This document discusses hematuria (blood in the urine) and obstructive uropathy (blockage of urine flow in the urinary tract). It covers evaluating hematuria through urinalysis, imaging tests, and cystoscopy. Common causes of hematuria include infections, stones, tumors, and glomerulonephritis. Obstructive uropathy can be congenital or acquired and cause changes to the urethra, bladder, ureters, and kidneys over time. Relieving the obstruction through surgery, stents, or nephrostomy is the main treatment approach.
3. Physical Examination of Urine an evaluation of color, turbidity, specific gravity and osmolality, and pH.
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6. The reagent strip that detects blood utilizes hydrogen peroxide, which catalyzes a chemical reaction between hemoglobin (or myoglobin) and the chromogentetramethylbenzidine
9. Centrifuged urine In hemoglobinuria, the supernatant will be pink. This is because free hemoglobin in the serum binds to haptoglobin, which is water insoluble and has a high molecular weight. This complex remains in the serum, causing a pink color. Free hemoglobin will appear in the urine only when all of the haptoglobin-binding sites have been saturated.
10. Centrifuged urine In myoglobinuria, the myoglobin released from muscle is of low molecular weight and water soluble. It does not bind to haptoglobin and is therefore excreted immediately into the urine. Therefore, in myoglobinuria the serum remains clear.
11. Quantity of Hematuria Microscopic Hematuria : seen only under microscope Gross Hematuria : visible, urine is pink, cola, red 5 times the number of life-threatening conditions when compared with patients with microscopic hematuria.
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13. At what time during urination does the hematuria occur (beginning or end of stream or during entire stream)?
29. Clots The presence of clots usually indicates a more significant degree of hematuria, and, accordingly, the probability of identifying significant urologic pathology increases.
84. History taking: Present Illness 2.Upper urinary tract ( ureter and kidney) -pain in the flank radiating along the course of the ureter -gross hematuria (from stone) -GI symptoms -fever with chills - may be asymptomatic
87. Pathogenesis (pathophysiology) The changes in the various segments in the urinary tract, depending on the obstructive severity and duration 1. Urethral changes: dilatation, diverticulum
90. 4. Pelvicalyceal changes: first shows evidence of hyperactivity and hypertrophy and then progressive dilatation and followed by flattening of the papillae and finally clubbing of the minor calyces. 5. Renal Parenchymal Changes : compression, ischemic atrophy.
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92. Clinical findings 1.Symptoms and signs: infravesical obstruction :difficulty of voiding,weak stream ,diminished flow rate,terminal dribbling,burning ,frequency. Supravesical obstruction :renal pain or renal colic,if gradually--asymptomatic or enlarged kidney
93. Clinical findings 2.Laboratory findings Urinalysis BUN Creatinine Impaired kidney function elevated blood urea nitrogen and serum creatinine
94. Clinical findings 3.X-Ray findings , IVP, Cystoscopy , Retrograde pyelography localizing the site of obstruction demonstrate the extent of the obstructed segment anatomic changes functional changes
95. Clinical findings 4.Special Examination Instrumental calibration of sites of obstruction is also valuable radioisotope renography ultrasonic examination shows hydronephrosis and residual urine Urine flow rate CT
96. Treatment 1. Relief of obstruction -BPH or obstructing bladder tumors require surgical removal -impacted stones must be removed