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Urology > Hematuria (Cooke) > Flashcards

Hematuria (Cooke) Flashcards

1
Q

Macroscopic hematuria

A
  • visible discoloration
  • could be from lower urinary tract
    • bladder or lower
  • could be from upper urinary tract
    • ureters RARE
  • Systemic disease
  • Other pigment
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2
Q

Microscopic hematuria

A
  • no visible discoloration
  • > 5 rbc’s per hpf
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3
Q

Pigmenturia hx questions

A
  • dysuria/stranguria
  • urine stream
  • repro status
  • drugs
  • localization
    • throughout urination (total hematuria)
    • blod at end of urination (terminal hematuria)
    • Independant of or at beginning of urination

*“what do you see when he urinates”

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4
Q

Terminal hematuria cause

A
  • usually from bladder
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5
Q

Independent/beginning of urination hem. cause

A
  • from sphincter of bladder to the outside world
    • urethra
    • prostate
    • vagina
    • vaginal vestibule
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6
Q

Physical exam Urinary tract

A
  • Kidneys
    • size/shape
    • evidence of pain
  • Bladder
    • Size/wall thickness
    • crepitus
    • pain
  • Rectal exam
    • prostate
    • urethra
  • vaginal exam
  • prepuce/penis
    • extrude
    • sheath
  • observe urination
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7
Q

Urinalysis

A
  • Free catch vs cysto
    • iatrogenic hemorrhage
  • Bacteria
  • Casts
  • Parasite eggs (rare)
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8
Q

Bloodwork

A
  • +/- CBC with platelet count
    • BMBT
  • +/- Assess coagulation status
    • PT/PTT
    • ACT
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9
Q

Rads (survey)

A
  • uroliths
  • kidney size and shape
  • prostate size and shape
  • lymph nodes
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10
Q

Abdominal ultrasound

Look at…

Look for…

A
  • Look at
    • Kidneys
    • Bladder
    • Prostate
      • FNA
  • Look for
    • cysts
    • masses
    • abscesses
    • stones
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11
Q

Contrast radiography

A
  • Double contrast cystogram
    • radioluscent cystoliths
    • masses in bladder
  • Retrograde urethrogram
    • radioluscent stones in urethra
    • masses in urethra
  • Excretory urogram
    • filling defects in kidney (lack of blood supply)
    • irregularity (mass)
    • stones in ureter
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12
Q

Other diagnostics

A
  • cystoscopy
  • laparotomy
  • biopsy
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13
Q

Hematuria WITHOUT dysuria/stranguria/pollakiuria

A
  • USUALLY
    • systemic (animal VERY SICK)
      • heat stroke
      • trauma
      • coagulopathy
    • Upper urinary tract : KIDNEY
      • renal neoplasia
      • polycystic kidneys (mic hem)
      • nephroliths (mic hem)
      • pyelonephritis (mic hem)
      • glomerulonephritis (mic hem)
      • idiopathic renal bleeding (mic/mac hem)
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14
Q

Hematuria WITH dysuria

A
  • Usually Lower urinary tract
    • cystitis
      • infectious/inflammatory
    • Urolithiasis
    • Prostatitis
    • Benign prostatic hyperplasia
    • Neoplasia
    • Trauma (HIC, shaken, kicked by horse)
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15
Q

Hemoglobinuria

A
  • THINK THINGS THAT CAUSE HEMOLYSIS
    • IMHA
    • DIC
    • Heat stroke
    • Caval syndrome: D. immitis
    • Other: toxins, blood parasites

*spun supernat DOESN’T clear

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16
Q

Order of presenting a patient

A
  1. Signalment
  2. Presenting complaint
  3. Pertinent history
  4. Physical exam
  5. Problems
  6. Differential diagnoses
  7. Plan
17
Q

