Special Operations Forces Medical Handbook

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

1. 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.


2. 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).


3. 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.


4. 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

1. 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.


2. When there is visible blood in the urine, the protein from the blood can raise the urine dipstick protein
   value to 2+.


3. 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).


4. Infections can be nitrite negative.