i hope you will find it helpful

1. Seminar on
HEMATURIA
28/06/08 E.C
Bahir Dar University
CMHS
Department of SURGERY
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 Group 8
 C-I
 2008 E.C

2. Group Members
1.Yaregal Kindae
2.Wendwesen Alemu
3.Wudie Gedefaw
4.Woyinitu Getnet
5.Tsegaye
Moderator: Dr. Getasew, Urologist
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3. 05/03/2016
3
Evaluation of the Urologic
Patient: History, Physical
Examination
Slide Design & Preparation By:
Wondwesen Alemu
Email: Wendweesena@gmail.com
 Tel: +2519 32 89 62 14

4. History
Components:
•Identification
•Chief compliant
•History of present illness /HPI/
•Past Medical illness
•Medication history
•Family, personal & Social History
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5. Identification
Age
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Adults/elderly
• PSAGN
• HSP
• IgA Nephropathy
• Bladder ca
• RCC
• Urinary stones
Children

6. Females
Males
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Sex
• Lupus Nephritis
• Wegener Granulomatosis
• PSAGN
• HSP
•
• IgA nephropathy
• Nephrolithiasis
• RCC, bladder ca
Alport syndrome: M:F = 4:1

7. • IgA nephropathy: common in Asians
&Caucasians
Rare Blacks
• SLE : higher among Asians, African Americans,
African Caribbeans, & Hispanic Americans
Occurs infrequently in Africa
• Kidney stones
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Race/ Ethnicity

8. Occupation
 Occupation has well established effects
 Accounts 4% of cancer in US
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• Textile industry
• Leather and rubber
• Painting
• Peterolium and gases
• Metalworking
Nephrolithiasis
• Cooks
• Engineering room
personnel
Bladder Ca & RCC

9. Chief Compliant
• Must be clearly defined because:
• provides the initial information
• clues to begin formulating DDx
• constant reminder to the urologist as to why the
patient initially sought care
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10. History of Present Illness/HPI
• The duration
• Severity
• Chronicity
• Periodicity and
• Degree of disability are important considerations
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11. How to Characterize
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Hematuria

12. 1.Is the hematuria gross or microscopic?
Gross hematuria
• Significant pathology
• Increase with the degree of hematuria
• Can’t miss underlying pathology!
• Microscopic hematuria a negative
urologic evaluation
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Cont’d...

13. 2. At what time during urination the hematuria
does occur?
Initial Hematuria
Hematuria at the beginning of urination
Urethral source
2o to inflammation
Least common form of Hematuria
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Cont’d...

14. Total Hematuria
Hematuria occurring throughout voiding
Originate from the bladder, ureters, or kidneys
The commonest form of Hematuria
Terminal hematuria
Hematuria the end of voiding
Bladder neck or prostatic urethra
Bladder neck contracts, squeezing out the last
amount of urine
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Cont’d...

15. 3. Is the hematuria associated with pain?
•Usually painless
•Painful if inflammation or obstruction
Cystitis
•Painful urinary irritative symptoms
•Pain is usually not worsened with passage of
clots
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This helps identify the source of the hematuria!!!

16. Upper urinary tract hematuria
•Pain + hematuria usually
•results from obstruction of ureters with clots
•Passage of these clots colicky flank pain
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17. • Deep seating/bursting/loin pain
Renal pelvis obstruction
• Colicky / sharp excruciating /pain
Acute ureteric obstruction
• Penetrating ach/inguinal discomfort
Prostitis
• strangury/scalding pain on micturation
Cystitis
• Painless hematuria malignant
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18. 4.Is the patient passing clots?
 Significant degree of hematuria
 Almost always due to extraglomerular bleeding
 Probability urologic pathology
Do the clots have a specific shape?
 Amorphous clots Bladder or prostatic urethral
origin
 Vermiform clots Ureteric Origin
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19. • Past Medical illness
• History of similar illness
• Other diseases (e.g. Tb)
• Previous hx of surgery
• Hx of drug intake
•Family History
• Hereditary nephritis
• PCKD
• Sickle cell disease
• Malignancies
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20. Anything else you want to ask ?
 A recent URTI
 Recent vigorous exercise or trauma
 History of a bleeding disorder or bleeding from multiple
sites due to excessive anticoagulant therapy
 Cyclic hematuria in women
• suggesting endometriosis of the urinary tract
• Contamination with menstruation
 Travel or residence in areas endemic for Schistosoma
haematobium or TB
 Recent Diet
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21. Physical Examination
General Appearance
 Normal
 Wasted
 Acutely sick looking
 In distress
Vital Signs
BP
• Normal
• Hypertension
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22. Tempratureº
• Normal
• Febrile
• Hpothermia
PR
• Normal
• Tachycardic
RR
• Normal
• Tachypenic
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23. HEENT
Eye
• Pale conjunctiva
• Anterior Lenticonus
• Macular Flecks
• Conjuctival Ulcerations
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24. Ear
– Sensorineural hearing loss in AS
•Weber Lateralization test
•Rinnes test Air and bone conduction
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25. Lymphoglandular System
• Supraclavicular lymphadenopathy
 Most commonly prostate and testis cancer
• Inguinal lymphadenopathy
 Carcinoma of the penis or urethra
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26. Abdominal Examination
Per rectal Examination/PRE/
 Asymmetric areas of induration or frank nodules
are suggestive of prostate cancer
 Symmetric enlargement and firmness of the prostate
are more frequent in men with benign prostatic
hyperplasia (BPH)
 Tender----Prostatitis
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27. Genito-Urinary System
• Suprapubic Tenderness
• CVAT
• Bimanual Palpation
 Assessing the regional extent of a bladder tumor
or other pelvic mass
 The bladder is palpated between the abdomen
and the vagina in the female or the rectum in the
male
 Define areas of :
 Induration
 Mobility
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28. 05/03/2016 28

29. hank ou
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T Y !!!