B bladder carcinoma 146 diagnostic ultrasound renal

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( B ) Bladder carcinoma. 146 Diagnostic ultrasound Renal and bladder ultrasound
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ultrasound is designed to answer focused questions. Any abnormality out- side this scope of practice should be referred for formal testing. Sample clinical protocol Figure 6.19 shows a protocol for the use of renal and bladder ultrasound. Figure 6.18 Prostate hypertrophy. Patient with flank pain, hematuria or bladder distention Focused renal ultrasound Severe hydronephrosis Mild to moderate hydronephrosis No hydronephrosis Assess aorta Repeat US after hydration Normal aorta Consider CT if stable, surgery and OR if unstable Assess bladder volume Increased bladder volume: Foley and reassess Normal bladder volume: Treat clinically for renal colic Improved, discharge for urology follow-up Not improved, consider CT, urology consult/admit No hydro, consider alternative diagnosis Consider CT scan Abnormal aorta Figure 6.19 Sample clinical protocol. Diagnostic ultrasound 147 Renal and bladder ultrasound
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Literature review New directions One area of potential research for renal bedside ultrasound is assessing the outcomes and number of patients identified with renal cell cancer when performing renal scanning in the emergency department. As Man- davia et al. showed [ 16 ], incidental cancer identification is not unexpected given the volume of ultrasound scanning that is performed in most major trauma centers. In the future, perhaps patients will be screened for both AAAs and renal cell cancer when they come to the emergency department. In addition, with increased attention of both the public and clinicians focused on limiting radiation exposure, the diagnostic evaluation of renal colic is primed for re-evaluation [ 17 , 18 ]. Outcome studies looking at ultrasound as Reference Methods Results Notes Sheafor et al. 2000 [ 2 ] Prospective comparison of helical CT and US in patients with renal colic. CT much more sensitive in identifying stones (96% vs. 61%). Sensitivity for CT and US comparable in identifying hydronephrosis (100% vs. 92%). Radiology literature showing advantages of CT but also that US is comparable when looking for hydronephrosis. Chan 1993 [ 12 ] Compare bladder volume estimations calculated using US with catheterized bladder volumes. Urinary retention suspected clinically. Correlation of two measurements highly significant ( r ¼ 0.983). Provided data supporting ultrasound use in calculating bladder volume. Gaspari & Horst 2005 [ 6 ] Evaluate sensitivity and specificity of renal US in diagnosing renal colic as compared to helical CT. Impact of hematuria on test characteristics was also evaluated. In patients with hematuria, US was 87.8% sensitive and 84.8% specific for renal colic (86.8% and 82.4% without hematuria). Ultrasound shows very good sensitivity and specificity for diagnosing renal colic. Edmonds et al. 2010 [ 15 ] Retrospective chart review of all patients, looking at ultrasound findings and need for urologic intervention.
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