MT 35 (LAB): Physical Examination

The testing of urine with procedures commonly performed in an expeditious, reliable, accurate, safe, and cost-effective manner (CLSI)

URINALYSIS

Fill In the blanks: URINALYSIS aims to aid in the ___ __ ___ and screen

______ people.

diagnosis of disease; ASYMPTOMATIC

Fill in the blank: urine is a filtrate of ____

blood

Why do SYMPTOMATIC people are not required to undergo urinalysis?

Because their symptoms are visible or observed

The first part of urinalysis

Physical examination

True or False: Physical examination provides valuable clues on the solute concentration and possible pathologic conditions of urine

True.

Physical Examination: This involves assessing the urine's ___, ___, and ____

Color, clarity, and odor

An overall general screening test because The results can indicate conditions like diabetes,

kidney disease, liver disease, urinary tract infections, and more

Chemical analysis

This step uses chemical test strips (dipsticks) to

detect the presence of substances such as glucose, proteins, ketones, blood,

pH levels, and bilirubin

Chemical analysis

In this phase, a urine sample is examined

under a microscope to detect cells, crystals, bacteria, and other substances

Microscopic Examination

This can provide additional information about infections, kidney function,

and other health issues

Microscopic Examination

Only done to confirm the ABNORMAL results of the chemical and physical examinations

Microscopic Examination

TRUE/FALSE: Choosing an appropriate preservative for a particular specimen is essential for preventing erroneous results.

TRUE

Why are Specimens contaminated w/ feces or toilet paper?

Because it results to turbidity and may be mistakenly indicated as having a pathological significance

Preservative ideal for steroids and hormones

Acid as a preservative

Urine must be processed within what time limit?

within 2 hours

True/False: PREGNANCY TESTING requires random urine specimen to prevent a false negative result

False, first morning urine

The parameters that are observed in Physical Examination

Color, Clarity, Specific gravity, Volume, Odor, Taste

Urine volume excreted is usually determined by the body’s ___ __ ____

state of hydration

Normal Range (24 Hours) of URINE VOLUME

600-2000 mL

Average Output (24 hours) of Urine Volume

1200-1500 mL

Day: Night Ratio of URine Volume

2:1 to 3:1 with Night urine <400 mL

Why do you urinate more in the day than in the night?

because of your body’s metabolic activities is higher in the day

The final decider of how much urine is excreted in your body

Anti-diuretic Hormone (ADH)

Oliguria Commonly seen when body enters a state of ____ due to excessive water loss

dehydration

Oliguria means decrease in urine output because AVP/ADH is ____ (higher/lower)

Higher

Cases that result to dehydration and oliguria

Vomiting, Diarrhea, Renal Calculi (kidney stones)

Why is Renal calculi tied to oliguria?

Because of the stones blocking the ureters, preventing urine to be excreted

Cessation of urine flow

ANURIA

Why does Decrease in blood flow to the kidney result to anuria?

due to low blood volume

What is the urine volume and SG of patients with nocturia?

>500 mL and <1.018

A possible cause of nocturia

Bladder enlargement due to OLD AGE

Diuretics that increase urine volume and cause nocturia

Alcohol and caffeinated beverages

Urine volume of polyuria

>2.5 L/day (adults)

Polyuria is Usually caused by ___ __ ___

increased water intake, Diabetes mellitus, Diabetes Inspidus

Most common abnormal color of urine

Red/ Red Brown

True/False: URINE COLOR is Examined under a good light source and well-mixed

True

Read the Urine specimen against a ____ ___

White Background

Urine color is a rough indicator of the Degree of ___ and correlates with urine ___ ___

Hydration, Specific Gravity

What are the GENERAL FACTORS AFFECTING URINE COLOR?

Diet, Medication, Fluid Intake, Disease

Example of diet affecting urine color

Beets (red)

Example of medication affecting urine color

Rifampin (red)

Medication for TB and causes abnormal urine color

Rifampin

Example of disease affecting urine color

Porphyria (Portwine or Burgundy red)

—build-up of porphorins which are building blocks of hemoglobin

— high porphorins = your body is not able to produce hemoglobin

Porphyria

Fill in the blank: The yellow color of urine is primarily due to the pigment ________.

Urochrome.

Urochrome was discovered by ___ ___ on ___

Ludwig

What two pigments contribute to the color of refrigerated urine besides urochrome?

Uroerythrin and Urobilin.

