Haematuria Flashcards
Definition
Presence of blood in the urine
It should never be ignored
2 types of haematuria
Visible - macroscopic
Non-visible - microscopic
Visible haematuria
Macroscopic
Gross, frank haematuria
Visible haematuria is regarded as a symptom of urologic malignancy until proven otherwise. True or false?
True
Non visible haematuria
Microscopic
Found on urinalysis
Check for risk factors of cancer development
Symptomatic non-visible haematuria
UUTS: - colic LUTS: - frequency - hesitancy - urgency - dysuria - retention - incontinence
Asymptomatic non-visible haematuria
Incidental finding
Causes - benign
Infection
Stones
BPH
Causes - malignant
Tumours
- RCC (all ages)
- TCC (e.g. of bladder - over 50)
- invasion from other sites
Causes - trauma
Haematoma
Sport haematuria
Causes - medication
Anticoagulants
Rifampicin
Nitrofurantoin
Chloroquine
Causes - contamination
Menstrual
Foods - beetroot
Myoglobin
Long and worm like clots are said to be from the UPPER/LOWER urinary tract?
Upper
Shapeless clots are said to be from the UPPER/LOWER urinary tract?
Lower
Schistosome gives you an increased risk of developing which type of cancer?
Squamous cell carcinoma
Clinical examination
Abdominal exam
Bladder exam
PR exam
Always refer patients (of any age) with visible haematuria for further testing. True or false?
True
Do not always need to refer patients (of any age) with symptomatic non-visible haematuria for further testing. True or false?
False
- always refer these patient
All patients with asymptomatic non visible haematuria should be sent for further testing. True or false?
False
- only if 40 and over
Investigation aims
Examine the whole urinary tract by the simplest means
Investigation options are the same irrespective of age?
False
- depend on age
First line investigations
Urinalysis
Urine sample sent for C+S
What is cytology good for?
High grade cancer detection
First line imaging test
US
Which investigation is commonly carried out after US?
CT
MRI
Contrast imaging
IV urogram
CT urogram
IV urogram - function
Shows filling defects
IV urogram - if bladder is filled with contrast but the contrast does not reach the bladder walls, what is the suspected pathology?
Bladder cancer
- filling some but not all of the bladder
What is the first line investigation if there is frank haematuria in over 50 year olds?
CT urogram
CT urogram - function
Examines kidneys, collecting systems and ureters
CT urogram - procedure
CT with no contrast: most sensitive way to detect calculi
Administer 75ml contrast - look at collecting system and ureters
Administer another 75ml contrast after 15 mins - enhances renal parenchyma
Use CT urogram in people under 50 and over 50?
False
- over 50 only.
- under 50yo less likely to have cancer
Cytoscopy - what is it good to use in?
Bladder investigation
