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73 Cards in this Set
- Front
- Back
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Classification |
Glomerular disorders Tubular disorders Interstitial disorders - wont deal with this. Least understood and refractory to treatment |
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Glomerular immunologic disorders |
- Majority are immunologic disorders - immune complexes from immunologic reactions throughout body - increased serum immunoglobulins are deposited on the glomerular membranes - immune system mediators: complement migrate and produce change and damage to membranes - formation of immune complexes like with strep and you get kidney failure by clogging from immune complexes |
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Glomerular non immunologic disorders |
- chemical and toxins, deposition of amyloid material and acute phase reactants, electrical charge interference, membrane thickening - nonimmunological is some kind of toxin, chemical, drinking antifreeze. Chemicals, toxins, other materials of biological nature that interferes with glomerulus |
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Glomerular disorder caste description |
- Large castes in urine if glomerular disorder - Could be broad waxy type caste - Possible blood and white cells |
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Glomerular disorder glomerulonephritis |
- General term for sterile, inflammatory process affecting the glomerulus - Causes blood, protein, and casts in urine |
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Glomerular disorders Types of Glomerulonephritis |
- Progress through various disorders - Acute glomerulonephritis to chronic glomerulonephritis to nephrotic syndrome to renal failure |
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Goodpasture's Syndrome |
- Teacher just wants us to know that this syndrome is an autoimmune disorder - Resembles crescenteric GN - cytotoxic antibody following viral respiratory disease: antiglomerular basement membrane antibody - hemoptysis, hematuria, proteinuria, RBC casts - chronic glomerulonephritis to end stage renal failure is common |
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Wegener's Granulomatosis |
- Inflammation and granulomas in small blood vessels of kidney and respiratory system - key to diagnosis is an antineutrophilic cytoplasmic antibody (ANCA) - neutrophils initiate immune response, producing granulomas - pulmomary symptoms first, then hematuria, proteinuria, RBC casts, elevated BUN and creatinine levels - immunofixation for p-ANCA/c-ANCA |
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Henoch - Schonlein Purpura |
- affects children following upper respiratory infections - raised, red patches on skin - blood in sputum and possibly stools - renal involvement is the most serious complication of the disorder. Causes proteinuria and hematuria and RBC casts - 50% complete recovery - follow patients for more serious renal problems - people who recover usually have permanent renal impairment and have breathing problems |
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Chronic glomerulonephritis |
- Progression from previous disorders - Fatigue, anemia, hypertension, edema, oliguria gradually worsening - oliguria is the production of abnormally small amounts of urine - hematuria, proteinuria, glycosuria (tubular damage), many types of casts including broad and waxy casts - Markedly decreased GFR - broad waxy castes are also known as renal failure casts - large casts mean larger problem because they originate in much larger tubules |
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Nephrotic Syndrome |
- Acute onset from systemic shock (low blood pressure) or glomerulonephritis complication - Glomerular membrane damage and changes in podocyte electrical charges - Protein passes through membrane; serum albumin depleted, causing increased lipid production - Edema from loss of oncotic pressure - Tubular damage - Acute onset means sudden drop in blood pressure |
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Urinalysis for Nephrotic Syndrome |
- Marked proteinuria greater than 3.5 grams per day - Fat droplets, oval fat bodies, fatty casts, renal tubular epithelial cells and casts, waxy casts, microscopic hematuria |
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Diabetic Nephropathy |
- Most common cause of end stage renal disease - glomerular basement membrane thickening - Increased proliferation of mesangial cells (specialized cells around blood vessels in kidney/ removes trapped residues and aggregated protein from the basement membrane keeping filter free of debris) - Increased deposition of cellular and acellular material within matrix of bowmans capsule and around capillary tufts - Deposition associated with glycosylated proteins from poorly controlled diet - Sclerosis of vascular structure - Reason for early microalbumin test
- at least remember this is due to glomerular basement membrane thickening - early indication of diabetic changes in kidney is microalbumin testing |
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Acute Tubular Necrosis |
