Presentation of Urine & Stool Analysis

بسم الله الرحمن بسم الله الرحمن الرحيمالرحيم

Urine AnalysisUrine Analysis

By

Dr. Ahmed Badr

IndicationsIndications

Change in the color of urine (GN,UTI, Hepatitis,Acute hemolytic crisis) Dysuria (UTI)

Generalized edema (NS) FUO (UTI)

Polyuria (DM,DI)

Items to be checkedItems to be checked

Physical Color Aspect Reaction Sp. gravity Volume

Chemical Proteins Glucose Ketones Bilirubin Urobilinogen Hb Microscopic

RBC WBC Casts Crystals Epithelial cells Ova Parasites

Items to be checkedItems to be checked

Physical

Color (amber yellow)

Aspect (Clear)

Reaction (pH =5-7)

Specific gravity (1015-1025)

Volume (1-3cc/kg/hr)

Chemical

Proteins (Nil) Proteinuria+++

Glucose (Nil) DM

Ketones (Nil) DKA

Bilirubin (Nil) Cholestasis

Urobilinogen (traces) Hemolytic J

Hb (Nil) Acute H. crisis

Microscopic RBC (0-5 /HPF) Hematuria

WBC (0-5 /HPF) Pyuria Infection/GN Casts (Tubular structures Glomerular/Tubular)

Hyaline casts Normal Red cell casts GN

White cell casts PN / GN Crystals (Ca oxalate, triple phosphate)

Epithelial cells Ova (Bilharzial)

Parasites (Entrobius)

•PSGN (Hematuria)Hematuria: RBC > 5/HPFRBCs castsColor: Smoky± Proteinuria± Pyuria (WBCs > 5/HPF)

•UTI (Pyuria = WBCs > 5/HPF)Pyuria only = CystitisPyuria + WBCs casts = Pyelonephritis

•Bilirubinuria: Hepatitis, Biliary atresia & Cholestasis•Diabetes (Glucosuria)•DKA (Glucosuria + Ketonuria)•Nephrotic (Proteinuria): Usually proteinuria only [MCNS]•Acute hemolytic crisis (Hemoglobinuria)

PleasePlease Comment On The Following Urine Comment On The Following Urine AnalysisAnalysis

Physical Color smoky Aspect Turbid

Reaction 6 Sp. gravity 1030 Volume 30 cc

Chemical Proteins++ Glucose Nil Ketones Nil Bilirubin Nil

Urobilinogen traces Hb Nil

Microscopic RBC >100 /HPF

WBC 50-60/HPF Casts

Hyaline casts++ Red cell casts+++

Please Comment On The Following Urine Please Comment On The Following Urine AnalysisAnalysis

Physical Color Yellow Aspect Turbid

Reaction 6.5 Sp. gravity 1030 Volume 40 cc

Microscopic RBC 3-5 /HPF

WBC 70-80/HPF Casts

Hyaline casts+ Crystals Nil

Epithelial cells++ Ova Nil Parasites Nil

Chemical Proteins+

Glucose Nil Ketones Nil Bilirubin Nil

Urobilinogen traces Hb Nil

Please Comment On The Following Urine Please Comment On The Following Urine AnalysisAnalysis

Physical Color Dark Yellow

Aspect Turbid Reaction 6

Sp. gravity 1020 Volume 30 cc

Chemical Proteins Nil Glucose Nil Ketones Nil

Bilirubin+++ Urobilinogen traces

Hb NilMicroscopic RBC 3-5 /HPF

WBC 3-5/HPF Casts Nil

Crystals Ca oxalate+ Epithelial cells++

Ova Nil Parasites Nil

PleasePlease Comment On The Following Urine Comment On The Following Urine AnalysisAnalysis

Physical Color yellow Aspect Turbid

Reaction 7 Sp. gravity 1025 Volume 30 cc

Chemical Proteins+

Glucose Nil Ketones Nil Bilirubin Nil

Urobilinogen traces Hb NilMicroscopic

RBC 10-12 /HPF WBC >100/HPF

Casts White cell casts++

Crystals Nil Epithelial cells++

Ova Nil Parasites Nil

Please Comment On The Following Urine Please Comment On The Following Urine AnalysisAnalysis