True or False: Urochrome decreases in concentration when urine is left to stand at room temperature.

False, increases.

Urochrome also increases

Identify one pigment that imparts a pink color to amorphous urates in refrigerated specimens.

Uroerythrin.

UROERYTHRYIN is most evident in specimens that have been ____

Refrigerated

Uroerythrin is a Precipitation of ____ ___ & ___ ___ Crystals

Amorphous Urates, Uric Acid

Uroerythrin is from ___ metabolism

melanin

Fill in the blank: Urobilin imparts a ________ hue to urine.

Orange-brown or Dark Yellow

True or False: Urine color may provide presumptive evidence of disease.

True.

This indicates that the urine is NOT FRESH (Present in Old Specimens)

Urobilin

It is caused by the presence of the abnormal pigment BILIRUBIN and is an indication of liver disease

DARK YELLOW / AMBER / DARK ORANGE

What color is associated with bilirubinuria when urine is shaken?

Amber (with yellow foam).

Identify one cause of red or pink urine.

Hematuria, Hemoglobinuria, Myoglobinuria, or Beets.

Fill in the blank: ________ causes port wine-colored urine in porphyrias.

Porphobilinogen.

True or False: Metronidazole may cause brown or dark-colored urine.

True.

ay be caused by bacterial infections including urinary tact infections (UTI) by

Pseudomonas species

GREEN

Green urine may be caused by what representative species of bacteria?

Pseudomonas aeruginosa

Dark yellow urine may be caused by what?

B complex vitamins, Bilirubin

A patient taking an anti-depressant like Amitriptyline may have a urine color of?

Blue-green

What are the cause of blue-green urine?

Amitripyline, clorets, Indican, familial hypercalcemia

A type of inborn error of metabolism and aka Hartnap disease

Familial hypercalcemia

An inborn error of metabolism that causes brown-black urine

Alkaptonuria

What condition causes urine to turn black upon standing due to homogentisic acid?

Alkaptonuria.

Antimalarial drugs that cause brown or black urine

Chloroquine and primaquine

Malignant melanoma, melanin, or melanogen, causes what urine color?

Brown Black

Fill in the blank: The clarity of urine is best assessed against a ________ background.

White.

Urine clarity is aka?

Urine Transparency / Turbidity / Character

True/False: Color & Clarity are routinely determined at the same time

True

For urine clarity, view the urine against a ___ ___

Newspaper print

Normal Urine Clarity is Freshly voided urine that is ____ (esp. if midstream clean catch)

Clear

True/False: Cloudiness or slight turbidity upon long standing at RT is abnormal

False, it is normal.

Normal cloudiness due to settling down of sediments when urine is long standing at RT

NABECULAE

True or False: Slightly hazy urine may still be considered normal.

True.

White Cloudiness is precipitation of ____ ___

Amorphous phosphates or carbonates

True/False: AMORPHOUS URATES cause white cloudiness and do not at 37*C

False, amorphous phosphates or carbonates

Urine clarity: No visible particulates, transparent

Clear

Urine clarity: Few particulates, print easily seen through urine

Visible particles presen

Hazy

Urine clarity:

Many particulates, print blurred through urine

Significant Particulate Matter

Cloudy

URine clarity: Print cannot be seen through the urine

Turbid

What clarity classification is often associated with pyuria?

Turbid.

Fill in the blank: Amorphous phosphates typically form in ________ urine.

Alkaline.

What type of urine causes amorphous urates to appear pinkish and cloudy?

Acidic.

True or False: Vaginal creams and talcum powder may cause nonpathologic turbidity.

True.

What condition is associated with milky urine appearance due to chyle?

Chyluria.

Yeasts, Trichomonads are pathologic causes that are especially present in what patients?

Patients with Diabetes mellitus

What is pathological cause of renal tubular epithelium (RTEs) in your urine?

Damage in the kidney structures

Fill in the blank: Foul-smelling urine suggests ________.

Urinary Tract Infection (UTI).

A material that is injected to the patient when undergoing an x-ray examination

Radiographic Contrast Media

True or False: Semen, Spermatozoa, Prostatic Fluid are pathologic causes of urine

True, they can also be non-pathologic

True or False: Fecal contamination brought by fistulas is non-pathologic

False, it is pathologic

connects 2 body parts that don’t normally connect

FISTULA

Intestine connects to the bladder, causing fecal matter to go into it

Enterovesical fistula

Normal Odor: of Urine

Aromatic