《杭州电视台全国主持人招聘·我是主。。。.ppt

Hematuria ;Gross hematuria: Suspected if a red or brown color change of urine Intermittent red or brown color urine a/w variety of clinical setting Medications (phenazopyridine, microbid, NSAID) Ingestion of beets or certain dyes Metabolities Myoglobinuria or hemoglobinuria If pass clot, indicate lower urinary source ;Work up Centrifuge the specimen, Supernatant be tested for heme (hemoglobin or myoglobin) with a urine dipstick. ;Causes of heme-negative red urine;Approach to the patient with red or brown urine ;Microscopic hematuria: Accidental finding from UA or urine dipstick 3 or more RBC/hpf in spun urine sediment. No safe lower limit below which significant disease can be excluded Often asymptomatic The degree of hematuria does not correlate with the seriousness of the underlying cause of the bleeding. ;Dx:;Major causes of hematuria by age and duration;The evaluation should address the following three questions 1. Are there any clues from the history or physical examination that suggest a particular diagnosis? 2. Does the hematuria represent glomerular or extraglomerular bleeding? 3. Is the hematuria transient or persistent? ;Urethral: First 10-15 mL Bladder: Final 10-30 mL Upper urinary tract: Throughout;Goal is to quickly identify Infection Kidney stone Malignant Need immediate attention;History and Physical;History Abdominal or flank pain ?? Dysuria, frequency, urgency ?? Trauma ?? Strenuous exercise ?? Menstruation ?? Recent URI/ sore throat ?? Skin rashes/ skin infection ?? Diarrhea (especially bloody) ?? Joint pains/swellings ?? Medications/toxins ?? h/o sickle cell disease or sickle trait ;Family history Hematuria , Hearing loss, HTN, Stones, Renal disease, Dialysis or transplant, Sickle cell trait *: Coagulopathy, ;Medication Hx;Mechanisms by Which Selected Drugs May Cause Hematuria;Physical Exam ?? Vital sign: BP, T, HR Skin: Rashes, evidence or trauma, bruising ?? Abdomen for masses, tenderne