Assistant prof Dr Mayasah A Sadiq FIBMSFM Approach to Patient with blood in urine History taking Physical examination Investigation Lab Radiology History Taking Associated symptoms ID: 933793
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Slide1
An Approach to a Patient with
Assistant prof. Dr. Mayasah A. Sadiq F.I.B.M.S.-FM
Slide2Slide3Slide4Slide5Slide6Slide7Slide8Slide9Slide10Approach to Patient with blood in urine
History taking§Physical examination§Investigation, Lab , Radiology
Slide11Slide12Slide13Slide14Slide15History Taking
Associated symptoms :Fever, back pain, dysuria, urgency, frequency (UTI)renal colic or previous nephrolithiasis (renal stone disease)
weight loss, especially with abdominal pain (RCC)
weight loss with a significant smoking history,
or exposure to industrial dyes (
bladder carcinoma
)
Symptoms of prostatic obstruction in older men such as hesitancy and dribbling (
BPE
)
recent sore throat or skin infection, edema,
hypertension (
glomerulonephritis)
Slide16History Taking
Associated symptoms(continued) : recent back, abdominal, or urethral injury or vigorous exercise (
trauma)history of
heart murmur
with recent dental or genitourinary manipulation (
endocarditis
)
or a history of bleeding from other sites, a previous bleeding disorder, or family history of a
bleeding disorder
(
systemic coagulopathy
).
Cyclic hematuria
in women that is most prominent during and shortly after menstruation, suggesting
endometriosis
of the urinary tract.
Sterile pyuria with hematuria
, which may occur with renal tuberculosis, analgesic nephropathy and other interstitial diseases
Loin pain-hematuria syndrome (LPHS):
(rare) recurrent episodes of severe unilateral or bilateral loin (flank) pain that were accompanied by gross or microscopic hematuria, associated with use of
OCPs,pregnancy,MC
.
Slide17History taking
Urine Color, pattern: What color is your urine? Are you taking rifampicin? Have you eaten beetroot (
Beeturia)? Is it pure blood or mixed with urine?
Are there any
clots
? (
lower urinary tract source
)
–
Does it happen all the time when you pass water?
Is it near the beginning, end or during the entire urine stream?
Post operative , recent urological surgery ?
Slide18Rifampicin Vs beetroot
Slide19Red flags
Painless gross hematuria in an elderly, in the absence of infection, is caused by malignancy unless proved otherwiseHematuria in elderly, which may be transient, intermittent, or asymptomatic, always warrants a comprehensive evaluation to exclude malignancyPersistent hematuria warrants thorough evaluation when found in patients of any ageHematuria associated with sterile pyuria
is genitourinary TB or interstitial nephritis until proved otherwise
Slide20Slide21Slide22Slide23Slide24 It is difficult to localize the site of bleeding by routine examination of the patient with hematuria.
However, certain findings may be very helpful depend on size & shape of RBCs. For example, casts form in the lumina
of renal tubules. Therefore, the presence of RBCs casts localizes the site of bleeding to the renal parenchyma.
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