41-year-old Patrick Granite has been diagnosed with renal calculi. He presented with excruciating pain to the Emergency Department (ED) describing pain which “moves” radiating from his back to his groin; on presentation he was administered a strong analgesic (Morphine). Now on the ward, Patrick indicates his pain has increased again. The Registered Nurse administers prescribed PRN analgesic Oxycodone 5mg and 1g of Paracetamol. Patrick is confused about his condition and asks you what is causing this intense moving pain.

• Explain to Patrick what is occurring in his body to cause this pain. In your explanation, you need to outline the pathophysiology of this condition so that the marker will recognise your understanding, but also that the patient will understand.

ANSWER

Patrick, the intense moving pain you’re experiencing is a result of a condition called renal calculi, commonly known as kidney stones. Let me explain the process happening in your body to help you understand why you’re feeling this way.

Kidney stones are small, hard deposits that form within your kidneys. These deposits can be made up of different substances, such as calcium, oxalate, uric acid, and cystine. The pain you’re feeling is due to the passage of these kidney stones from your kidneys through your urinary tract, which includes your ureters, bladder, and urethra.

As the kidney stones travel through your urinary tract, they can cause irritation, inflammation, and even blockages. The pain often starts when a stone moves from your kidney to your ureter, which is the narrow tube connecting your kidney to your bladder. The pain you’re experiencing is commonly described as colicky pain because it comes and goes in waves and can be quite severe.

When a kidney stone moves and gets stuck in a narrow part of your urinary tract, it causes a blockage. This blockage disrupts the normal flow of urine and can lead to increased pressure in the affected area, which contributes to the pain you’re feeling. The pain can radiate from your back to your groin as the stone’s movement triggers nerve responses in various areas along the urinary tract.

To help manage this pain, you’ve been prescribed analgesics like Oxycodone and Paracetamol. These medications work to relieve your pain by targeting pain receptors in your body and reducing the sensations of discomfort.

The treatment for kidney stones varies depending on the size and location of the stones. Some smaller stones may pass on their own with proper hydration and pain management, while larger stones may require medical intervention to break them down or remove them.

I hope this explanation helps you understand why you’re experiencing this intense pain. Please remember that you’re not alone in this, and our healthcare team is here to support you throughout your treatment. If you have any more questions or concerns, feel free to ask.