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Flashcards in Haematuria Deck (40):
1

What is haematuria?

Blood in the urine

2

What is visible and non-visible haematuria called respectively?

Visible - macroscopic/gross
Non visible - microscopic/dipstick positive

3

When is haematuria diagnosed?

Presence of at least 5 red blood cells per high powered field in 3 consecutive centrifuge specimens obtained at least 1 week apart
OR
Dipstick (usually dipstick tbh)

4

What is spurious contamination?

Discoloured urine caused by contaminants (blood, etc) from a non-urinary tract source

5

List some lower urinary tract symptoms that may present in conjunction with haematuria

Hesitancy
Frequency
Urgency
Dysuria

6

List some upper urinary tract symptoms that may present in conjunction with haematuria

Renal colic (loin to groin pain)

7

List causes of red appearing spurious contamination?

Menstruation
Food (rhubarb, beetroot)
Myoglobin in urine
Drugs
Toxin (lead, mercury)

8

How much blood does it take to give the urine a red appearance?

1ml

9

When is myoglobin found in the urine?

Bywater's syndrome (crush syndrome)
Rhabdomyolisis (statins)
McArdle sydrome

I.e damage to muscles

10

Which drugs can cause spurious contamination?

Nitrofurantoin (UTI treatment)
Rifampicin
Chloroquine
Senna containing laxatives

11

List the appearance of brown appearing spurious contamination

Porphyrias
Urobilinogen in urine

12

When is urobilinogen found in urine?

Liver dysfunction
Icterus
Haemolysis

13

Blood thinners increase incidence of haematuria. T/F

True in overdose - warfarin, heparin & aspirin

14

Which percentage of patients with frank haematuria have cancer?

20-30%

15

What are the risk factors for serious pathology of the urinary tract?

Smoking
Chemical/dye exposure
Gross haematuria
>40 y/o
History of urologic disorder
History of irritative voiding symptoms
History of UTI (reassuring)
Analgesia abuse

16

Cystitic can cause frank haematuria. T/F

True

17

What are the infective causes of haematuria?

Uretitis
Cystitis
Ureteritis
Pyelonephritis
Prostatitis

18

Can glomerulonephritis cause haematuria?

Yes - autoimmune in origin

19

When does prostatitis cause haematuria?

When it is associated with UTI
Trauma to blood vessels

20

Do UT stones cause haematuria? If so, which type?

The majority of the time - microscopic

21

Can renal tumours cause haematuria? If so, which type?

Yes - commonly frank but either

22

What is the isreal triad?

Pain
Kidney mass
Haematuria

Usually at least one will be present in kidney tumours

23

What types of kidney tumours are there?

Renal cell cancer (renal parencyme)
Transitional cell cancer (renal pelvis, calycs, etc)

24

How do tumours of the lower urinary tract present?

Haematuria
Retention
Urinary irritative symptoms
Loin pain

25

What is sports/joggers haematuria?

Haematuria presenting in patients who do non-contact sport due to vasoconstriction of renal vessels particularly the efferent renal arteriole

(--> hypoxic damage to kidney and increased glomerular filtration pressure)

26

What is the natural history of joggers haematuria?

Disappears within a week

27

Can contact sports cause joggers haematuria?

No. But can cause haematuria through trauma

28

What is decompression haematuria?

Occurs when bladder drained too quickly by catheterisation causing rupture of blood vessels

29

Foreign bodies lodged in the urinary tract can cause haematuria. T/F

True

30

Which questions should be asked on taking a history of a patient with haematuria?

Gynaecological & surgical history
Pneumonuria
Faecaluria
Vaginal bleeding
Abdominal and/or loin pain
Weight loss
Anaemia

31

When do pneumonuria and faecaluria occur?

Pneumonuria - fistula
Faecaluria - fistula (e.g vesico-diverticular)

32

Which aspects of the history are important for generating a differential?

Sex (UTI in females ; prostate in males)
Age (benign ; cancer)
Trauma
Country (schistomosis, aristochola)
Bleeding disorders
Phenacetin abuse (cocaine addicts)
History of UTI
Occupation

33

How does a ruptured kidney present?

Loin pain
Haematuria
Trauma
Malaise

34

How does a ruptured kidney present on CT?

Lots of dark bleeding surrounding where kidney should be

35

How does the colour of urine give a hint as to which pathology?

Dark blood with clots - old pathology
Fresh red blood - something happening right now

36

What do veriform ("worm-like") clots indicated?

Bleeding coming from upper urinary tract
(esp if associated with loin pain - renal colic on passing clots)

37

How does the timing of the blood help differentiate pathology?

Initial - urethra/prostate
Terminal - urethra/prostate/terminal vesicles/bladder neck
Total - bladder/kidney/ureter

38

How does pain pattern help differentiate pathology?

Flank - pyelonephritis/renal nephrolithiasis
Radiates to groin - renal stones
Suprapubic - bladder stone

39

How can haematuria be investigated?

Urinalysis
Urine culture
Cytology
Bimanual palpation
PR exam
Urinary x-ray dye test
CT urogram (with/without contrast)

40

How is traumatic haematuria investigated?

CT scan (first line)
USS
MRI

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