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What causes nausea and pains in right upper quadrant when suffering from kidney stones?

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General Surgeon
Practicing since : 2008
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Last week I was very sick with nausea and jabbing pains in my right upper quadrant. I thought it was my gallbladder, but when I went to the ER, the xray showed it was a 9mm kidney stone. The ER doctor told me it was probably too big to pass, but I should have it removed. He referred me to a urologist, whom I saw yesterday. The new xray shows that the stone has worked its way into the ureter. The urologist chose to treat it with Tramsulosin. He explained that it could have trouble passing from the ureter into the bladder because of its size, but we would "deal with that if and when the time comes." In the meantime, I am not in excrutiating pain, just some jabbing pain here and there. I don't have a fever but I am a little bit nauseated and I am exhausted. The doctor said this stone could take a month to pass. I don't want to feel this way for a month, plus, I have been very anxious since I talked to the doctor because my husband had a kidney stone and it was not a pretty sight. My question is whether or not it would be appropriate (and medically sound) to ask the doctor to just go ahead and remove the stone so I can start feeling well again and get on with my life; plus I don't want to always worry about having problems passing this thing like my husband did.
Posted Fri, 31 Jan 2014 in Urinary and Bladder Problems
 
 
Answered by Dr. Ashish Verma 2 hours later
Brief Answer: You can take a call in 2 weeks if you are able to tolerate the pain now. Detailed Answer: Hi, This is Dr. Ashish Verma, general surgeon, answering your query. It's good that you got your doubts clarified. As I see this query here, I choose to give provide an opinion. When the stone passes down the ureter it distends it leading to pain and nausea/vomiting, and yes it may take a long time to pass in case of a large stone. But every person has his/her own pain threshold, and maybe your husbands stone was larger in size as compared to you. Also these pain and nausea can be easily controlled by analgesics and antiemetics. Therefore I think it is up to you who has to decide if you can bear that little jabbing pain with nausea. But if you ask me, I would say, if you can tolerate that (with medications), then you may wait for a few weeks to let the stone pass. But repeat the x-ray after a week to see if its moving down or not. If the stone is not at the same level even after two weeks, then I would suggest you go for endoscopic removal. Hope I have answered all your queries. If you still have any further doubts, I will be glad to answer them. Get well soon! Dr. Ashish Verma
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Follow-up: What causes nausea and pains in right upper quadrant when suffering from kidney stones? 6 hours later
Thank you for giving me a second opinion. I appreciate it because I am really torn as to what I should do. I guess my biggest fear is that I will be at work (Child Protective Services) and will suddenly start having terrible pain that people frequently describe as feeling "worse than having a baby." If I am out on a call with children in my car late at night, alone and/or driving, what would I do? So, my burning question (and probably one there is no answer for) is, how likely am I to pass an 8mm stone on my own without that level of difficulty, using Tramsulosin and pushing the water? It has moved ever so slightly in ten days, but it is moving, with mild to moderate discomfort, controlled fairly well with Ibuprofin. That's my big question. Is it likely to pass when it gets to my bladder without unbearable pain and nausea? Thank you so much for taking the time to give me another opinion. I sent the question by accident and didn't mean to undermine or doubt the other doctor's response.
 
 
Answered by Dr. Ashish Verma 21 minutes later
Brief Answer: you can do it, but its always your call Detailed Answer: Hi, You do have a genuine concern, but as you are saying that the stone is moving down (though its moving slowly) and the pain is mild to moderate and controlled fairly by ibuprohen...then i m sure you can continue with this...and this also answers your concern about sudden onset of pain during your work... See the thing is if the stone is moving down and you are able to tolerate the pain...its very rare that the pain level will increase more than this...at the most you may need a double dose of analgesic in case of an emergency... that should be acceptable to you... If not, then as i had said earlier, its your call, and will always be... Comming to your next concern...the lumen of urethera is more than the ureter...so the stone will pass down more easily... also the length of female urethera is just 4 cm, compared to 12-16cm of male urethera...it will pass down before you will know without getting struck... Hope i answered all your queries...if you dont have further queries, you may close this discussion and rate the response. Regards Dr. Ashish Verma
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