From the Guidelines
Kidney stones typically do not cause pain in the epigastric region. The pain from kidney stones, known as renal colic, usually begins in the flank (the area between the ribs and hip) or lower back and may radiate to the lower abdomen and groin. This pain pattern follows the path of the ureter as the stone moves from the kidney toward the bladder. The epigastric region, which is the upper middle portion of the abdomen just below the sternum, is more commonly associated with pain from conditions affecting the stomach, pancreas, or gallbladder. If you're experiencing epigastric pain, it's more likely related to these organs rather than kidney stones. However, pain can sometimes be referred to different areas, and individual experiences may vary.
Key Points to Consider
- The location and size of the stone are important determinants in stone passage and the need for invasive management, with larger and more proximally located stones being associated with lower rates of spontaneous passage 1.
- Imaging, such as noncontrast CT (NCCT), plays a crucial role in the diagnosis of stones and assessment of alternative diagnoses, complications, and appropriateness of potential therapies 1.
- For patients with known disease and recurrent symptoms of urolithiasis, NCCT remains the test of choice for evaluation 1.
Clinical Implications
If you're experiencing persistent abdominal pain, regardless of location, it's essential to seek medical evaluation to determine the cause and appropriate treatment. A thorough medical history, physical examination, and imaging studies, such as NCCT, can help diagnose the underlying cause of the pain and guide treatment decisions.
Important Considerations
- The American College of Radiology recommends NCCT as the imaging study of choice for initial evaluation of patients with acute onset of flank pain and suspicion of stone disease without known prior stone disease 1.
- Ultrasound may have a role in evaluating for signs of obstruction, but its sensitivity is lower compared to NCCT 1.
From the Research
Kidney Stone Pain Location
- Kidney stones can cause severe pain, but the location of the pain is not always in the epigastric region.
- The epigastric region is the upper middle part of the abdomen, and kidney stone pain is typically felt in the flank or lower back area 2.
- However, it is possible for kidney stone pain to radiate to other areas, including the abdomen, but this is not typically described as being in the epigastric region specifically.
Characteristics of Kidney Stone Pain
- Kidney stone pain is often described as severe and crampy, and can be accompanied by nausea, vomiting, and frequent urination 2.
- The pain can be constant or come and go, and can be exacerbated by movement or activity.
- The location and severity of the pain can vary depending on the size and location of the stone, as well as the individual's overall health.
Treatment of Kidney Stone Pain
- Treatment for kidney stone pain typically involves pain management with medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids 3, 4.
- NSAIDs are often preferred for kidney stone pain due to their anti-inflammatory properties and lower risk of addiction compared to opioids 4.
- In some cases, medical expulsive therapy with an alpha blocker may be used to help pass the stone, and lifestyle modifications such as increased fluid intake can help prevent future stone formation 2.