HEMATURIA Flashcards
Anatomyof a patient with Hematuria.
(1) Kidneys
(2) Ureters
(3) Bladder
(4) Urethra
the presence of blood in the urine
Hematuria
blood in the urine - visible to the naked eye
Gross hematuria
blood in the urine- only detectible by examination of the urine sediment by microscopy, or urinalysis
Microscopic hematuria
Which one requires further evaluation
Both
The lower tract source (bladder and urethra) of gross hematuria (in the absence of infection) is most commonly from**
urothelial carcinoma of the bladder.
Microscopic hematuria in the male is most commonly from**
benign prostatic hyperplasia.
the presence of blood at the beginning of the urinary stream that clears during the stream, implies an anterior (penile) urethral source.**
Initial hematuria
the presence of blood at the end of the urinary stream,
implies a bladder neck or prostatic urethral source**
Terminal hematuria
the presence of blood throughout the urinary stream, implies a bladder or upper tract source**
Total hematuria
Hematuria associated with renal colic suggests
ureteral stone.
Irritative voiding symptoms in a young woman may suggest
- acute bacterial infection
2. associated cystitis.
If cultures are negative or hematuria persists after therapy, then what
further evaluation is warranted
In the absence of other symptoms, gross hematuria may be more indicative of
tumor.
Laboratory Findings
(1)Urinalysis
Proteinuria and casts suggest
renal origin.
Laboratory Findings
(1)Urinalysis
Other findings
- Irritative voiding symptoms, bacteriuria, and a positive urine culture in the female suggest urinary tract infection,
What all labs do you order
(1) UA
(2) Urine Culture
(3) BUN and Creatinine
Imaging
(1) CT scan of the upper tract without contrast
(2) Cystoscopy
Whats the CT evaluating for
1) Neoplasm of the kidney or ureter
2) Urolithiasis
3) Obstructive uropathy
4) Intrinsic kidney disease
Whats the cystoscopy evaluating for
1) Bladder or urethral neoplasm
2) Benign prostatic enlargement
3) Radiation or chemical cystitis
*Indicated in patients with gross hematuria or those over 35 years with asymptomatic hematuria
Treatment
dependent on the underlying disease process
Referral
(1) Urology
(a) In the absence of infection or other benign etiology
An upper urinary tract source can be identified in __% of patients with gross hematuria**
10%
