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Urine 3 Flashcards

1
Q

what is the normal amount of glucose that should be in the urine?

A

none

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2
Q

how do you test for glucose in the urine?

A

dipstick test

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3
Q

what is the confirmstion test for any reducing sugar glucose, fructose or galatose?

A

clinitest

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4
Q

what happens if the dipstick test is positive for sugar in the urine?

A

get a fasting blood sugar and correlate to history (family history, over weight, >40 yo, polyuria, polydipsia, etc)

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5
Q

describe what happens to sugar in the kidneys

A

it is filtered by glomeruli and reabsorbed in proximal tubules

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6
Q

what is renal thereshold value?

A

AKA blood threshold value
140-180mg/dL
diabetics could have a higher than normal value
how much glucose the kidney can handle before spilling over into the urine

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7
Q

when might you see glucosuria?

A

diabetes
after eating high carb meal
kidney disease affecting renal rubules

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8
Q

describe renal glycosuria

A

glucose in urine because of kidney disease affecting the renal tubules
may lower RTV

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9
Q

RTV

A

renal threshold value

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10
Q

hyperglycemia and glucosuria are due to?

A 
diabetes mellitus
endocrine disorders (acromegaly)
pancreatic problems (tumor, pancreatitis)
adrenal disorders (Cushings)
hyperthyroidism
pregnancy
stress
CNS disorders
tumor, hemorrhage
stroke
disturbances of metabolism (burns, infections, MI, obesity)
liver disease
exercise
certain drugs
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11
Q

when do we see ketones? what are ketones?

A

when there is a lack of available sugar getting to cells due to lack of insulin
ketones are a byproduct of fat metabolism

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12
Q

how are ketones reported?

A

negative, trace, small moderate or large amounts (1+,2+,3+,4+)

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13
Q

what is considered normal ketones?

A

negative

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14
Q

what do ketones include?

A

acetone
beta hydroxybutric acid
acetoacetic acid

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15
Q

what are ketones in the urine associated with?

A

poorly controlled diabetes mellitus

may warn of an impending diabetic coma

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16
Q

diabetes mellitus positive labs?

A

ketones and sugars in urine

possible fruity odor in urine

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17
Q

how could one with diabetes mellitus have ketones in urine?

A

fasting, starvation
low carb, high protein diet
dehydration

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18
Q

high levels of ketones indicate?

A

body is using fat as major source of energy

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19
Q

what other ways can a patient have ketones in the urine?

A

electrolyte imbalance
alcoholism
babies and children with fever

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20
Q

in nondiabetic patients, ketonuria indicates?

A

reduced carb metabolism and excessive fat metabolism

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21
Q

what is the normal level of bilirubin in the urine?

A

negative

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22
Q

most bilirubin is formed in? Why?

A 
reticuloendothelial system (spleen, liver, marrow)
as a breakdown product of RBC hemoglobin released from senescent RBCs
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23
Q

indirect/unconjugated bilirubine

A

prehepatic

broken down RBC hemoglobin released from senescent (biological aged) RBCs

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24
Q

what can unconjugated bilirubin not do?

A

pass glomerular filter because it isn’t water soluble

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25
Q

describe what the reticuloendothelial system does

A

releases bilirubin into blood stream
binds with albumin to transport it to the liver
it is then conjugated with glucuronic acid to become direct/conjugated bilirubin (water soluble)

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26
Q

what does the liver do with the direct/conjugated bilirubin?

A

excretes it into the bile that goes to the small intestine

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27
Q

how does bilirubin become urobilinogen?

A

when bacteria acts upon it

28
Q

what happens to urobilinogen?

A

reduced to stercobilinogen (color to feces)

29
Q

what does conjugated bilirubin in the urine indicate?

A

obstruction to flow of bile from the liver

gallstones, tumor, pancreatic cancer, liver inflammation/infection

30
Q

what are the signs of bilirubin in the urine?

A

urine is dark and may have yellow foam (if shaken)
jaundice
pale colored feces

31
Q

bilirubinuria is associataed with?

A

elevated serum conjugated bilirubin which is an indicator of liver dysfunction or biliary obstruction

32
Q

abnormal bilirubin values may indicate?

A

pre-hepatic problems
hepatic problems
post hepatic problems

33
Q

pre-hepatic problems

A

unconjugated bilirubin doesn’t appear in urine
anemia
excessive breakdown of RBC

34
Q

hepatic (liver disease) problems

A

hepatitis
cirrhosis
obstruction of biliary duct
toxic liver damage

35
Q

post-hepatic problems

A

biliary tree obstruction

36
Q

a positive test for urine bilirubin confirms that any raised plasma levels are from?

