin-dependent pathways. Among colicky syndromes, renal colic secondary to nephrolithiasis is the most common, affecting approximately one in ten adults in Western populations, with a rising global incidence strongly linked to metabolic comorbidities, dietary factors, and climate-related determinants.
In the emergency department (ED), the assessment of a patient with colicky pain requires a systematic approach that simultaneously achieves effective analgesia, confirms the diagnosis through approp-riate laboratory and imaging investigations, identifies conditions requiring urgent intervention, and excludes life-threatening diagnoses that may present with a similar clinical picture. Renal colic is evaluated with urinalysis and non-contrast computed tomography of the abdomen and pelvis, which remains the gold standard for stone detection with sensitivity exceeding 95%. Point-of-care ultra-sound is an effective first-line alternative in patients with known urolithiasis and in pregnant patients. Non-steroidal anti-inflammatory drugs, particularly ketorolac or diclofenac, are superior to opioids as first-line analgesics and are endorsed by current European Association of Urology guidelines. Me-dical expulsive therapy with tamsulosin is indicated for distal ureteral stones of 5–10 mm in patients selected for conservative outpatient management. Fever in the setting of suspected renal colic man-dates consideration of obstructed infected kidney, a urological emergency requiring prompt drainage.
Biliary colic and acute cholecystitis, the second most clinically important colicky syndromes in emer-gency practice, require differentiation by clinical duration, fever, and inflammatory markers, with abdominal ultrasonography as the diagnostic cornerstone. Early laparoscopic cholecystectomy within 72 hours is the recommended definitive treatment for confirmed acute cholecystitis. Intestinal colic demands exclusion of small bowel obstruction and acute mesenteric ischemia, a rapidly fatal condi-tion requiring immediate diagnostic and therapeutic action. Other colicky syndromes, including pri-mary dysmenorrhea, adnexal torsion, and early appendicitis, carry specific diagnostic and therapeutic requirements that the emergency physician must recognize promptly.
This chapter provides emergency physicians with a structured, evidence-based framework for the recognition, differential diagnosis, and management of all major colicky pain syndromes encountered in the ED setting, with emphasis on the primacy of adequate analgesia, rational imaging use, and the identification of conditions requiring urgent specialist consultation.
Keywords: Renal colic; Nephrolithiasis; Visceral pain; Urolithiasis; Pain management; Analgesic