Presentation Urinary retention is a common problem encountered in the emergency department. Acute urinary retention (AUR) presents as a sudden inability to voluntarily void. The patient, usually male, may complain of increasing dull, low abdominal discomfort or pain and the urge to urinate, without having been able to urinate for many hours. Lower abdominal pain may become severe. Urinary hesitancy, sensation of incomplete voiding, an interrupted…

Presentation A man complains of dysuria, a burning discomfort along the urethra, pruritus of the urethral meatus, and/or a urethral discharge. A copious, thick yellow-green discharge that stains underwear is characteristic of gonorrhea, whereas a thinner mucopurulent or white scant discharge with milder symptoms is characteristic of Chlamydia. These symptoms may be transient. Urethritis in a woman may be asymptomatic or indistinguishable from cystitis or vaginitis.…

Presentation A man complains of acute onset of malaise, fever, chills, and perineal, rectal, or low back pain. He also may have dysuria, urinary urgency and frequency, and signs of obstruction to urinary flow, ranging from a weak stream to urinary retention. There may be painful ejaculation and hematospermia. On gentle examination, the prostate is swollen, hot, and exquisitely tender. The infection may spread from or…

Presentation Phimosis is the inability to retract the foreskin over the glans and is usually the result of a contracted preputial opening ( Fig. 81.1 ). Patients with phimosis may seek acute medical care when they develop signs and symptoms of infection, such as pain and swelling of the foreskin and a purulent discharge. Pediatric patients with acute phimosis are either fussy or complain of penile…

Presentation The patient may be distraught with severe genital pain, with subsequent outbreak of painful vesicles on the external genitalia that may ulcerate or erode. Alternatively, the patient may just be concerned about paresthesias and subtle genital lesions, may want pain relief during a recurrence, or may be suffering complications such as superinfection or urinary retention. Often, with primary infection, there are associated systemic symptoms such…

Presentation A male child, adolescent, or adult complains of dull to moderately severe unilateral scrotal pain developing gradually over a period of hours to days and possibly radiating to the ipsilateral lower abdomen or flank. In adult or adolescent males, there may be a history of recent urinary tract infection, urethritis, prostatitis, or prostatectomy (allowing ingress of bacteria), strain from lifting a heavy object, or sexual…

Presentation Patients may complain of or be frightened about the color of their urine. Color may be one component of some urinary complaint, or the color may be noted incidentally on urinalysis. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Presentation Blunt injuries to the scrotum usually occur in patients who are younger than 50 years of age as a result of an athletic injury; a straddle injury; an automobile, motorcycle, or industrial accident; or an assault. Patients present with various degrees of pain, ecchymoses, and swelling as well as faintness, nausea, or vomiting ( Fig. 77.1 ). The symptoms from minor injuries will gradually resolve…

Presentation The patient typically seeks medical care 1 to 6 hours after eating because of severe nausea, vomiting, retching, and abdominal cramps that may progress later into diarrhea. Patients may present with a wide range of findings. Signs and symptoms can range from mild to severe illness. It begins with minor nausea, vomiting, malaise, and diarrhea, progressing to conditions where patients may appear very ill: pale,…

Presentation Recurring, unpredictable, clonic contractions of the diaphragm that produce sharp inhalations are known as singultus or more commonly as hiccups. Hiccups are usually precipitated by some combination of laughing, talking, eating, and drinking but may also occur spontaneously. Most cases resolve spontaneously, and patients do not come to a physician’s office unless hiccups are prolonged or severe. A bout of hiccups is any episode lasting…

Presentation Patients with external hemorrhoids ( Fig. 74.1 ) generally complain of a painful anal lump of sudden onset, which may become intense in severity. This type of pain, in most instances, represents a thrombosed hemorrhoid, which will appear to be purple and is located within the anal canal. It may have been precipitated by straining during defecation, heavy lifting, or pregnancy, but in most cases,…

Presentation Parents bring in a young child (usually between the ages of 6 months and 6 years) shortly after the child has swallowed a coin, safety pin, or toy. The child may be asymptomatic or have recurrent or transient symptoms of choking, gagging, vomiting, drooling, dysphagia, pain, or a foreign-body (FB) sensation. Stridor or dyspnea resulting from tracheal compression may occur in young children. Disturbed or…

Presentation Rectal foreign bodies may present with abdominal pain, anorectal pain, obstipation, acute urinary retention, or blood or mucous discharge from the rectum. Such foreign bodies are often difficult to diagnose because the history may not be offered by the patient unless directly asked. Sometimes the patient will not volunteer that any object has been inserted or will give outlandish explanations, such as having sat or…

Presentation The patient develops symptoms either immediately after swallowing a large mouthful of food (usually inadequately chewed meat) or as the result of intoxication, wearing dentures, or being too embarrassed to spit out a large piece of gristle. The patient often develops substernal chest pain that may mimic the pain of a myocardial infarction. This discomfort increases with swallowing and is followed by retention of salivary…

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Presentation Complaints may range from occasional stool that is not well formed to acute, copious diarrhea that produces profound dehydration and shock. Patients with inflammatory or infectious diarrhea often present with fever, tenesmus (the frequent urge to defecate), abdominal pain, and hemoccult-positive stool. These conditions usually cause a more severe form of diarrhea and require more careful assessment and more aggressive treatment. Noninflammatory diarrhea is usually…

Presentation Patients with functional constipation will often come in with the complaint of abdominal pain or bloating. Often it is not until they are asked that they will describe infrequent bowel movements, straining at stooling, incomplete evacuation, hard or small stools, a blockage in the anal region, or the need for digital manipulation to enable defecation. Patients with irritable bowel syndrome (IBS) will complain of abdominal…

Presentation The patient presents complaining of a gastrostomy tube (G-tube) or jejunostomy tube (J-tube) that is not functioning properly. The most common complaints are that the tube is obstructed, leaking, displaced, or that there is pain and/or redness surrounding the stoma. Depending on how long the complication has persisted and how dependent on the tube the patient is, the presentation can range from otherwise well-appearing patients…

Presentation In most patients, the symptoms are so characteristic that they are nearly diagnostic. Initial onset of pain often occurs during or after defecation, usually after passing a large, hard bowel movement or following an explosive bout of diarrhea. Later, patients complain of severe intense pain with subsequent defecation. It can be described as knifelike, cutting, or tearing in character. This pain can persist for a…

Presentation A patient with an isolated rib fracture or a minor costochondral separation usually has recently fallen, injuring the side of the chest; been struck by a blunt object; coughed violently; or leaned over a rigid edge. The initial chest pain may subside, but over the next few hours or days the pain increases with movement, interferes with sleep and activity, and becomes severe when the…