A

conjugated hyperbilirubinemia

37
Q

urobilinogen formation

A 
lysed RBC
free hemoglobin
indirect unconjugated bilirubin
liver
direct conjugated bilirubin
intestines with bile and acted on bacteria becomes urobilinogen and stercobilinogen
kidney
urobilinogen
38
Q

what are normal levels of urobilinogen in the urine?

A

0.1-1.0mg/dL

39
Q

what is urobilinogen?

A

by-product of hemoglobin metabolism with bilirubin breakdown in the intestine

40
Q

what does abnormal urobilinogen test indicate?

A

liver problems

41
Q

what kind of bilirubin is prehepatic

A

unconjugated

42
Q

what does conjugated/direct bilirubin do?

A

combines with bile in the GI tract acted on by bacteria in the colon to become urobilinogen and stercobilinogen

43
Q

where does stercobilinogen go?

A

goes to give feces color
some is released back into circulation and re-extreted in the bile
some is absorbed by the kidneys and passed out in urine

44
Q

urobilinogen in the urine indicates?

A

liver disease

hemolytic condtions

45
Q

why does urobilinogen get put into te urine with liver disease?

A

urobilinogen is not re-excreted in the bile, therefore there are increased levels in the urine

46
Q

why does urobilinogen get put into the urine with hemolytic disorders?

A

the amount of unconjugated bilirubin that is present in the blood increases, causing an increase in hepatic extretion of conjugated bilirubin, resulting in increased amounts of urobilinogen that in turn causes an increase in reabsorption, recirculation and renal extretion

47
Q

increased urobilinogen in the urine indicates?

A 
overburdening of liver
excessive RBC breakdown
increased urobilinogen production
re-absorption (large hematoma)
restricted liver function
hepatic infection
poisoning
liver cirrhosis
48
Q

decreased values after urobilinogen indicates?

A

failure of bile production

obstruction of bile passage

49
Q

urobilinogen and bilirubin levels in the urine are where in normal people?

A

urobilinogen <1unit

bilirubin none

50
Q

urobilinogen and bilirubin levels in the urine are where in liver/biliary disease

A

urobilinogen increased

bilirubin positive

51
Q

urobilinogen and bilirubin levels in the urine are where in biliary tract obstruction

A 
urobilinogen low (partial obstruction)/absent (complete obstruction)
bilirubin positve
52
Q

urobilinogen and bilirubin levels in the urine are where in prehepatic disease/hemolytic anemia

A

urobilinogen increase

bilirubin negative/normal

53
Q

signs of liver/biliary tract disease

A 
dark yellow/brown/green colored urine
\+ bilirubin
\+ urobilinogen
discomfort, mid back pain
jaundice of skin and sclera
increased liver enzymes
grey/white stools
usually caused by gallstone
54
Q

what should you do with someon you suspect has gallstones, but doesn’t have symptoms?

A

expectant management

wait and see until they start having symptoms

55
Q

what should you do with someone who has gallstones and has symptoms?

A

if they are a good surgical candidate, they will get a cholecystectomy
if they aren’t, then they will get nonsurgical therapy

56
Q

normal blood in urine?

A

no blood in urine

57
Q

what would make you suspect blood in the urine?

A

smoky colored urine

cloudy urine

58
Q

if there is blood in the urine, what could it possibly be?

A

hematuria, hemoglobinuria, myoglobinuria

59
Q

hemoglobinuria, myoglobinuria

A

+OB (red urine)

normal RBC

60
Q

+OB, yellow urine

A

micromyoglobulinuria
microhematuria
microhemoglobinuria

61
Q

blood in urine could indicate?

A

kidney and bladder calculi

damage to kidney or urinary tract

62
Q

hemoglobinuria indicates?

A

breakdown of RBCs

63
Q

myoglobinuria indicates?

A

MI

muscle damage

64
Q

hematuria

A

urine is light red yellow to fairly dark red, smoky
blood or RBCs in urine
may be an early indicator of renal disease

65
Q

hematuria may be due to?

A

malignancy, infection, stones, menses, trauama, exercise

inkids, 1/3 of hematuria is idiopathic

66
Q

elevated RBCs, +OB

A

hematuria

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