- Ischemia where there is a severe decrease in blood flow, associated with trauma, surgery, cardiac failure, electricity, toxogenic bacteria, and anaphylaxis - Kidneys rely upon hydrostatic pressure of blood flowing into kidney for normal kidney function and big drop in blood flow can start an ischemic event - Nephrotoxic agents: aminoglycosides, amphotericin B, ethylene glycol, heavy metals, mushroom poisoning, hemoglobin, myoglobin. He mentions vancomycin, an aminoglycoside - Noticeable renal tubular epithelial cells (RTE) fragments - Hyaline, waxy, granular, broad casts - hyaline casts are possible but need to be accompanied with large broad waxy granular casts |
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Hereditary and Metabolic Disorders Fanconi Syndrome |
- Generalized proximal convoluted tubule reabsorption failure - inherited with cystinosis and Hartnup disease - acquired: heavy metals, outdated tetracycline - complication of multiple myeloma, renal transplant - glycosuria and electrolyte imbalance - Hallmarks are high levels of glucose in urine with the absence of glucose levels in serum - people being managed for fanconi syndrome usually are managed using urine and serum analyzations simultaneously |
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Acute Pyelonephritis |
- Ascending movement of bacteria. Conditions affecting emptying of bladder. Calculi, pregnancy, reflux of urine from bladder to ureters - rapid onset, urinary freqeuncy, burning, lower back pain (slap patient in back and if it hurt alot, most likely pyelonephritis) - urinalysis: similar to cystitis with one exception: presence of WBC casts. Will find WBCs and WBC casts. - infection in kidney itself - ascending because infection goes from bladder to kidneys |
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Chronic Pyelonephritis |
- Damage to tubules, possible renal failure - Congenital structural defects causing reflux are most common cause - Can affect emptying of collecting ducts - Often diagnosed in children - Early urinalysis similar to acute pyelonephritis - Later granular, waxy, and broad casts: increased protein, hematuria and decreased specific gravity - most men diagnosis, few white blood cells and a few occasional wbc castes. - chronic is a result of permanent damage to tubules and can lead to renal failure. Can result from trauma from some form of invasive process or surgery |
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Renal Failure Two Forms (acute and chronic) Chronic Renal Failure |
- Progression from original disorders to end stage renal disease - GFR less than 25 ml per min, increased BUN and creatinine levels, electrolyte imbalance, isothenuria, proteinuria, renal glycosuria (excess sugar in urine), increased granular, waxy, broad casts - Continuous gradual decrease of GFR |
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Renal Lithiasis |
- Renal Calculi (kidney stones) in calyces and pelvis of kidney, ureters, bladder - staghorn, round and smooth, barely seen - Severe back pain radiating from lower back to legs when passing - Lithotripsy: high-energy shock waves break up stones (small stones) - Also surgical removal (large stones) - Opiates used to reduce pain |
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Overflow Versus Renal Disorders |
- Disruption of a normal metabolic pathway - Increased plasma concentrations of the nonmetabolized substances - Overrides reabsorption ability of renal tubules - Inherited lack of specific enzyme for protein, fat, or carbohydrate metabolism in born error of metabolism - overflow would be some type of metabolic defect and in excess of certain substances filtered by kidney
- Renal malfunctions in the tubular reabsorption mechanism
- Difference between the two is overflow is an overwhelming amount of substances that prevent reabsorption while renal is a problem with the tubular reabsorption mechanism itself |
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Disorders Classified by Defect |
- Overflow: phenylketonuria, tyrosinemia, alkaptonuria, maple syrup urine disease, organic acidemias, cystinosis, porphyria, mucopolysaccharides, galactosemia, lesch-nyhan disease
Metabolic: infantile tyrosinemia, melanuria, indicanuria, 5-hydroxyindoleaxetic acid, porphyria
Renal: Hartnup disease, Cystinuria |
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Amino Acid Disorders (Aminoacidurias) |
- Phenylketonuria, tyrosluria, alkaptonuria - Phenylketonuria (PKU): 1 in 10,000 to 20,000 births. Autosomal recessive and heterozygotes normal. Eliminate phenylalanine from diet (milk). Damage to child's mental capacity. Alternate pathways as child matures. Avoid increased phenylalanine foods (aspartame)
- First screening for pku in childrens blood or if you find in urine, its significant l. - Used for pediatric and metabolic screening tests - Can be managed through diet
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Melanuria |
- Second pathway for tyrosine. Melanin, thyroxine, epinephrine, protein, and tyrosine sulfate - Melanin: pigment for dark hair, skin. Defect causes albinism. Increased production causes malignant melanoma. 5,6 - dihydroxyindole causes dark urine from oxidation of melanogen to melanin
