Hematuria (Cooke) Flashcards Preview

Urology > Hematuria (Cooke) > Flashcards

Flashcards in Hematuria (Cooke) Deck (23):
1

Macroscopic hematuria

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

2

Microscopic hematuria

  • no visible discoloration
  • > 5 rbc's per hpf

3

Pigmenturia hx questions

  • 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"

4

Terminal hematuria cause

  • usually from bladder

5

Independent/beginning of urination hem. cause

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

6

Physical exam Urinary tract

 

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

7

Urinalysis

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

8

Bloodwork

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

9

Rads (survey)

  • uroliths
  • kidney size and shape
  • prostate size and shape
  • lymph nodes

10

Abdominal ultrasound

Look at...

Look for...

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

11

Contrast radiography

  • 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

12

Other diagnostics

  • cystoscopy
  • laparotomy
  • biopsy

13

Hematuria WITHOUT dysuria/stranguria/pollakiuria

  • 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)

14

Hematuria WITH dysuria

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

15

Hemoglobinuria

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

*spun supernat DOESN'T clear

16

Order of presenting a patient

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

17

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

  • 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

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

  • 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

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 

  • 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

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

  • 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

Case 2: Plan

  • Urinalysis
  • Urine culture
    • +/- abdominal rads
    • +/- abdominal U/S
  • USG: 1.030
  • Dipstick
    • blood 3+
  • Sediment
    • 1+ cocci

  • 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

Case 2: Diagnosis

  • Radiographs: Lateral proj
    • mineral opacity around prostate...?
    • mineral opacities in bladder
  • Culture: no growth
  • Now what?

  • Now
    • diet?
    • surgery
    • voiding urohydropulsion

*In summary, something about DO A URINALYSIS

23

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

  • Problem distal to bladder
    • urethra
    • vagina
    • vestibule

*More notes to do a urinalysis....