Case 1: 6yo, NM Beagle cross

  • Persistent hematuria (3-4 months)
  • several courses antibiotics: imp but not resolved hematuria
  • appetite/activity normal
  • fenced yard, escapes occaisionally
A
  • History questions
    1. Straining?: NO
    2. When does it occur?: THROUGHOUT
    3. Pollakiuria?: No
  • Probs Upper tract
  • DDX
    1. cancer (renal)
    2. idiopathic renal hemorrhage IRH
    3. stones (kidney?! don’t always cause mac hem)
    4. Infection (should be sicker)
    5. coagulopathy (sicker/bleeding else where)
  • Diagnostic plan
    1. Watch pee
    2. PE (140$)
    3. Urinalysis (35$)
    4. +/- culture/sensitivity (50$)
    5. CBC: because of bleeding (40$)
    6. Chem: renal stuff (40$)
18
Q

Case 1: Work up/labs results

  • USG: 1.012
  • Dipstick
    • Pro - 2+
    • Bili - 2+
  • Sediment
    • Inf cocci, TNTC RBCS, WBC’s: 0-5/hpf
  • abdominal rads (150$)
    • soft tissue mass caudal plane right kidney
    • small irregular kidneys
  • chest rads: neoplasia (150$)
  • +/- ultrasound (255$)
    • renal mass
A
  • USG: can’t tell us anything
  • Dipstick
    • pigment will discolor all the pads
  • Probs not infection (very few white cells)
  • Uroliths still possible
  • Renal mass
    • do an FNA
    • ultrasound guided bx
    • remove and submit kidney
      • DO NUCLEAR SCINTIGRAPHY
19
Q

Case 1: We have a mass, now what?

  • Excretory Urogram (150$)
    • Right renal mass within pelvis, proximal ureter and medial aspect of kidney
    • small cystic lesion in left kidney
A
  • CT with Excretory Urogram (500$)
    • will help quantitate renal function
  • CT EU and Nuc scintigraphy not at normal primary care practices
  • Surgery
    • histopath: carcinoma
20
Q

Case 2: 8yo MC chihuahua

  • PC-hematuria, 2 day duration
  • accidents in house, small spots red urine everywhere
  • asks to go out 6-8 times a day
A
  • Pollakiuria
  • Ask
    1. straining: possible
    2. when blood: can’t tell
    3. any medications: No
  • PE: WNL
  • Problems/DDX
    1. Pigmenturia: blood vs hemoglobin vs myoglobin
    2. Pollakiuria: Lower tract
      • infection (bladder, prostate)
      • Uroliths
      • neoplasia (bladder, prostate, urethra)
      • inflammation (bladder, prostate, urethra)
    3. +/- stranguria
21
Q

Case 2: Plan

  • Urinalysis
  • Urine culture
    • +/- abdominal rads
    • +/- abdominal U/S
  • USG: 1.030
  • Dipstick
    • blood 3+
  • Sediment
    • 1+ cocci
A
  • Dipstick: this DOES mean he has blood in Urine
  • 1+ cocci probs mean infection
    • do a culture
  • Next step
    1. urine culture
    2. abdominal rads
    3. +/- abdominal U/S
22
Q

Case 2: Diagnosis

  • Radiographs: Lateral proj
    • mineral opacity around prostate…?
    • mineral opacities in bladder
  • Culture: no growth
  • Now what?
A
  • Now
    • diet?
    • surgery
    • voiding urohydropulsion

*In summary, something about DO A URINALYSIS

23
Q

Case 3: 8yo FS Australian Shepherd

  • PC: hematuria
  • HX
    • 5-7 day duration, mild stranguria, appetite and activity normal
  • Free catch UA
    • 3+ blood, protein on dipstick
    • TNTC RBC/hpf
  • Cystocentesis UA
    • blood neg
    • protein neg
    • 0-1 RBC/hpf
A
  • Problem distal to bladder
    • urethra
    • vagina
    • vestibule

*More notes to do a urinalysis….

Urology (15 decks)

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