GenitourinaryKidney 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.www.webster.com 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 stones AAA

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

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.