PHYSICALEXAMINATION Flashcards
OBJECTIVE observation: physical examination
Color, Volume,Clarity, Odor, and Specific Gravity
Provides preliminary information:
glomerular bleeding
liver disease
inborn errors of metabolism
urinary tract infection
used to confirm or to explain findings in the chemical and microscopic
areas of urinalysis
Physical examination
◦ normal metabolic functions
◦ physical activity
◦ingested materials
◦ pathologic conditions
Colorless to black
Normal Urine Color
pale yellow, yellow, dark yellow, and amber
ØYellow color
Øproduct of endogenous metabolism, and
under normal conditions the body produces it
at a constant rate
Urochrome
Øincreased amounts produced in thyroid
conditions and fasting states.
Øincreases in urine that stands at room temperature
Urochrome
most evident in specimens that have been refrigerated ◦attaches to the urates, producing a pink color to the sediment.
Uroerythrin
◦an oxidation product of the normal urinary constituent
urobilinogen ◦imparts an orange-brown color to urine that is not fresh.
Urobilin
Recent fluid consumption
- Commonly observed with random specimens
Colorless
Urine color of Polyuria or diabetes insipidus, DM and dilute random specimen
Pale yellow
Pale yellow that Increased 24-hour volume
Polyuria or DI
Pale yellow that Elevated specific gravity and positive glucose test result
DM
Pale yellow that Recent fluid consumption
Dilute random specimen
Color of urine that Concentrated specimen
Dark yellow
Color of urine that Dehydration from fever or burns
Amber
Color of urine that Bilirubin oxidized to biliverdin
Yellow to green or yellow brown
Colored foam in acidic urine and false-negative chemical test results for bilirubin
Yellow green or yellow brown
Orange color of urine
Bilirubin
Acriflavine
Phenazopyridine (pyridium)
Nitrofurantion
Phenindione
Orange color of urine that Yellow foam when shaken and positive chemical test results for
Bilirubin
Orange color of urine that Negative bile test results and possible green fluorescence
Acriflavine
Orange color of urine that Drug commonly administered for UTI and May have orange foam and thick orange pigment that can obscure or interfere with
reagent strip readings
Pyridium
Orange color of urine that Antibiotic administered for UTI
Nitrofurantion
Orange color of urine that Anticoagulant, orange in alkaline urine, colorless in acid urine
Phenindione
Pink to Red color of urine
RBC
Hemoglobin
Myoglobin
Porphyrin
Beets
Rifampin
Mestrual contamination
Pink to Red color of urine that Cloudy urine, blood test (+) and RBCs visible microscopically
RBC
Pink to Red color of urine that Clear urine blood test (+); intravascular hemolysis
Hemoglobin
Pink to Red color of urine that Clear urine with positive chemical test results for blood;
muscle damage
Myoglobin
Pink to Red color of urine that Negative chemical test results for blood and port wine
Porphyrin
Pink to Red color of urine that Detected with Watson-Schwartz screening
test or fluorescence under ultraviolet light
Porphyrin
Pink to Red color of urine that drugs that affect color
Rifampin
Pink to Red color of urine that Cloudy specimen with RBCs, mucus, and
clots
Menstrual contamination
Brown to Black color of urine
Homogentisic acid (alkaptonuria)
Melanin
Phenol derivatives
Argyrol (antiseptic)
Methyldopa or levodopa
Metronidazole (flagyl)
Brown to Black color of urine that Seen in alkaline urine after
standing; specific tests
Homogentisic acid (Alkaptonuria)
Brown to Black color of urine that Urine darkens on standing
and reacts with nitroprusside
and ferric chloride
Melanin
Brown to Black color of urine that Interfere with copper
reduction tests
Phenol derivatives
Brown to Black color of urine that Color disappears with ferric
chloride
Argyrol (antseptic)
Brown to Black color of urine that Antihypertensive
Methyldopa or levodopa
Brown to Black color of urine that Darkens on standing
Metronidazole (Flagyl)
GreeN / BLUE-green color of urine
Pseudomonas infection
Phenol
Methocarbamol (robaxin)
Amitriptyline
Clorets
Indican
Methylene blue
GreeN / BLUE-green color of urine that Positive urine
culture
Pseudomonas infection
GreeN / BLUE-green color of urine that Muscle relaxant,
may be green-brown
Methocarbamol (robaxin)
GreeN / BLUE-green color of urine that Antidepressant
Amitriptyline
GreeN / BLUE-green color of urine that Bacterial infection (Klebsiella,
Providencia)
Indican
GreeN / BLUE-green color of urine that Fistulas
Methylene blue
GreeN / BLUE-green color of urine that When oxidized
Phenol
Urine foam that URINE WITH LARGE AMOUNT OF PROTEIN
Albumin
cause a stable white foam to be
produced when urine is poured or
agitated
Albumin
FOAM IF PRESENT WILL BE
CHARACTERISTICALLY YELLOW
Bilirubin
transparency/turbidity of a
urine specimen
Clear container
Urine transparency
Urine transparency Visually examine
Mixed well , view in clear container and maintain light
No visible particulates, transparent.
