Genitourinary Kidney stone vs AAA Lisa Chance, RN, BSN, CCRN

Kidney Stones (calculi) or AAA? Symptoms of a kidney stone verses abdominal aortic aneurysm (AAA) can be very much alike. You can hear a word pronounced! Calyces is pronounced “Kay-la-sees.”

One condition is painful annoying Other can be fatal if not treated promptly. Vital for nurses to know the difference! Could be a matter of life & death.

Hematuria Severe colicky flank pain Nausea/vomiting Severe colicky back pain Lightheadedness Hypertension Hematuria Severe flank pain Abdominal pulsating mass Severe abdominal pain Severe back pain Hypertension Syncope Shock (late sign) Kidney stonesAAA

What to do. Address pain relief Hydration Draw blood (R/O renal function, infection, or blood loss) CBC /c differential (checking the white cell count) Hemoglobin & Hematocrit (H&H) Platelets

… And? Chem 7 (Panel 7) - comprehensive metabolic panel to test: Electrolytes BUN Creatinine Obtain urine for a urinalysis that will test for: Nitrates Leukocytes blood in the urine

Also, keep in mind that the urinalysis alone doesn’t tell the whole story. Do not conclude that the patient has a kidney stone just because he has hematuria. In one study, more than 87% of patients with an AAA also had hematuria.

Today’s gold standard is non-contrast computed tomography (CT) scan. Differentiation

If facility does not have access to CT, X-ray of kidneys, ureters, & bladder is considered accurate also. Differentiation …continued

X-rays, can not be performed on pregnant women  probably ultrasound Ultrasound may also be preformed if the patient is too unstable for transport.

Or trained cardiologist or surgeon can perform a TEE (transesophageal echo) to verify AAA at the bedside. Differentiation …continued

Complications After tx: Not getting relief with prescribed pain medication Or experiencing: Fever Chills nausea or vomiting The above are signs of pyelonephritis (kidney infection), usually from a blocked ureter.