- rarely occurs. Where melanin pigment produced by the skin is dumped in urine. - Certain melanin producing tumors that you'll find in advanced cases of skin cancer, where you'll find in urine. - High fatality rate for malignant melanoma and not too successfully treated. |
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Indicanuria |
- Tryptophan enters intestine, is reabsorbed or is converted to indole by bacteria, and leaves in the feces - Intestinal disorders and Hartnup disease cause increased tryptophan conversion to indole. - Increased indole reabsorbed, excreted by kidney on its way to liver. - Exposure of urine to air causes indigo blur color
- Exposure to air produces indigo blue color in urine, hallmark of hartnup disease pr blue diaper syndrome. - Very rare disorder - Deals with tryptophan metabolic pathway and buildup of excess indole and clearing and finding in urine |
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Indicanuria Hartnup Disease: Blue diaper syndrome |
- Inherited disorder affects intestinal reabsorption of indole and renal tubular reabsorption and causes Fanconi syndrome - Requires dietary supplements: niacin
- can be managed dietarily and its a rare situation |
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5 - Hydroxyindoleacetic Acid (5-HIAA) |
- Tryptophan produces serotonin - serotonin from tryptophan is produced by the intestinal argentaffin cells and is carried in the body to the muscles by platelets - Excess excreted in the urine as 5-HIAS - Argentaffin (enterichromaffin) cell tumors = increased 5-HIAA in urine from excess serotonin produced
- Tryptophan serotonin metabolic pathway, we frequently test for this. - The 5-HIAA, find in urine samples. Associate with serotonin and tryptophan metabolism |
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Porphyrin Disorders |
- Intermediate compounds in the production of heme - primary porphyrins: uroporphyrin, coproporphyrin, protoporphyrin - precursors: alpha aminolevulinic acid (ALA) and porphobilinogen - detection of pathway disruptions in urine, blood, bile, and feces - urine: ALA, porphobilinogen, urobilinogen - feces/bile: coproporphyrin, protoporphyrin - blood: free erythrocyte protoporphyrin (FEP) for lead poisoning
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Porphyrin Disorders are collectively termed Porphyrias |
- inherited: gene in metabolic pathway is missing - classified by clinical symptoms as neurologic/psychiatric, cutaneous/ photosensitivity, or both - acquired (more common): lead poisoning, alcoholism, iron deficiency, chronic liver and renal disease |
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Fecal Analysis |
- Feces are the end product of digestion - analysis: macroscopic, microscopic, chemical - GI bleeding - liver and biliary biproducts - maldigestion/malabsorption syndromes - pancreatic diseases - inflammation - diarrhea and steatorrhea (abnormal quantities of fat with feces) - detection and identification of pathogenic bacteria, viruses, and parasites |
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GI physiology |
- approximately 9000 ml of ingested fluid, saliva, gastric, liver, pancreatic, and intestinal secretions enter the digestive tract each day - majority of fluids involved in digestion are reabsorbed, with only about 150 ml excreted in feces - excess water (>3000 ml) reaching large intestine causes diarrhea
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Diarrhea |
- greater than 200 g stool weight per day with increased liquid and more than three movments per day - four factors: illness duration, mechanism, severity, stool characteristics - >4 week duration is chronic - - mechanisms of diarrhea is secretory, osmotic, and altered motility - lab tests: fecal electrolytes, osmolarity, and pH. Ph - total fecal osmolarity is close to serum osmolarity (290 mosm/kg) - osmotic gap is 290 [2 x (fecal Na + fecal K)] - osmotic diarrhea >50 mosm/kg - secretory diarrhea - Electrolytes: increased in secretory and negligible in osmotic diarrhea - sectetory diarrhea increased electrolytes in stool should be reabsorbed but isnt |
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Secretory Diarrhea |
- Bacterial, viral, and protozoan infections increase secretion of water and electrolytes. Examples are e coli, clostridium, v cholerae, salmonella, shigella, staph, campy, cryptosporidium - drugs, laxatives, inflammatory bowel disease/colitis, endocrine disorders, malignancy, collagen vascular disease |
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Altered Motility |
- irritable bowel syndrome (IBS): hypermotility and constipation; food, chemicals, stress, and exercise are causes - rapid gastric emptying (RGE; dumping syndrome): <35 minutes - divided into early and late dumping syndrome based on timing of symptoms (10 to 30 minutes versus 2 to 3 hours) - gastrectomy, gastric bypass, postvagotomy, duodenal cancer, diabetes mellitus - OIC - opiate induced constipation
- dumping syndrome where things pass through unaffected. Food just goes through body without anything being done - surgical problems with OIC because it shuts down GI. Doctors must listen for movement after surgery to tell if everything is fine |
