An East Carolina University faculty member in Physician Assistant Studies is prompting emergency department clinicians to thoroughly analyze urinalysis results for the possible diagnosis of serious illnesses.
Natalie Smith, a clinical assistant professor and practicing physician assistant in emergency medicine, was published in the Journal of Urgent Care Medicine after she determined that routine urinalysis results can show an underlying presence of potentially life-threatening diseases. In her article, “Hyperbilirubinemia – An Urgent Care Approach,” Smith describes how she was able to link the presence of bilirubin in urine to a serious diagnosis of pancreatic cancer.
Bilirubin is a waste product of the normal breakdown of red blood cells and is responsible for the typical brown appearance of feces and yellow appearance of urine. It is most known for causing medical issues when it gets into the blood stream, usually resulting in jaundice, or yellow discoloration of the skin and eyes.
It was while working in the emergency department that Smith came across a case that demonstrated the importance of thoroughly reviewing urinalysis results. The patient, a 65-year-old woman, reported symptoms of dark urine as well as discomfort and a burning sensation while urinating. The patient, along with her family, viewed those symptoms as the result of a urinary tract infection and requested antibiotics that would address what she considered to be a UTI.
Smith ordered a urinalysis and all of the results were consistent with a UTI, with the exception of the presence of bilirubin. Bilirubin led Smith to believe there was a hepatobiliary system issue, which can affect the liver, pancreas, bile ducts, and gall bladder. Additional tests and procedures determined the patient did indeed have a serious health concern and she was eventually diagnosed with pancreatic cancer.
Smith, who is the first professor in the PA Studies department to be published, believes this case and discovery serves as a reminder to her students that they should consider the worst possible outcome, even when the patient’s presentation of symptoms seems to be routine.
“As the instructor, it is my responsibility to enable our students to think critically to understand the clinical significance of the diagnostic tests they will be ordering and interpreting,” said Smith. “On the surface, [this case] seems routine and uncomplicated, but upon more meticulous investigation actually revealed a diagnostic wolf (pancreatic cancer) disguised in seemingly benign UTI clothing.”