F: fluids, fertility

renal

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

creatinine

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

pelvis

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