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Steatorrhea |
- Increased fats in the stool >6 g/day - pancreatic insufficiency and malabsorption and lack of bile salts (triglyceride digestion) - cystic fibrosis, pancreatitis, and malignancy decrease pancreatic enzymes for lipid breakdown - D-xylose test for malabsorption; D-xylose does not need to be digested but must be reabsorbed to appear in urine
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Fecal Specimen Collection |
- patients need detailed instructions - use clean container and transfer to lab container - no toilet water contamination but acceptable for some occult blood test kits - ova and parasite containers are used only for that purpose - quantitative collections are 72 hours, which is the time required to pass through intestine |
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Fecal Color |
- brown color is from urobilin - pale, alcoholic stools: bile duct blockage, barium sulfate xray contrast - blood: bright red or dark red to black, depending on area of digestive tract that is bleeding; black indicates upper tract. Also medications, iron, bismuth, charcoal are black, beets are red - green: antibiotics, bilirubin to biliverdin |
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Fecal Appearance |
- watery means diarrhea, hard means constipation, ribbon like means obstruction - steatorrhea is pale, bulky, frothy, foul odor - mucus coated means intestinal irritation, inflammation, colitis, straining - blood streaked mucus means intestinal wall damage, dysentery, malignancy - always report mucus |
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Fecal microscopic examination |
- fecal leukocytes - primarily neutrophils. Present in bacterial dysentery caused by salmonella, shigella, campylobacter, yersinia, and e coli O157 because they invade the intestinal wall. Dysentery from bacterial toxins; staph and vibrio do not have leukocytes. Also relates to good poisoning (staph versus invasive dysentery.
- alot of wbcs indicates shigella. - salmonella does not have that much wbcs |
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Fecal muscle fibers |
- pancreatic insufficiency, cystic fibrosis - undigested striated muscle - slide: feces in 10% alcoholic eosin. Examine slide for 5 minutes, count number of fibers with well preserved striations. Undigested: vertical and horizontal striations. Partially digested: striations only in one direction. Digested: no striations. Only undigested counted; >10/slide is abnormal - patients: must eat red meat before starting collection |
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Qualitative Fecal Fats |
- microscopic screening for steatorrhea. Lipids included: neutral fats (triglycerides), fatty acid salts (soaps), free fatty acids, and cholestrol. Stain with sudan III (most common) or IV, oil red O. - two part test: neutral fat and split fat. Neutral fat: large red orange droplets. 60 per hpf indicative of steatorrhea. Split fat is more indicative
- qualitative fecal fats are more commonly done compared to quantitative - fat takes 3 different forms. Neutral, split, and suponified |
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Neutral Fat Stain Procedure |
- homogenize one part stool with two parts water - mix emulsified stool with one drop 95% ethyl alcohol on slide - add two drops saturated sudan III in 95% ethanol - mix and cover slip - examine under high power - count orange droplets per high power field
- use these fat stains to detect these fats if present or not |
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Split Fat Stain |
- mix specimen with acetic acid and heat - free fatty acids and fatty acids from soap hydrolysis and neutral fats - number and size evaluated: normal up to 100 small (<4 nanometers)/hpf: slightly increased: 100 (1 to 8 nanometers); increased; 100 (6 to 75 nanometers) - cholestrol crystals form after heating and cooling; have characteristic flat shape and notched corners
- staining method kind of a stretch. Staining reaction is graded. Fat is fat. Cholestrol is a type of fat |
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Fecal Occult Blood Testing Guaiac test |
- test principle: pseudoperoxidase activity of hemoglobin - hemoglobin plus h2O2 plus guiac (colorless) becomes oxidized guaiac and water (blue color) - guaiac is less sensitive than urinalysis reagent because up to 2.5 ml of blood in stool is normal; eliminates false positives from vegetable and bacterial peroxidases diet
- guaiac test is being phased out. Csn is getting alot of them because people are donating them because they arent using them anymore. |
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Microscopic examination of vagina |
- fresh secretions - "Gold Standard". Saline wet mount examination. KOH examination. Gram stain. - litmus ph levels - dna probe testing - culture - point of care test kits likes osom for trichomonas
- KOH is not routinely used unless looking for fungi specifically. - when doctors order KOH, they are looking for yeast or fungi. - Have BV blue for detection of metabolic byproducts of bacteria that causes bacterial vaginosis. This is commonly used in quick care centers. - main question to ask is is it yeast, trichomonas, or bacterial vaginosis. |
