Coming through the ER complaining of severe abdominal pain (acute abdomen), this
ID: 148687 • Letter: C
Question
Coming through the ER complaining of severe abdominal pain (acute abdomen), this 20yearold woman was admitted to R/O appendicitis, pancreatitis, pyelonephritis, abdominal abscess, or ruptured viscus. Because she was 36 weeks’ (estimate) IUP, a low Csection was performed and the child was delivered. Her appendix was found to be ruptured, and it was removed at the same time. Blood cultures were positive for E. coli, sensitive to Cefotan (cefotetan disodium) and to gentamicin, which she was given. The urinalysis, obtained two days postsurgery, was as follows:
glucose negative
bilirubin small
ketones 40 mg/dL
specific gravity 1.025
blood negative
pH 6.5
protein 30 mg/dL
urobilinogen 1.0 EU/dL
nitrite negative
leukocyte esterase trace
color orange
WBCs 510/HPF
RBCs rare/HPF
epithelial cells 1+/HPF
bacteria 1+/HPF
bactera 1+
casts 15 granular
Icotest negative
C&S was not requested on this urine.
Case Question:
What aspects of the urinalysis do you find significant? Explain.
What would one expect see in her urine microscopic exam?
Explanation / Answer
1. Microrganisms: In an healthy individual, there is nor presence of microorganisms in the urine sample. Microorganisms are usually reported as none, few, moderate or many present per high power field of the microscope.
Leucocyte esterase: It is normally negative. However, its presence is indicative of white blood cells in the urine, which suggests Urinary Tract Infection. WBC greater than 5/HPF is indicative of an inflammatory process in the urinary tract.
Granular casts: These are indicative of significant renal disease. The cast containing finer granules is generally light in colour whereas granular cast containing courser granules is darker in colour.
2. Urine microscopic exam would be seen to contain bacteria (E.coli), neutrophils. fibrin and cell debris.