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Year 2 > Haematuria > Flashcards

Haematuria Flashcards

1
Q

What is haematuria?

A

Blood in the urine

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2
Q

What is visible and non-visible haematuria called respectively?

A

Visible - macroscopic/gross

Non visible - microscopic/dipstick positive

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3
Q

When is haematuria diagnosed?

A

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)

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4
Q

What is spurious contamination?

A

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

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5
Q

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

A

Hesitancy
Frequency
Urgency
Dysuria

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6
Q

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

A

Renal colic (loin to groin pain)

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7
Q

List causes of red appearing spurious contamination?

A 
Menstruation 
Food (rhubarb, beetroot)
Myoglobin in urine 
Drugs 
Toxin (lead, mercury)
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8
Q

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

A

1ml

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9
Q

When is myoglobin found in the urine?

A

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

I.e damage to muscles

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10
Q

Which drugs can cause spurious contamination?

A

Nitrofurantoin (UTI treatment)
Rifampicin
Chloroquine
Senna containing laxatives

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11
Q

List the appearance of brown appearing spurious contamination

A

Porphyrias

Urobilinogen in urine

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12
Q

When is urobilinogen found in urine?

A

Liver dysfunction
Icterus
Haemolysis

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13
Q

Blood thinners increase incidence of haematuria. T/F

A

True in overdose - warfarin, heparin & aspirin

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14
Q

Which percentage of patients with frank haematuria have cancer?

A

20-30%

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15
Q

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

A 
Smoking
Chemical/dye exposure
Gross haematuria
>40 y/o
History of urologic disorder
History of irritative voiding symptoms 
History of UTI (reassuring)
Analgesia abuse
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16
Q

Cystitic can cause frank haematuria. T/F

A

True

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17
Q

What are the infective causes of haematuria?

A 
Uretitis
Cystitis
Ureteritis 
Pyelonephritis 
Prostatitis
18
Q

Can glomerulonephritis cause haematuria?

A

Yes - autoimmune in origin

19
Q

When does prostatitis cause haematuria?

A

When it is associated with UTI

Trauma to blood vessels

20
Q

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

A

The majority of the time - microscopic

21
Q

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

A

Yes - commonly frank but either

22
Q

What is the isreal triad?

A

Pain
Kidney mass
Haematuria

Usually at least one will be present in kidney tumours

23
Q

What types of kidney tumours are there?

A

Renal cell cancer (renal parencyme)

Transitional cell cancer (renal pelvis, calycs, etc)

24
Q

How do tumours of the lower urinary tract present?

A

Haematuria
Retention
Urinary irritative symptoms
Loin pain

25
Q

What is sports/joggers haematuria?

A

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
Q

What is the natural history of joggers haematuria?

A

Disappears within a week

27
Q

Can contact sports cause joggers haematuria?

A

No. But can cause haematuria through trauma

28
Q

What is decompression haematuria?

A

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

29
Q

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

A

True

30
Q

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

A 
Gynaecological & surgical history
Pneumonuria 
Faecaluria
Vaginal bleeding
Abdominal and/or loin pain
Weight loss
Anaemia
31
Q

When do pneumonuria and faecaluria occur?

A

Pneumonuria - fistula

Faecaluria - fistula (e.g vesico-diverticular)

32
Q

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

A 
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
Q

How does a ruptured kidney present?

A

Loin pain
Haematuria
Trauma
Malaise

34
Q

How does a ruptured kidney present on CT?

A

Lots of dark bleeding surrounding where kidney should be

35
Q

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

A

Dark blood with clots - old pathology

Fresh red blood - something happening right now

36
Q

What do veriform (“worm-like”) clots indicated?

A

Bleeding coming from upper urinary tract

esp if associated with loin pain - renal colic on passing clots

37
Q

How does the timing of the blood help differentiate pathology?

A

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

38
Q

How does pain pattern help differentiate pathology?

A

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

39
Q

How can haematuria be investigated?

A 
Urinalysis
Urine culture
Cytology
Bimanual palpation
PR exam
Urinary x-ray dye test
CT urogram (with/without contrast)
40
Q

How is traumatic haematuria investigated?

A

CT scan (first line)
USS
MRI

Year 2 (72 decks)

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