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Vaginal specimen collection and handling |
- collection during a pelvic examination - the specimen is collected by swabbing the vaginal walls and vaginal pool. Sterile, polyester tipped swabs on plastic shaft. No cotton tip, wood shaft or calcium alginate. - swab in tube containing 0.5 to 1.0 ml of sterile physiologic saline and agitated - properly labeled specimens should be placed in a biohazard bag - transport expediently for immediate analysis (within 2 hours)
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Color appearance of vaginal specimens |
Abnormal - appear as an increased thin, homogenous white to gray discharge is bacterial vaginosis. - white "cottage cheese" like discharge is candida infections. Yeast infections. - yellow green, frothy, adherent discharge is trichomonas vaginalis - yellow, opaque cervical discharge is chlamydia trachomatis
- easiest to observe is yeast when you smell the cottage cheese. The others are harder to tell.
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Vaginal Squamous epithelial cells |
- originate from the vagina and female urethra - 25 to 70 nanometers in diameter - polygonal "flagstone" appearance - prominent centrally located nucleus
- look for squamous epithelial cells in the vaginal specimen that indicates collection problems in UA |
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Vaginal Clue cells |
- Abnormal variation of the squamous epithelial cell - coccobacillis bacteria attached in clusters on the cell surface - described as "shaggy" - diagnostic of bacterial vaginosis. Gardnerella vaginalis
- if there are clue cells, these epithelial cells will have abnormal amounts of bacteria adhering to epithelial cells. |
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Vaginal White blood cells |
- 14 to 16 nanometers in diameter - polymorphonuclear white blood cells (PMNs). Multilobed nucleus - >3+ WBCs suggest vaginal candidiasis. Atrophic vaginitis. Infections with trichomonas, chlamydia, neisseria gonorrhoeae, or herpes simplex
- report wbcs if present |
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Vaginal red blood cells |
- 7 to 8 nanometers in diameter - somewhat distorted in vaginal specimens - normally present during menstruation - RBCs can be confused with yeast cells. KOH will distinguish
- KOH lyse rbcs and yeast will remain to differentiate the two |
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Vaginal bacteria |
- vagina has complex endogenous bacterial flora - lactobacillus spp is large, gram positive, and nonmotile rod - anaerobic strep - diphtheroids - coagulase negative staph - alpha hemolytic strep - alteration in the normal flora can cause overgrowth of opportunistic flo |
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Trichomonas vaginalis |
- atrial flagellated protozoan - oval shaped, measures 5 to 18 nanometers - four anterior flagella and an undulating membrane that extends half the length of the body. "Jerky" motion of the flagella. Undulating membrane. - nonmotile trichomonas can be mistaken for wbcs - quickly lose their viability after collection. Maximum of 2 hours - can be seen in a urinary microscopic sample. - cannot be reported unless motility is observed. Movement across the slide or just in the tail. |
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Yeast cells |
- candida albicans and non candida spp. Fungal infections. - occasional yeast in vaginal secretions is considered part of the normal flora. Budding yeast cells (blastophores). Hyphae. Pseudohyphae. - differentiation can be made with KOH test. |
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Occult Blood |
- most frequent test - fecal occult blood testing (FOBT) - occult: "hidden" - appearance: black, tarry from upper GI tract; lower GI is red. 2.5 ml of blood/150 g stool is significant, so may not be visible - used for mass screening and yearly physicals; high predictive value for colorectal cancer
- test frequently done
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KOH preparation and Amine test |
- placing a drop of the saline specimen and one drop of 10% KOH solution on a clean slide. - amine ("whiff") test. "Fishy" amine odor - positive test result suggests bacterial vaginosis (BV). Gardnerella vaginalis in conjunction with mobiluncus spp. And with trichomonas vaginalis - KOH dissolves epithelial and blood cells. Allows observation of yeasts. Confirmation of BV with additional testing. |
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Gram stain of vaginal bacteria (Possibly ignore slide) |
- gold standard in identifying the causative organisms for BV - weighted combination of the following morphotypes. Lactobacillus acidophilus (large, gram positive rod). Gardnerella vaginalis and bacteroudes spp. (Small, gram variable or gram negative rods) - mobiluncus spp. (Curved, gram variable rods - nugent score. 0 to 3 is normal vaginal flora. 4 to 6 is reported as intermediate. Greater than 7 is diagnostic of bacterial vaginosis.
