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  #1  
Old 05-29-2011
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Urine Sample Abdominal Pain and this Urine Sample!

A 17 year old boy has been taken to the emergency dept 3 times for acute abdominal pain, but was released each time without a definitive diagnosis. The frustrated emergency dept physicians now consider him to be crazy and have labeled him as having "irritable bowel syndrome". On he fourth occasion, as part of the workup, a urinalysis is performed, the result of which are shown below:
Color: yellow brown
specific gravity: 1.0025
WBC: 25
RBC: 0
microscopic: gram -ve rods, mixed flora

Which of the following is the diagnosis?
A. Celiac disease
B. Crohn's disease
C. Renal colic
D. Diverticulitis
E. Renal stone
F. Ulcerative colitis
G. Whipple disease
...
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  #2  
Old 05-29-2011
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Is it renal colic? C?
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Old 05-29-2011
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i'm think A
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Old 05-29-2011
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RBC=0
I think is B or D...

Last edited by bebix; 05-29-2011 at 07:25 PM. Reason: wrong quote
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  #5  
Old 05-29-2011
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RBC is not seen because of the urine gravity is low, RBC are all lysed
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Old 05-29-2011
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B.......Crohn dis....due to fistula
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  #7  
Old 05-29-2011
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Answer as it looks to me is crohn dz due a fistula which is common among those pte and can result over the mixed flora.


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  #8  
Old 05-29-2011
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Crohn Disease
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c renal colic
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Old 05-29-2011
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B Chron's dz with fistula
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Old 05-30-2011
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Yes you all are right..
Its CROHN'S disease with fistula.
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Old 05-30-2011
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Struggle,

Fistula to urinary tract? Then why SG is so low, only 1.0025, should be much higher with pus
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Old 05-30-2011
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Quote:
Originally Posted by usluipek View Post
Struggle,

Fistula to urinary tract? Then why SG is so low, only 1.0025, should be much higher with pus
But in this case the urine didnīt have pus...
Color: yellow brown
WBC: 25
RBC: 0

so, 1.0025 is a plausible number...or not?
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Old 05-30-2011
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Quote:
Originally Posted by bebix View Post
But in this case the urine didnīt have pus...
Color: yellow brown
WBC: 25
RBC: 0

so, 1.0025 is a plausible number...or not?
i think it should be 1025 what you are trying to say, or not?
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Old 05-30-2011
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Hmmm, There are so many WBC in the urine, so there must be pus, is this from the fistula?

If pus leaked into urine from fistula, why urine SG is so low?
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Old 05-30-2011
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Smile 17 year old wih mixed flora

Quote:
Originally Posted by struggle View Post
A 17 year old boy has been taken to the emergency dept 3 times for acute abdominal pain, but was released each time without a definitive diagnosis. The frustrated emergency dept physicians now consider him to be crazy and have labeled him as having "irritable bowel syndrome". On he fourth occasion, as part of the workup, a urinalysis is performed, the result of which are shown below:
Color: yellow brown
specific gravity: 1.0025
WBC: 25
RBC: 0
microscopic: gram -ve rods, mixed flora

Which of the following is the diagnosis?
A. Celiac disease
B. Crohn's disease
C. Renal colic
D. Diverticulitis
E. Renal stone
F. Ulcerative colitis
G. Whipple disease
...
mixed flora is coming from the GI tract, so fistula from chron's disease
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  #17  
Old 05-30-2011
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Urine is yellow brown with WBCs due to fecal contamination with g-ve rods.
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Old 05-30-2011
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Quote:
Originally Posted by usluipek View Post
Hmmm, There are so many WBC in the urine, so there must be pus, is this from the fistula?

If pus leaked into urine from fistula, why urine SG is so low?
Are we confusing Urine Specific Gravity with Blood Sedimentation rate?

I just read up on Urine specific gravity and it seems to me that it is a measure of solute content in the urine. It gives an idea of concentration and size of solutes. It is generally related with Urine osmolality by a 0.001 increase in SG for every 35-40 mOsm/L. Therefore for a normal osmolality of about 280, Urine SG is about 1.008 or 1.009.

Urine SG is a comparison of the weight of the urine as compared to pure water so increased number of WBC's wouldnt really affect the weight of the urine to any significant amount. Glucose and radiocontrast dyes in urine are causes of increased SG as well as conditions like SIADH where the concentration of the urine far exceeds the plasma osmolality.

On the other hand, ESR is a marker for inflammation and would be increased in infection, but we are dealing with urine SG here.

Can anyone confirm or deny this?
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Old 05-30-2011
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Considering all possible choices, Crohn's disease makes the most sense.
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