After ABCDE, move on to F: fluids and fertility. Here are a few helpful mnemonics
Fluids: if a patient has renal failure think of CREATININE to work through the differential. This approach can also help consider some causes of hematuria.
pre-renal: increase urine specific gravity, decrease urine sodium (kidneys working)
- Cardiac failure
- Renal artery stenosis/renal vein thrombosis, including dissection, embolism
- Extracellular fluid loss: hemorrhage, GI/GU, third spacing
renal: increase urine sodium (kidneys not working) + casts
- Auto-immune glomerulonephritis: GMN, HSP, SLE
- Tubular necrosis: ischemic, toxic
- Interstitial nephritis: AIN (meds), lymphoma
post-renal
- Neoplastic/ascites/AAA (extrinsic compression)
- Impacted stone
- Neurogenic
- Enlarged prostate/structure
Female fertility: when considering pelvic pathology think of PELVIS
- Pregnant/miscarrriage: +betaHCG + IUP on POCUS
- Ectopic: +betaHCP without IUP on POCUS (unless heterotopic) +/- free fluid –> Gyne for surgery vs medical treatment
- Luteal cyst hemorrhage: abdo pain + free fluid on POCUS –> analgesia, transfuse/surgery if large hemoperitoneum
- Vascular torsion: ovarian torsion around cyst/tumour/fibroid/pregancy, causing sudden sever pain, US decrease flow –> surgery
- Infection: STI, PID, endometritis
- Structural, eg fibroid, cancer, endometriosis
Male fertility: when male patients present with groin pain, think of A TESTICLE
- Appy, AAA: referred pain
- Torsion: sudden severe pain, POCUS decrease flow –> urology, detort
- Epididymitis: gradual positional pain with lower urinary tract symptoms: US, UA, swab, antibiotics, NSAID
- Structural: hydrocele, varicocele: outpatient urology
- Torsion of the appendix
- Incarcerated hernia –> surgery
- Cancer
- Lymph node; orchitis
- Enoch-schonlein purpura