Physical Color Yellow

Aspect Clear Reaction 5.5

Sp. gravity 1018 Volume 40 cc

Chemical Proteins++++

Glucose Nil Ketones Nil Bilirubin Nil

Urobilinogen traces Hb Nil

Microscopic RBC 2-3 /HPF

WBC 2-3/HPF Casts

Hyaline casts++ Crystals Nil Epithelial cells Nil Ova Nil

Parasites Nil

Please Comment On The Following Urine Please Comment On The Following Urine AnalysisAnalysis

Physical Color Yellow

Aspect clear Reaction 6

Sp. gravity 1030 Volume 40 cc

Chemical Proteins Nil Glucose++

Ketones+++ Bilirubin Nil

Urobilinogen traces Hb Nil

Microscopic RBC 1-2 /HPF

WBC 2-3/HPF Casts Nil Crystals Nil

Epithelial cells+ Ova Nil Parasites Nil

Urine AnalysisPhysical Color smokyAspect Turbid

Chemical Proteins ++ Glucose Nil Ketones Nil Bilirubin Nil

Microscopic

RBC >100 /HPF

WBC 50-60/HPF

Hyaline casts ++

Red cell casts +++

Crystals few Ca oxalate

Epithelial cells NilA- Hypertension may be a complication.A- Hypertension may be a complication.B- Serum Albumen is usually below 2mg/dl.B- Serum Albumen is usually below 2mg/dl.C- It is not uncommon to find elevated C- It is not uncommon to find elevated BUNBUN..D- Buffy eyes are D- Buffy eyes are not uncommon not uncommon ..

Q- 14 Urine Analysis

Physical Color Yellow Aspect Clear

Chemical Proteins++++

Glucose Nil Ketones Nil

Microscopic

RBC 2-3 /HPF

WBC 2-3/HPF

Hyaline casts ++ Crystals few Ca oxalate

Epithelial cells Nil

A- Acute renal failure is constant.A- Acute renal failure is constant.B- Blood pressure is usually not affected.B- Blood pressure is usually not affected.C- Serum cholesterol is increased.C- Serum cholesterol is increased.D- The starting dose of steroid is 0.5 mg/kg .D- The starting dose of steroid is 0.5 mg/kg .

Q-14 Urine AnalysisPhysical Color YellowAspect Turbid

Chemical Proteins + Glucose Nil Ketones Nil

Microscopic

RBC 3 - 5 /HPF

WBC 70 - 80 /HPF

Hyaline casts +

Crystals Nil

Epithelial cells ++

A- Females affected more than males.A- Females affected more than males.B- Tender loin is expected.B- Tender loin is expected.C- Prolonged fever may be a presentation.C- Prolonged fever may be a presentation.D- Urine culture should be done.D- Urine culture should be done.

Stool AnalysisStool Analysis

By

Dr.Ahmed Badr

IndicationsIndications

Gastroenteritis

Dysentry (Diarrhea +tenesmus +Blood& Mucous)

Maldigestion / Malabsorption

Parasites

Bleeding per rectum

Items to be checkedItems to be checked

Macroscopic Color

Consistency

Reaction

Mucous

Blood

Microscopic RBCs

WBCs

Fat globules

Protozoa(cysts)

Protozoa(vegetative)

Ova

Bacteria

Macroscopic

Color (Brownish, yellowish, greenish) ?? (Clay, Red, Black) Consistency (soft, loose, watery, hard)

Reaction (Alkaline) ?Acidic (Lactose intolerance) Mucous (Nil) Dysentry Blood (Nil)

Microscopic

RBCs (1-3/HPF) WBCs (1-3/HPF) Fat globules (Nil) Protozoa(cysts) (Nil) Protozoa(vegetative) (Nil) Ova (Nil) Bacteria (Nil)

ProtozoaProtozoa

Ova

Giardia Lamblia

Trematodes

Cestodes

Nematodes

Entameba histolytica

Bilharziasis

Fasciola

Taenia(S&S)H.nanaD.latum

AscarisAnkylostoma

Entrobius

Please Comment On The Please Comment On The FollowingFollowing Stool AnalysisStool Analysis

Macroscopic

Color Brownish

Consistency loose

Reaction Alkaline

Mucous++++

Blood++

Microscopic RBCs >100/HPF WBCs 20-25/HPF Fat globules ++ Protozoa(cysts) Nil Protozoa(vegetative) E.histolytica Ova Nil

Please Comment On The Please Comment On The FollowingFollowing Stool AnalysisStool Analysis