Clear
Few particulates, print easly seen through urine.
Hazy
Many particulates, print blurred through urine.
Cloudy
Print cannot be seen through urine.
Turbid
May precipitate or be clotted.
Milky
Collected urine for normal
Clarity
Midstream or clean catch
Pathologic Causes of Urine Turbidity
RBCS
WBCs
Bacteria
Yeast
Nonsquamous epithelial cells
Abnomal crystals
Lymph fluid
Lipids
Nonpathologic Causes of Urine Turbidity
Squamous epithelial cells
Mucus
Amorphous phosphates, carbonates, urates
Semen, spermatozoa
Fecal contamination
Radiographic contrast media
Talcum powder
Vaginal creams
Laboratory Correlations in Urine Turbidity: Acidic Urine
Amorphous urates
Radiographic contrast media
Laboratory Correlations in Urine Turbidity: Alkaline Urine
Amorphous phosphates
carbonates
Laboratory Correlations in Urine Turbidity: Soluble With Heat
Amorphous urates, uric acid crystals
Laboratory Correlations in Urine Turbidity: Soluble in Dilute Acetic Acid
RBCs
Amorphous phosphates
carbonates
Laboratory Correlations in Urine Turbidity: Insoluble in Dilute Acetic Acid
WBCs Bacteria
yeast
Spermatozoa
Laboratory Correlations in Urine Turbidity: Soluble in Ether
Lipids
Lymphatic fluid
chyle
The ability of the kidneys to selectively
reabsorb essential chemicals and water
from the glomerular filtrate
Specific gravity
detects possible dehydration or
abnormalities in antidiuretic hormone
Specific gravity
of a solution compared with the density of a similar volume of distilled water at a similar temperature
Density
Direct method: SG
Urinometer
Indirect method: SG
Refractometer
direct method: urinometer used in
harmonic oscillation densitometry
Indirect method: refractometer used in
REAGENT STRIP
Urinometer (hydrometer) principle
Density
weighted float attached to a scale ◦sink to a level of 1.000 in distilled water ◦less accurate than the other methods
Urinometer
Major disadvantage of urinometer
◦ Requires large volume (10-15ml)
◦ Spinning motion
◦ Read at lower meniscus
Urinometer (hydrometer)
Tempt. Sensitive
20 degree celsius
Refractometer
Principle:
refractive index
The concentration of dissolved particles present in
the solution determines the velocity and angle at
which light passes through a solution.
Refractometer
Refractometer Advantage:
Small amount (1 to 2 drop)
Temperature compensated bet. 15-38°C
is a comparison of the velocity of light in air with
the velocity of light in a solution.
Refractive index
Harmonic oscillation densitometry
Principle
Density
The frequency of a sound wave
entering a solution changes in
proportion to the density of the
solution
Harmonic oscillation densitometry
Harmonic oscillation debate Results are linear up to a specific
gravity of
1.080
Reagent strip Method
Principle:
pKa changes of a polyelectrolyte
Isosthenuric SG
1.010 SG OF URINE
Hyposthenuric SG
< 1.010 SG OF URINE
Hypersthenuric SG
> 1.010 SG OF URINE
ABNORMALLY HIGH S.G RESULTS ARE SEEN:
> 1.035
S.G OF RANDOM SPECIMEN FALLS BETWEEN
1.015-1.025
SPECIMEN WITH S.G OF ________ PROBABLY ARE NOT URINE.
1.003
Freshly voided urine
Aromatic odor
Prolonged standing of specimen and Breakdown of urea
Ammoniacal
