hematuria approch

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2. Haematuria in UK English Hematuria in US English Definition: is the passage of red blood cells in urine.2 3. Not all red urine is Hematuria>> may caused by Haemoglobinuria Myoglobinuria Acute inttermittent porphyria ( error in metabolism of heam) Beetroot ( name of plant) Blackberries , food colors Senna ( name of plant) PhenolphthaleinDrugs :Rifampicin, Doxorubicin, Chloroquine, Deferoxamine, Ibuprofen ,Iron sorbitol, Nitrofurantoin, Phenazopyridine ,Phenolphthalein 3 4. Kidney Glomerular disease Carcinoma Stone Trauma ( including renal biopsy) Polycystic kidney TB tuberculosis Embolism Renal vein thrombosis Vascular malformation 4 5. Ureter Stone neoplasm5 6. Bladder Carcinoma Inflammatory: e.g. cystitis, TB, schistosomiasis Stone trauma6 7. Prostate Benign prostatic hypertrophy carcinoma7 8. Urethra Trauma Stone Urethritis neoplasm8 9. General Anticoagulant therapy Thrombocytopenia Strenuous exercise Hemophilia Sickle cell disease Malaria (common where malaria is endemic)9 10. Pain associated with hematuria suggest infection or inflammation. Painless hematuria suggests tumor or tuberculosis. Total haematuria ( throughout the stream ) suggest bleeding from the upper urinary tract or bladder. Initial hematuria ( at the start of the stream) suggest bleeding from the urethra or the prostate 10 11. Terminal haematuria (at the end of the stream) suggest bleeding from the bladder or the prostate. Ask about family history of polycystic kidney disease History of TB Any recent foreign travel suggest schistosomiasis 11 12. Loin pain suggest kidney disease History of ureteric colic suggest passage of a stone or clot down the ureter Suprapubic pain, frequency and dysuria suggest a problem in the bladder Difficulty in starting poor stream and nocturia suggest prostatism ( lower urinary tract symptoms ) 12 13. History of falling astride , pelvic fracture or trauma suggest urethral injury Is the patient on anticoagulant? Evidence of sickle cell disease or exposure to malaria History of strenuous exercise Has there been any recent renal biopsy? 13 14. Others causing red urine not hematuria Recent crush injuries or ischemia of themuscles suggest myoglobiuria with haemolysis Eating or ingestion of substances that make urin red Acute inttermittent porphyria : rare disorder and accompanied by abdominal pain Urine if kept in light become purplish-red 14 15. Look for anemia, weight loss and signs of chronic renal failure. Abdominal examination for palpable mass egg polycystic kidney disease and distended bladder Rectal examination to detect enlargement in prostate Feel along the urethra for stones or neoplasm Examine the chest for TB and metastasis from renal cancer. 15 16. Full blood count and erythrocyte sedimentation rate ( CBC & ESR) Increase in WBCs so infection ESR increase so malignancy or TBDipstick testing not enough you must do microscopyUrine microscopy Red blood cells ? WBCs so infecton Organisms so infection Cytology for cancer cells 16 17. Urea and electrolytes for renal failure Clotting screen for anticoagulant Chest X-ray for metastasis Kidney Ureter Bladder plain X-ray for calculus PSA for prostate cancer Sickling test for sickle cell disease Intravenous urography for stones and tumor and TB. 17 18. Ultra sound for stone and urinary tract obstruction Cystoscopy for infection tumor and stones Ureteroscopy for tumor and obstruction. Renal angiography for vascular malformation and embolism Renal biopsy for renal tumor and glomerular disease Prostatic biopsy for tumor of prostate 18end 19. themost common in the primary malignant renal tumors Occurs in old ages males : females 2:1 more common in male derived from the renal tubular epithelium ( adenocacinomas) 1% occur bilateral 19 20. Etiology: increased incidence in those who smoke tobacco , besides chemical carcinogens, von Hippel-lindau syndrome, and polycystic kidney Symptoms Pain Haematuria Weight loss Flank mass Hypertension 20 21. Diagnosis by: IVP Abdominal CT scan with contrast Staging Stage 1 : < 2.5 cm N0 M0 Stage 2 : > 2.5 cm limited to kidney N0 M0 Stage 3 : 2 cm , +ve N 21 22. mainroutes of metastasis is blood spread to lung Liver Brain Bone Badprognosis 22 23. 23 24. Second most common urologic malignancyTransitional cell carcinoma ( most common) squamous or adenocarcinoma Etiology : increase risk by smoking , carcinogens, schistosomiasis, truck drivers, petroleum workers , cyclophosphamide. 24 25. Symptoms: Painless Haematuria Frequancy increaseDiagnosis: Urinalysis and culture, IVP Cystoscopy Cytology biopsy 25 26. Staging Stage 0 : in situ Stage 1 : invades sub epithelial tissue Stage 2 : invades superficial or deepmusclaris propria Stage 3 : invade perivesical tissue Stage 4 : N +ve and distant M26 27. 27 28. 28 29. 29 30. Most common genitourinary cancer Occur mostly in elderly about 70 Occur in males more than in females ( for fun only) Type : most adenocarcinoma Symptoms: Asymptomatic Found accidentally on PR 30 31. Occur usually at peripheral parts of the gland Etiology: Not known Diagnosis: Trans rectal ultra sound Trans rectal biopsy 31 32. In elderly usually Occur at periurethrally Symptoms : Obstructive symptoms Urinary retention Hesitancy Weak stream Nocturia intermittency UTI 32 33. 33 34. Diagnosed by History Digital rectal examination Elevated post void residual???? Urinalysis Cystoscopy Ultra sound34 35. Treatment Alpha 1 blockers Antiandrogen Surgery Trans urethral balloon dilatation35 36. 1.Glomerular cause 1.Primary glomerulanephritis 1. IgA nephropathy 2. Post streptococcal glomeruronephritis2.Secondary glomerulonephritis 1. Lupus nephritis 2. Vaculitis 3. Henoch Scolein purpura36 37. Thank you Thank youThank youThank Th you an kThan Thank k you Thank youyo uThank youThank youT h a n k y o uThank youTha Thank you nk Thank you you Thank youThank youThank you37T h a n k y o 38. Prostate specific antigen : an enzyme produced by the glandular epithelium of the prostate . Increased in quantities are secreted when the gland is enlarged . PSA increase in blood significantly in case of cancer above 4 ngramml 38 39. Examine the urethral opening and its place Examine the scrotum and testis in male 39