4-87
Combination Agents: Aztreonam 2 gm IV q 8 hr plus metronidazole 500 mg IV q 8 hr
Patient Education
General: Pain lasting more than 4 hrs should be evaluated by a health care professional.
Diet: Low roughage if a history of recurrent partial small bowel obstructions.
No Improvement/Deterioration: Persistent pain or pain associated with vomiting, dehydration, bleeding, or
fever should be evaluated promptly.
Follow-up Actions
Return evaluation: Routine post-operative follow-up.
Evacuation/Consultation Criteria: Evacuate ASAP. Consult general surgery.
Chapter 8: Genitourinary (GU)
GU: Urinary Tract Problems
CAPT Leo Kusuda, MC, USN
Introduction: This section will provide tips for the assessment and disposition of major symptoms associated
with the urinary tract, excluding trauma.
Examination Tips
- Assessing a flank pain:
Lightly tap or push with fingers on right or left lower chest wall. If there is significant kidney irritation,
this will elicit increased pain. - Abdominal exam:
a) Percuss the region superior to the pubic bone. A dull tap suggests a distended bladder holding a large
volume of urine. In the female, the pubis is much lower and a smaller volume of urine can be
appreciated on percussion or bimanual exam.
b) Look for peritoneal signs: increased pain with light tapping on the abdomen, pain with shaking of the
abdomen and hips, pain when suddenly releasing pressure on the abdomen (rebound). - Scrotal exam:
a) If possible, always exam the patient in both the standing and supine positions.
b) Testis position and varicoceles can only be appreciated in the standing position.
c) Examine the testis of a patient complaining of pain in the scrotum while he is lying down. Increased
pain in the testis may cause the patient to faint.
d) If a bright light such as for an otoscope is available, transilluminate all scrotal masses to determine
cystic (bright, diffuse glow) or solid nature of the mass. - Rectal Exam
a) Prostates are generally the size of a walnut and no more than 2 finger breadths wide.
b) With the patient standing and bending over the top of the prostate should be easy to reach. In young
men, the presence of a large soft mass on rectal exam usually is the bladder. Some prostates in young
men are difficult to palpate.
Urinalysis
- Dilute urine with a specific gravity of 1.005 or less, or concentrated urine (dehydration, first morning void,
etc.) of 1.015 or higher suggests normal renal function. - When there is visible blood in the urine, the protein from the blood can raise the urine dipstick protein
value to 2+. - Nitrite positive urine can be from skin bacteria if the person (male or female) voided a small amount
without doing a clean catch. (Avoid this problem by starting to void, then sliding the cup into the stream). - Infections can be nitrite negative.