Hematuria (Cooke) Flashcards
1
Q
Macroscopic hematuria
A
- visible discoloration
- could be from lower urinary tract
- bladder or lower
- could be from upper urinary tract
- ureters RARE
- Systemic disease
- Other pigment
2
Q
Microscopic hematuria
A
- no visible discoloration
- > 5 rbc’s per hpf
3
Q
Pigmenturia hx questions
A
- 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
Q
Terminal hematuria cause
A
- usually from bladder
5
Q
Independent/beginning of urination hem. cause
A
- from sphincter of bladder to the outside world
- urethra
- prostate
- vagina
- vaginal vestibule
6
Q
Physical exam Urinary tract
A
- 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
Q
Urinalysis
A
- Free catch vs cysto
- iatrogenic hemorrhage
- Bacteria
- Casts
- Parasite eggs (rare)
8
Q
Bloodwork
A
- +/- CBC with platelet count
- BMBT
- +/- Assess coagulation status
- PT/PTT
- ACT
9
Q
Rads (survey)
A
- uroliths
- kidney size and shape
- prostate size and shape
- lymph nodes
10
Q
Abdominal ultrasound
Look at…
Look for…
A
- Look at
- Kidneys
- Bladder
- Prostate
- FNA
- Look for
- cysts
- masses
- abscesses
- stones
11
Q
Contrast radiography
A
- 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
Q
Other diagnostics
A
- cystoscopy
- laparotomy
- biopsy
13
Q
Hematuria WITHOUT dysuria/stranguria/pollakiuria
A
- 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)
- systemic (animal VERY SICK)
14
Q
Hematuria WITH dysuria
A
- Usually Lower urinary tract
- cystitis
- infectious/inflammatory
- Urolithiasis
- Prostatitis
- Benign prostatic hyperplasia
- Neoplasia
- Trauma (HIC, shaken, kicked by horse)
- cystitis
15
Q
Hemoglobinuria
A
- THINK THINGS THAT CAUSE HEMOLYSIS
- IMHA
- DIC
- Heat stroke
- Caval syndrome: D. immitis
- Other: toxins, blood parasites
*spun supernat DOESN’T clear
16
Q
Order of presenting a patient
A
- Signalment
- Presenting complaint
- Pertinent history
- Physical exam
- Problems
- Differential diagnoses
- Plan
17
Q
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
A
- History questions
- Straining?: NO
- When does it occur?: THROUGHOUT
- Pollakiuria?: No
- Probs Upper tract
- DDX
- cancer (renal)
- idiopathic renal hemorrhage IRH
- stones (kidney?! don’t always cause mac hem)
- Infection (should be sicker)
- coagulopathy (sicker/bleeding else where)
- Diagnostic plan
- Watch pee
- PE (140$)
- Urinalysis (35$)
- +/- culture/sensitivity (50$)
- CBC: because of bleeding (40$)
- Chem: renal stuff (40$)
18
Q
Case 1: Work up/labs results
- USG: 1.012
- Dipstick
- Pro - 2+
- Bili - 2+
- Sediment
- Inf cocci, TNTC RBCS, WBC’s: 0-5/hpf
- abdominal rads (150$)
- soft tissue mass caudal plane right kidney
- small irregular kidneys
- chest rads: neoplasia (150$)
- +/- ultrasound (255$)
- renal mass
A
- 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
Q
Case 1: We have a mass, now what?
- Excretory Urogram (150$)
- Right renal mass within pelvis, proximal ureter and medial aspect of kidney
- small cystic lesion in left kidney
A
- CT with Excretory Urogram (500$)
- will help quantitate renal function
- CT EU and Nuc scintigraphy not at normal primary care practices
- Surgery
- histopath: carcinoma
20
Q
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
A
- Pollakiuria
- Ask
- straining: possible
- when blood: can’t tell
- any medications: No
- PE: WNL
- Problems/DDX
- Pigmenturia: blood vs hemoglobin vs myoglobin
- Pollakiuria: Lower tract
- infection (bladder, prostate)
- Uroliths
- neoplasia (bladder, prostate, urethra)
- inflammation (bladder, prostate, urethra)
- +/- stranguria
21
Q
Case 2: Plan
- Urinalysis
- Urine culture
- +/- abdominal rads
- +/- abdominal U/S
- USG: 1.030
- Dipstick
- blood 3+
- Sediment
- 1+ cocci
A
- Dipstick: this DOES mean he has blood in Urine
- 1+ cocci probs mean infection
- do a culture
- Next step
- urine culture
- abdominal rads
- +/- abdominal U/S
22
Q
Case 2: Diagnosis
- Radiographs: Lateral proj
- mineral opacity around prostate…?
- mineral opacities in bladder
- Culture: no growth
- Now what?
A
- Now
- diet?
- surgery
- voiding urohydropulsion
*In summary, something about DO A URINALYSIS
23
Q
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
A
- Problem distal to bladder
- urethra
- vagina
- vestibule
*More notes to do a urinalysis….
