A Patient presents With Acute Abdominal Pain Secondary To Renal stones....

A 34-year-old man presents to an emergency surgery with abdominal pain. This started earlier on in the day and is getting progressively worse. The pain is located on his left flank and radiates down into his groin. He has had no similar pain previously and is normally fit and well. Examination reveals a man who is flushed and sweaty but is otherwise unremarkable.
What is the most suitable initial management?
A. Oral ciprofloxacin
B. IM diclofenac 75 mg
C. Oral co-amoxiclav and metronidazole
D. IM morphine 5 mg
E. IM diclofenac 75 mg + start bendroflumethiazide to prevent further episodes

Answer:
B. IM diclofenac 75 mg

Discussion: This man may need to be referred acutely to the surgeons for pain relief and investigations to exclude obstruction. It would not be suitable to start bendroflumethiazide in the initial phase of the first episode

Acute Management Of Renal Colic:
Medication 
 the British Association of Urological Surgeons (BAUS) recommend diclofenac (intramuscular/oral) as the analgesia of choice for renal colic
 BAUS also endorse the widespread use of alpha-adrenergic blockers to aid ureteric stone passage

Imaging 
 patients presenting to the Emergency Department usually have a KUB x-ray (shows 60% of stones)  the imaging of choice is a non-contrast CT (NCCT). 99% of stones are identifiable on NCCT. Many GPs now have direct access to NCCT Stones < 5 mm will usually pass spontaneously. Lithotripsy and nephrolithotomy may be for severe cases.

Prevention of renal stones 
Calcium stones may be due to hypercalciuria, which is found in up to 5-10% of the general population.
 high fluid intake
 low animal protein, low salt diet (a low calcium diet has not been shown to be superior to a normocalcaemic diet)
 thiazides diuretics (increase distal tubular calcium resorption)

Oxalate stones 
 cholestyramine reduces urinary oxalate secretion
 pyridoxine reduces urinary oxalate secretion

Uric acid stones 
 allopurinol
 urinary alkalinization e.g. oral bicarbonate