Gross Hematuria

HISTORY:

Gross hematuria for ‍ ‍hoursdays

Type: ‍pinkbright reddark redcola-colored, ‍withwithout clots

Episodes: ‍ times ‍per dayoverall

‍dysuria

‍urgency

‍foul-smelling urine

‍suprapubic pressure

‍abdominal pain

‍flank pain

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍nausea

‍vomiting

‍incontinence

‍hesitancy

‍nocturia



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

CVA tenderness: ‍negativepositive on Rpositive on L

Anorectal: DRE ‍normal, prostate ‍normal, anus ‍normal

Genital: ‍normal, testicles ‍normal, penis ‍normal

Pelvic: vulva ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍no cervical motion tenderness



ASSESSMENT:

‍Gross hematuria ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍BUN, ‍CRP, ‍coagulation profile

- Urine: ‍urinalysis, ‍urine culture, ‍urine cytology

- CT pyeloscan

- Cystoscopy

- ‍Antibiotics if infection suspected

- Reassess medications that may contribute, such as anticoagulants and antiplatelets

- Increase fluid intake

- Referral to urologist

- Referral to nephrologist

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop

- Go to ER if severe pain, fever, or inability to urinate occurs