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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
describe what the reticuloendothelial system does
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)
26
what does the liver do with the direct/conjugated bilirubin?
excretes it into the bile that goes to the small intestine
27
how does bilirubin become urobilinogen?
when bacteria acts upon it
28
what happens to urobilinogen?
reduced to stercobilinogen (color to feces)
29
what does conjugated bilirubin in the urine indicate?
obstruction to flow of bile from the liver | gallstones, tumor, pancreatic cancer, liver inflammation/infection
30
what are the signs of bilirubin in the urine?
urine is dark and may have yellow foam (if shaken) jaundice pale colored feces
31
bilirubinuria is associataed with?
elevated serum conjugated bilirubin which is an indicator of liver dysfunction or biliary obstruction
32
abnormal bilirubin values may indicate?
pre-hepatic problems hepatic problems post hepatic problems
33
pre-hepatic problems
unconjugated bilirubin doesn't appear in urine anemia excessive breakdown of RBC
34
hepatic (liver disease) problems
hepatitis cirrhosis obstruction of biliary duct toxic liver damage
35
post-hepatic problems
biliary tree obstruction
36
a positive test for urine bilirubin confirms that any raised plasma levels are from?
conjugated hyperbilirubinemia
37
urobilinogen formation
``` 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
what are normal levels of urobilinogen in the urine?
0.1-1.0mg/dL
39
what is urobilinogen?
by-product of hemoglobin metabolism with bilirubin breakdown in the intestine
40
what does abnormal urobilinogen test indicate?
liver problems
41
what kind of bilirubin is prehepatic
unconjugated
42
what does conjugated/direct bilirubin do?
combines with bile in the GI tract acted on by bacteria in the colon to become urobilinogen and stercobilinogen
43
where does stercobilinogen go?
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
urobilinogen in the urine indicates?
liver disease | hemolytic condtions
45
why does urobilinogen get put into te urine with liver disease?
urobilinogen is not re-excreted in the bile, therefore there are increased levels in the urine
46
why does urobilinogen get put into the urine with hemolytic disorders?
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
increased urobilinogen in the urine indicates?
``` overburdening of liver excessive RBC breakdown increased urobilinogen production re-absorption (large hematoma) restricted liver function hepatic infection poisoning liver cirrhosis ```
48
decreased values after urobilinogen indicates?
failure of bile production | obstruction of bile passage
49
urobilinogen and bilirubin levels in the urine are where in normal people?
urobilinogen <1unit | bilirubin none
50
urobilinogen and bilirubin levels in the urine are where in liver/biliary disease
urobilinogen increased | bilirubin positive
51
urobilinogen and bilirubin levels in the urine are where in biliary tract obstruction
``` urobilinogen low (partial obstruction)/absent (complete obstruction) bilirubin positve ```
52
urobilinogen and bilirubin levels in the urine are where in prehepatic disease/hemolytic anemia
urobilinogen increase | bilirubin negative/normal
53
signs of liver/biliary tract disease
``` 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
what should you do with someon you suspect has gallstones, but doesn't have symptoms?
expectant management | wait and see until they start having symptoms
55
what should you do with someone who has gallstones and has symptoms?
if they are a good surgical candidate, they will get a cholecystectomy if they aren't, then they will get nonsurgical therapy
56
normal blood in urine?
no blood in urine
57
what would make you suspect blood in the urine?
smoky colored urine | cloudy urine
58
if there is blood in the urine, what could it possibly be?
hematuria, hemoglobinuria, myoglobinuria
59
hemoglobinuria, myoglobinuria
+OB (red urine) | normal RBC
60
+OB, yellow urine
micromyoglobulinuria microhematuria microhemoglobinuria
61
blood in urine could indicate?
kidney and bladder calculi | damage to kidney or urinary tract
62
hemoglobinuria indicates?
breakdown of RBCs
63
myoglobinuria indicates?
MI | muscle damage
64
hematuria
urine is light red yellow to fairly dark red, smoky blood or RBCs in urine may be an early indicator of renal disease
65
hematuria may be due to?
malignancy, infection, stones, menses, trauama, exercise | inkids, 1/3 of hematuria is idiopathic
66
elevated RBCs, +OB
hematuria

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