STUDY - Technical - New Dacian's Medicine
Hematuria
(Classical / Allopathic Medicine)
A cardinal sign of
renal and urinary tract disorders, hematuria is the abnormal
presence of blood in the urine. Strictly defined, it means
three or more red blood cells (RBCs) per high-power
microscopic field in the urine. Microscopic hematuria is
confirmed by an occult blood test, whereas macroscopic
hematuria is immediately visible. However, macroscopic
hematuria must be distinguished from pseudohematuria.
Macroscopic hematuria may be continuous or intermittent, is
commonly accompanied by pain, and may be aggravated by
prolonged standing or walking.
Hematuria may be
classified by the stage of urination it predominantly affects.
Bleeding at the start of urination (initial hematuria) usually
indicates urethral pathology; bleeding at the end of urination
(terminal hematuria) usually indicates pathology of the
bladder neck, posterior urethra, or prostate; bleeding
throughout urination (total hematuria) usually indicates
pathology above the bladder neck.
Hematuria may
result from one of two mechanisms: rupture or perforation of
vessels in the renal system or urinary tract or impaired
glomerular filtration, which allows RBCs to seep into the
urine. The color of the bloody urine provides a clue to the
source of the bleeding. Generally, dark or brownish blood
indicates renal or upper urinary tract bleeding, whereas
bright red blood indicates lower urinary tract bleeding.
Although hematuria
usually results from a renal or urinary tract disorder, it may
also result from a GI, prostate, vaginal, or coagulation
disorder or therapy with certain drugs. Invasive therapy and
diagnostic tests that involve manipulative instrumentation of
the renal and urologic systems may also cause hematuria.
Nonpathologic hematuria may result from fever and
hypercatabolic states. Transient hematuria may follow
strenuous exercise.
HISTORY:
Ask the patient when he first noticed blood in his urine and if he has ever experienced this problem before.
Ask the patient if the bleeding varies in severity between voidings. Also, ask him if it's worse at the beginning, middle, or end of urination.
Ask the patient if he has noticed any clots. To rule out artifactitious hematuria, ask him about bleeding hemorrhoids. If the patient is female, ask her about the onset of menses.
Ask the patient if he has had recent abdominal or flank trauma.
Ask the patient if he has been exercising strenuously.
Review the patient's medical history for renal, urinary, prostatic, or coagulation disorders.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient when he first noticed blood in his urine and if he has ever experienced this problem before.
Ask the patient if the bleeding varies in severity between voidings. Also, ask him if it's worse at the beginning, middle, or end of urination.
Ask the patient if he has noticed any clots. To rule out artifactitious hematuria, ask him about bleeding hemorrhoids. If the patient is female, ask her about the onset of menses.
Ask the patient if he has had recent abdominal or flank trauma.
Ask the patient if he has been exercising strenuously.
Review the patient's medical history for renal, urinary, prostatic, or coagulation disorders.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
Palpate and percuss the abdomen and flanks. Next, percuss the costovertebral angle to elicit tenderness.
Check the urinary meatus for bleeding or other abnormalities.
Using a chemical reagent strip, test a urine specimen for protein.
A vaginal or digital rectal examination may be necessary.
Obtain a urine specimen, and note its color.
Palpate and percuss the abdomen and flanks. Next, percuss the costovertebral angle to elicit tenderness.
Check the urinary meatus for bleeding or other abnormalities.
Using a chemical reagent strip, test a urine specimen for protein.
A vaginal or digital rectal examination may be necessary.
Obtain a urine specimen, and note its color.
SPECIAL
CONSIDERATIONS:
Monitor the patient's vital signs and intake and output.
Monitor the patient's vital signs and intake and output.
PEDIATRIC
POINTERS:
Cyclophosphamide is more likely to cause hematuria in children than in adults.
Common causes of hematuria that chiefly affect children include congenital anomalies, such as obstructive uropathy and renal dysplasia; birth trauma; hematologic disorders, such as vitamin K deficiency, hemophilia, and hemolytic uremic syndrome; certain neoplasms, such as Wilms’ tumor, bladder cancer, and rhabdomyosarcoma; allergies; foreign bodies in the urinary tract; and venous thrombosis. Artifactitious hematuria may result from recent circumcision.
Cyclophosphamide is more likely to cause hematuria in children than in adults.
Common causes of hematuria that chiefly affect children include congenital anomalies, such as obstructive uropathy and renal dysplasia; birth trauma; hematologic disorders, such as vitamin K deficiency, hemophilia, and hemolytic uremic syndrome; certain neoplasms, such as Wilms’ tumor, bladder cancer, and rhabdomyosarcoma; allergies; foreign bodies in the urinary tract; and venous thrombosis. Artifactitious hematuria may result from recent circumcision.
AGING ISSUES:
Evaluation of hematuria in elderly patients should include a urine culture, excretory urography or sonography, and consultation with a urologist.
Evaluation of hematuria in elderly patients should include a urine culture, excretory urography or sonography, and consultation with a urologist.
PATIENT
COUNSELING:
Because hematuria may frighten and upset the patient, be sure to provide emotional support. Teach the patient to collect serial urine specimens using the three-glass technique to help determine whether hematuria marks the beginning, end, or entire course of urination.
Because hematuria may frighten and upset the patient, be sure to provide emotional support. Teach the patient to collect serial urine specimens using the three-glass technique to help determine whether hematuria marks the beginning, end, or entire course of urination.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)