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A 40-year-old woman presents to the emergency department with severe abdominal pain localized to the
right upper quadrant. A urine sample is taken for rapid dipstick reagent strip analysis. A
positive result for which of the following substances would most strongly suggest gallstone
disease as a possible cause of her abdominal pain?
A. Bilirubin
B. Glucose
C. Nitrite
D. Protein
E. Urobilinogen
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The correct answer is A. A small gallstone passing into the common bile duct can cause
obstructive jaundice with conjugated hyperbilirubinemia. The conjugated bilirubin will spill
into the urine, causing the bilirubin square on the reagent strip to react. This strip may also
react with other causes of intrahepatic or extrahepatic obstructive jaundice, so it is not
completely specific. It is worth becoming very familiar with the strengths and weaknesses of
reagent strip technology, however, since this information may be available hours before serum
chemistry values are reported.
High glucose (choice B) in urine suggests diabetes mellitus.
High nitrite (choice C) in urine suggests urinary tract infection.
High protein (choice D) in urine suggests renal disease or myeloma.
Urobilinogen levels (choice E) in obstructive jaundice can be normal, raised, or lowered;
consequently, they are not diagnostically helpful in the setting described in the question stem
unless urinary bilirubin is negative.
