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Urinary symptom and investigation:

الكلية كلية الطب     القسم  الجراحة     المرحلة 4
أستاذ المادة محمد رضا جودي عبود جلو       05/01/2017 04:17:27
Urinary symptom and investigation:

Urinary symptom:
Hemeaturia:
Presence of blood in urine, tiny amount of blood are insufficient to stain the urine (microscopic haematuria), significant amount in urine (macroscopic haematuria) give the urine red tinge even pass clot.
False positive and discolored urine:
Beetroot, drug (phenindion), pyridium, furadantin (absence of RBC) in urine.
May be: intermittent or persistent
May be in the beginning of stream as in lower urinary tract cause.
Uniform staining throughout the stream may point higher up.
Terminal heamaturia typical irritation by stone or infection.
If pain with haematuria help to identify the source of bleeding.
Malignant cause usually painless.

Each haematuria should investigate even the patient taking anti coagulant drugs.
Also it may caused by occult nephropathy so it is important to check for significant proteinuria and hypertension.
So haematuria is
*always abnormal.
*may caused by lesion anywhere in urinary system. exam. For infection by C\S, cytology, IVU, Ultrasound, cystoscopy.
*commonly caused by UTI.

PAIN:
Renal pain:
Due to inflammation, obstruction, acute obstruction felt as deep seated, ache in loin, May due to stretching of renal capsule.
Tumor or cyst are usually not painful unless very large.
Also renal trauma causing pain.

Ureteric colic:
Acute pain felt in loin and radiating to ipsilateral iliac fossa and genitalia. The patient rolls around. While in peritoneal pain the patient lies still to ovoid exacerbation by movement.
Caused by passage of stone clot or sloughed papilla.
Local tenderness is much less than would be expected from the severity of the pain.

Bladder pain: suprapubic discomfort made worse by bladder filling, referred to the tip of penis may result from irritation of trigon, can cause extrem discomfort at the end of micturition may sever (strangury).

Perineal pain:
Penetrating pain in perineum may associate with inguinal discomfort.
Named pelvic pain may due to chronic prostatitis may name prostadynia, but it occurs both in man and women.

Uretheral pain:
Is scalding or burning in vulva or penis during voiding

1. Symptom due to altered bladder function:
The urinary bladder has two functions: filling phase, and voiding phase.
Symptom due to filling phase:
Urgency: inapropperiate contraction of the bladder detruser muscle
Frequency (in day time), nacturia (at night).
Urge incontinence.
2. Symptom due to impaired emptying:
Mostly due to bladder outlet obstruction:
Hesitancy: difficulty initiating voiding.
Weak or slow stream.
Incomplete emptying : the patient feel the urine remain in bladder after voiding, with time the bladder become chronically overfull lead to spill of urine (overflow incontinence.

INVESTIGATION OF THE URINARY TRACT:

URINE:
Dipstick test to detect the presence of: Blood, protein, nitrite.this is convenient way to screen urine. This is simple test if fined positive result we can precede for farther chemical and microscopic examination.
Example if positive for protein and nitrite may indicate the presence of infection.
Also my give indication for urine PH, and specific gravity.

Microscopic examination.
To find: RBC, WBC, bacteria, protein cast (mostly renal pranchymal disease), RBC dysmorphya, schistosoms ova, vegitable and meat fiber (indicate presence of fistula with bowel.

Cytological examination.
Especially in case of malignant tumors of urinary system.

Bacteriological culture:
Using midstream urine sample for culture to identify urinary pathogen (especially bacteria).
If there are pus cell in urine but there is no growth of bacteria on culture media named STERILE PYURIA.
In case of TB we take multiple early morning urine specimens for culture on Lowenstein-Jensen medium.
Chlamydia not detected on routine culture.


Biochemical examination of urine:
For electrolyte, glucose, bilirubin, haemoglobin, myoglobin.

24 hours urine specimen of urine for investigation for calculus disease. (Test for calcium, oxalate uric acid).


Test of renal function:
MORE THAN 70% OF KIDNEY FUNCTION MUST BE LOST BEFORE RENAL FAILURE BECOMES EVIDENT.
Renal damage that causes renal impairment is of three types:
*Reduction of renal plasma flow: hypertension, renal artery stenosis.
*destruction of glomeruli: glomeriolonephritis, acute cortical necrosis.
*impairment of tubular function. pyelonephritis.
In obstructive uropathy back pressure on the renal parenchyma causes all three types of damage.

Level of blood urea and serum creatinine can affect by various factors.
*creatinine clearance test will give an approximate value for glomerular filtration rate.
*clearance of chromium-51- labeled: more accurate for GFR.
*specific gravity of the urine is fixed at low level when the kidney loses the power to concentration because of renal tubular dysfunction
*estimation of urinary lose of Na, beta 2 microglobulin, or N-acetylglucosamin (NAG) will farther define the nature of any functional impairment.





Dr. Muhammad redah Judi
Assist. Professor
Urology


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