6: Haematuria Flashcards
Haematuria is ___ ml of blood in 100ml of urine.
1+ ml
Which organs may haematuria be caused by?
Kidneys
Ureters
Bladder
Urethra
What are two types of bleeding related to haematuria in men and women?
Haematospermia
PV bleeding
Which disease can cause haematospermia?
Prostate cancer
What are the two types of haematuria?
Visible
Non-visible
What is another name for visible haematuria?
Frank haematuria
How may non-visible haematuria be detected?
Urinalysis
Urine microscopy
What is the definition of microscopic haematuria?
3+ RBCs in 3 different urine samples
The biggest concern re: cause of haematuria should be ___.
cancer
What are risk factors for bladder cancer?
Age > 40
PMX of renal/urological problems
Smoking
Exposure to dyes
Analgesia abuse
What can cause haematuria?
Inflammation
UTI
Renal calculi
Malignancy
Trauma
Why do tumours bleed?
Angiogenesis - crappy blood vessels which rupture easily
Invasion - damaging existing blood vessels
___ of the urinary tract often present with haematuria.
Tumours
What are other symptoms of renal/urological cancers apart from haematuria?
Loin pain or renal colic
Obstruction - frequency, hesitancy, urgency…
Fever, WL, fatigue, anorexia
Prostate cancer causes haemat___.
haematospermia
NOT haematuria
What therapy for prostate cancer can cause haematuria?
Radiotherapy
What ruptures the kidneys to cause haematuria?
Trauma
What types of sports can cause haematuria?
Long-distance running
Contact sports
Why does heavy exercise cause haematuria?
Systemic sympathetic vasoconstriction may cause hypoxic damage to nephrons
Also: rhabdomyolysis of skeletal muscle
Rapid ___ can cause haematuria.
catheterisation
or decathetisation
What are some iatrogenic causes of haematuria?
Surgery
Which cardiovascular drugs can cause haematuria?
Warfarin
Heparin
Aspirin
anti-coagulants
What chemical, found in the urine following skeletal muscle trauma, may mimic haematuria?
Myoglobin
rhabdomyolysis
What drug, used to treat TB, can cause orange urine?
Rifampicin
Which clotting factors are inhibited by
a) warfarin
b) heparin
c) LMWH?
a) II, VII, IX and Xa
b) IX and Xa
c) Xa
What symptoms suggest UTI?
Loin pain
Frequency
Urgency
Dysuria
Haematuria
Constitutional symptoms
What renal disease does smoking increase your chances of?
Bladder cancer
What does industrial exposure e.g dyes and rubber increase your risk of?
Bladder cancer
Which parasitic infection increases your chance of renal cancers?
Schistosomiasis
don’t swim in Lake Malawi
How is suspected schistosomiasis investigated?
Cystoscopy
If a man’s haematuria is
a) initial
b) terminal
c) mixed
in the stream, where is it likely coming from?
a) Urethra
b) Prostate
c) Bladder
Bruising in the perineum in a butterfly-shaped pattern suggests what?
Urethral trauma
What origin of haematuria is suggested by
a) wormy
b) round clots?
a) Upper urinary tract
b) Bladder
Loin pain radiating to the groin is suggestive of ___.
renal calculi
How are the kidneys palpated?
Balloting
two hands, anterior firm over the lumbar area, posterior bouncing the kidneys up and down
Where is the prostate gland found on PR exam?
Anterior
How does the bladder feel on PR exam in an advanced bladder cancer?
Hard, irregular and immobile
What causes of haematuria are suggested on urinalysis with
a) elevated leukocytes and nitrites
b) just haematuria?
a) UTI
b) Trauma, cancer, stones
Which investigations are good for viewing the kidney’s
a) parenchyma
b) collecting system?
a) USS, MRI, CT
b) IV, CT, MRI urogram
What might you see on urogram of the bladder in TCC?
Filling defect
contrast only reaches one side, other side is filled with tumour
What investigation is used to actually view the bladder for tumours, stones etc. causing visible haematuria?
Cystoscopy
What are the first line investigations for haematuria?
CT cystography
Cystoscopy
All patients with (visible haematuria / symptomatic non-visible haematuria) over the age of 40 should be investigated.
both groups
What criteria is required to investigate a patient with asymptomatic non-visible haematuria?
Age > 40