Macroscopic Color Yellowish brown

Consistency Soft Reaction Alkaline

Mucous++ Blood+++

Microscopic RBCs >100/HPF WBCs >100/HPF Fat globules + Protozoa(cysts) (Nil) Protozoa(vegetative) (Nil) Ova (Nil) Bacteria Gram –ve Bacilli

Please Comment On The Please Comment On The FollowingFollowing Stool AnalysisStool Analysis

Macroscopic Color Brown

Consistency formed Reaction Alkaline

Mucous Nil Blood Nil

Microscopic RBCs 1-2/HPF WBCs 1-2/HPF Fat globules + Protozoa(cysts) Nil Protozoa(vegetative) Nil Ova Oxyuris

Stool Analysis

MacroscopicConsistency Loose

Reaction Alkaline

Mucous ++++

Blood ++

Microscopic RBCs >100/HPF

WBCs 20-25/HPF

Protozoa E. histolytica

Ova Nil

A- Mebendazole is the drug of choice.

B- The patient is usually asymptomatic.

C- Rectal swab is indicated.

D- Jujenal aspiration is essential for diagnosis.

Q-15 Stool Analysis

Macroscopic

Consistency Formed

Reaction Alkaline

Mucous Nil

Blood Nil

Microscopic

RBCs 0-1/HPF

WBCs 0-1/HPF

Protozoa Nil

Ova Ankylostoma

A-A- Eggs may not be seen in stools of patient Eggs may not be seen in stools of patient with severe anemia. with severe anemia. B- HSM is a common finding.B- HSM is a common finding.C- Leukocytosis in CBC is expected.C- Leukocytosis in CBC is expected.D- Peri-anal itching is very common.D- Peri-anal itching is very common.

Q15- Stool Analysis

MacroscopicConsistency Formed

Reaction Alkaline

Mucous Nil

Blood Nil

Microscopic RBCs 0-1 / HPF WBCs 0-1 / HPF

Protozoa Nil

Ova Schistosoma mansoni

A- praziquantel is the drug of choice.

B- Blood transfusion is commonly needed.

C- Spleen never enlarge in such patient.

D- Bleeding varices is one of the most serious complication of that illness.

Stool AnalysisMacroscopic Consistency Loose

Reaction Alkaline

Mucous ++++

Blood ++

Microscopic

RBCs >100/HPF

WBCs 20-25/HPF

Protozoa(vegetative) E. histolytica

Ova Nil

1) albendazol is the drug of choice

2) Crampy abdominal pain is common.

3) Extra intestinal affection does not occur.

Stool AnalysisMacroscopic Consistency Watery

Reaction Alkaline

Mucous Nil

Blood Nil

Microscopic

RBCs 1-2/HPF

WBCs 0-1/HPF

Protozoa (cyst) Giardia

Ova Nil

1) Perianal itching is common.

2) Hepatic affection could occur.

3) Metronidazol is the drug of choice.

Stool AnalysisMacroscopic Consistency Formed

Reaction Alkaline

Mucous Nil

Blood Nil

Microscopic

RBCs 0-1/HPF

WBCs 0-1/HPF

Protozoa Nil

Ova Ankylostoma

1) Serum iron is usually decreased.

2) Cotrimoxazol is the drug of choice.

3) All members of the family with or without symptoms should be treated at the same time.

Stool AnalysisMacroscopic Consistency Formed

Reaction Alkaline

Mucous Nil

Blood Nil

Microscopic

RBCs 0-1/HPF

WBCs 0-1/HPF

Protozoa Nil

Ova Schistosoma mansoni

1) Long standing cases may be associated with HSM.

2) Never affect females.

3) Metronidazol is the drug of choice.

Stool AnalysisMacroscopic Consistency Watery

Reaction Alkaline

Mucous Nil

Blood Nil

Microscopic

RBCs 1-2/HPF

WBCs 1-2/HPF

Protozoa Nil

Ova Nil

1) Dehydration may occur.

2) It is always bacterial in origin.

3) It never occur in the 1st year of life.

Stool AnalysisMacroscopic Consistency Loose

Reaction Alkaline

Mucous +++

Blood +++

Microscopic

RBCs >100/HPF

WBCs >100/HPF

Protozoa Nil

Ova Nil

1) Fever may be present.

2) Dehydration is commom.

3) Metronidazol is the drug of choice.