ED blueprints

• cystitis
• urethritis (gonorrhea, chlamydia
• pyelonephritis
• vaginitis
• epididymitis
• balantitis
• prostatitis
• interstitial custitis
• urethral syndrome
• genital herpes
• atrophic vaginitis
• reactive arethritis (reiter's syndrome)

• cystitis
• urinary calculi
• BPH microscopic
• renal cell carcinoma
• Transitional cell carcinoma
• glomerulonephritis (IgA nephropathy)
• Polycystic kidney disease
• anticoagulant use
• prostate cancer
• papillary necrosis (NSAID overuse, DM, sickle cell)
• renal infarction
• interstitial nephritis
• medullary sponge kidney
• radiation or chemial cystitis
• atrophic vaginitis
• schistosomiasis
• menses

• think kidney stones or pyelo
• appendicitis
• AAA
• aoritc dissection
• mesenteric ischemia
• cholecystitis
• ectopic pregnancy
• gonadal torsion
• renal infarction
• herpes zoster
• drug seeking behavior

• transient incontinence DIAPPERS
• Delierium
• Infection
• Atrophic vaginitis or urethritis
• pharmacology (anticholinergics, diuretics, hypnotics)
• Psychiatric disorders (depression, psychosis)
• excess urine (edema, hyperglycemia, hypercalcemia)
• restricted mobility

• established incontinence
• Detrusor overactivity (urge incont. or overactive bladder)
• urethral incompetence (stress incont. pelvic surgery multiparity)
• urethral obstruction (bph)
• detrusor underactivity (overflow incontinence neurogenic bladder, anticholinergics)
• mixed incontinence (urge and stress)
• DDx
• cystitis
• prostatitis
• interstitial cystitis
• meds (diuretics, etoh, caffeine, hypnotics
• polyuria (DM, DI, hyper calcemia)
• vesicovaginal or ureterovaginal fistula
• dementia
• NPH

• renal colic- stones migrating down the ureter
• all ages affected M>F, <16 y.o. 7% of cases

• Acute onset of severe pain can be associated with N/V, diaphoresis. Pts often anxious and pacing, unable to hold still and hold conversation.
• Distal ureter is where 75% of stones are diagnosed, associated with ant. abdominal pain/suprapupic pain.

• CVA tenderness
• hematuria (renal colic)
• tachycardia, high BP (due to pain)

• DDx
• UA to rule out UTI
• Females get Beta HCG to rule out preggers
• noncontrast CT is choice of test in ED
• KUB can help to see the stone move down the ureter with a series
• US can determine anatomy (hydronephrosis and stones larger than 5mm)

Txketorolac 30 mgs IVP (caution in elderly and renal impairment) for painmorphine 5 mgs IV for painmetoclopramide 10 mgs IV antiiemeticsAlpha blockers tamulosin, terazosin, doxazosin up to 4 weeks to expulse the stone.Abx if signs of UTI cipro 500 mgs BID for 10 to 14 days

• testicular torsion should be considered for any male who complains of testicular pain.  Pain is usually sudden, severe, felt in the lower abdominal quadrant, inguinal canal, or testis.  pain is not dependent on position due to the ischemia. Testicle is firm, tender, and elevated. Lack of a cremaster reflex.
• DDx
• duplex US
• UA but pyruia does not rule out Test tors
• epididymitis, inguanal hernia,hydrocele, scrotal hematoma

• Emergency department care
• Urologic consultation is indicated for exporation with excellent salvage rates for those within 6 hours of symptoms
• The ED can try to detorsion by open book method-medial to lateral motion, is successful if pain is releived

UTI is the most common bacterial infx of the pregnant.

• Cystitis treated 10-14 days with nitrofurantoin,
• amoxicillin, or cephalexin

• Pyelonephritis- more severe and related to sepsis and preterm labor.  admit for IV hydration and abx.  (cefazolin, amp + gent)
• quinolones are CI in preggers and avoid sulfonamides during the third trimester

graudual onset of pain due to inflammatory causes. bacteria is the most common.  infecting agents are dependent of age. <40 y.o. is due to STD Clamydia and gonococcus.  Pain is relieved in the recumbant position with the scrotum elevated (phren's sign)

• DDx
• Testicular cancer (usually painless mass)

• ED care
• if toxic admit for IV abx (ceftriaxone 1 to 2 gms Q12hrs)
• outpt if non toxic with urologic follow up within one week.
•    <40 y.o. tx gonorrhea and clamydia with ceftriaxone 250 mg IM and doxycycline 100 mgs PO BID for 10 days
•     >40 y.o. tx gram negative bacilli with levofloxacin 500 mg PO daily for 10 days
•      scrotal elevation, ice , NSAIDS, opioid, and stool softeners

is treated with diz specific theray

Fever, irrative voiding, perneal or suprapubic pain, exquisite tenderness common on rectal examination. positive urine culture

usually caused by GNR e. coli and psudomonas and less commonly GP organisms (enterococci)

• CBC shows leukocutosis and a left shift
• UA shows pyuria, bacteriuria, and varying degrees of hematuria, urine cultures will demonstrate the offending pathogen.

• Tx
• hospitalization may be required
• IV ampicillian and aminoglycoside should be initiated until offending organism is found. after being afebrile for 24-48 hours oral abx (quinolones) can be used for 4-6 weeks of therapy

can be caused by hypovolemia from any cause, cardiac dz, vascular or thrombotic disorders, glomerular diseases, diseases affecting the renal tubules, dephrotoxic drugs, anotomic problems of the GU tract.

Nitrogen wastes will build up in serum. volume overload, htn. pulmonary edema, mentals status changes, n/v, bone and joint promblems, anemia, and increased susceptibility to infx.

• UA
• Chem 7, BUN, Cr, electrolytes
• Urinary sodium and creatinine and osmolality

Pre renal, renal or post renal

• Pre renal- intravascular volume should be resotred with normal saline or LR soln.
• If cardiac failure is causing prerenal azotemia cardiac should be optimizied to improve renal perfusion

• Renal failure (intrinsic)- IV fluids, ischemia or nephrotoxic are most commoncauses of intrinsic renal failure.
• 1. low dose dopamine may improve renal blood flow and urine output (not shown to lower mortality rates or improve recovery)
• 2. renally cleared drugs should be used with caution

• post renal failure
• 1. foley catheter
• 2.percutaneaous nephrotostomy

Monitor I/Os

Dialysis