GU ER Flashcards
Microscopic Hematuria value
Laboratory diagnosis (> 3 RBC/HPF)
Initial Hematuria
● Blood clearing at the beginning of stream or small
clots in the underwear
○ Urethral bleeding (below the bladder neck)
Gross Hematuria
● Bright red blood throughout micturition
○ Lower tract (bladder, ureters, prostate)
Casts, Protein, Dysmorphic RBCs
● Casts, significant proteinuria (>1,000 mg/24 hours),
dysmorphic RBCs
○ Upper tract (renal, glomerular)
Hematuria imaging
● KUB
● Ultrasound w/ post void residual
● CT Urogram
Cystitis Presentation
● Urgency, frequency, hesitancy, dysuria, hematuria, and/or suprapubic tenderness
● CVA tenderness may be present due to referral pain
● Vaginal discharge or irritation is more often associated with vaginitis, cervicitis, or
pelvic inflammatory disease
Bacteriuria lab on urinalysis
○ >1 bacterium/HPF is 95% sensitive and
>60% specific to predict a positive culture
○ False positives can result with contamination
or presence of epithelial cells
Does uncomplicated UTI need a urine culture?
maybe
○ If done, inform the Pt that you will
notify them of C&S results in afew days
to adjust the treatment if needed
Does complicated cystitis need a urine culture?
Urine Culture – yes
○ If done, inform the Pt that you will notify them of C&S results in a few days to adjust the
treatment if needed
Urethritis
● Dysuria with urethral discharge (can present without discharge)
○ May be secondary to urethral trauma (foley, instrumentation)
● UA/micro may reveal pyuria with or without bacteria
● Urethral swab vs “First-void” urine
ER-GU-1
“Tintinalli’s Emergency Medicine,” 9e, Tintinalli.
● If evidence of cervicitis, then think of a Chlamydia infection
Pyelonephritis Presentation
● Flank pain, CVA tenderness, especially in
association with fever, chills, nausea,
vomiting, or prostration (feel so bad you
want to lay down)
● May or may not have coexistent
symptoms of cystitis
Missed pyelonephritis could lead to ____
sepsis
Nephrolithiasis presentation
● Excruciating, unilateral flank and/or mid back pain that radiates to
the ipsilateral lower quadrant, groin, testicle, or labia
○ Sx may ebb and flow and pain may cause vasovagal syncope
● Nausea/Vomiting are common
● Gross hematuria
● LUTS (typically suggests a distal ureteral stone)
Nephrolithiasis imaging
Non-contrast CT abdomen/pelvis
(gold standard)
Nephrolithiasis analgesia
○ Ketorolac (Toradol®) IM or IV in the ED
■ Check creatinine first
○ Opioids
■ Comparative studies show little
difference between opiates & NSAIDS
Nephrolithiasis: admission criteria
● Intractable pain
● Intractable emesis
● Coexisting pyelonephritis/pyuria
● Documented or suspected renal dysfunction (↑
BUN or Cr levels, bilateral ureteral stones, oliguria
or anuria (very bad)
● Degree of obstruction or size of the stone
● Abnormal anatomy (solitary kidney)
Most common cause of prerenal AKI in the ER
Dehydration
Most common cause of intrinsic AKI in the ER
Ischemic injury, nephrotoxic drugs
Most common cause of postrenal AKI in the ER
(obstruction to urine outflow)
Uremia
“Urine in the blood”
● Toxic buildup of urea or other nitrogenous waste
● Develops when CrCl falls to < 10 mL/min
Nephrotoxins – AD A CaN
○ Aminoglycosides, Beta Lactams,
Quinolones
● Diuretics
○ Loop/Thiazide (Furosemide/HCTZ)
● ACE/ARB
● Cancer drugs
● NSAIDs
Changes associated with ↑ K+
Tall, peaked T waves with a
narrow base, shortened QT
interval, ST-segment depression
Test of choice for urologic
imaging
U/S
Metabolic acidosis (kidney)
○ Loss of HCO3
or increase in acid concentration
■ Failure of kidney to excrete acids (renal disease)
■ Formation of excess acid (DKA, lactic acidosis)
■ Loss of base from bodily fluids (severe diarrhea)