- save for micro. |
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Vaginal cultures |
- gold standard test for detecting yeast and trichomonas. Requires up to 2 days for a result. Diamond's medium is required for T. Vaginalis - commercial transport and culture pouch system for the detection of trichomonas. Specimen must be inoculated into the pouch within 30 minutes of collection. Incubated for 5 days at 37 degrees celsius in a CO2 atmosphere
- hardly anybody cultures for trichomonas because it takes 2 days to grow. |
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DNA testing for vaginal specimens |
- dna hybridization probe is method to identify the causative pathogen for vaginitis. Results are available in 1 hour with a sensitivity of 95 percent - trichomonas can also be detected by dna probes amplified by polymerase chain reaction. Advantage of detecting nonviable organisms.
- direct antigen test. |
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Point of care tests for vaginal specimens |
rapid diagnostic tests are available to quickly screen for the causative agents of vaginitis. - proline aminopeptidase activity in vaginal secretions for g. Vaginalis - OSOM trichomonas rapid test. T. Vaginalis antigen from vaginal swabs in 10 minutes. - OSOM BVBLUE test detects vagibal fluid sialidase. Enzyme produced by gardnerella, bacteroides, prevotella, and mobiluncus - commercial tests to measure an elevated vaginal ph and the presence of amines.
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Bacterial vaginosis |
- the most common cause of vaginitis, affecting 40% to 50% of women of child bearing age. Due to imbalance in the ratio of normal vaginal bacterial flora. Malodor and increased abnormal vaginal discharge result from this mix of organisms and is more apparent after intercourse. BV is associated with new or multiple sex partners, frequent douching, use of intrauterine devices, pregnancy, and a lack of the protectove lactobacilli. - recommended treatments are metronidazole (flagyl), metronidazole gel, or clondamycin cream. |
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Trichomoniasis |
- parasitic protozoon trichomonas vaginalis - infection classified as STD - frequently occurs with gonorrhea and chlamydia infections - vaginitis in women and sometimes urethritis in men. Most men are asymptomatic carriers. - recommended treatment: meteonidazole. A newer drug, tinidazole, is available. |
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Candidiasis |
- vulvovaginal candidiasis. Candida albicans. Nonalbican species such as c. Glabeata, c. Parapsilosis, c. Tropicalis, and c. Krusei - change in the vaginal environment that permits the overgrowth of candida. Broad spectrum antibiotics, oral contraceptives, or estrogen replacement therapy; hormonal changes that occur with pregnancy; ovulation; and menopause. Immunocompromised patients and those with conditions such as diabetes mellitus, iron deficiency and hiv infection - clinical symptoms include genital itching or burning, dyspareunia, dysuria, abnormal thick, white, curd like vaginal discharge.
- find candida with association with diabetics. If positive glucose on urine strip. |
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Candidiasis Tests |
- saline and KOH wet prep and gram stain. Budding yeast and pseudohyphae forms, large numbers of wbcs, lactobacilli, and large clumps of epithelial cells. - culture and dna hybridization probe. Confirm and identify the species of candida.
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Candidiasis treatment |
- treatment with OTC with butoconazole, clotrimazole, ticonazole, and miconazole. - rx treatment with oral fluconazole or intravaginal butoconazole, nystatin, and terconazole.
- lots of good otc treatments for this now. - duration of treatment for these two especially miconazole is 3 days now, used to be 7 days. |
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Fecal occult blood testing Commercial testing kits |
- commercial testing kits: given to patients with instructions. Samples from three different stools to confirm negative. 3 days prior: no red meat, horseradish, melons, raw broccoli, cauliflower, radishes, turnips, no aspirin, anti inflammatory agents 7 days; avoid vitamin C and iron 3 days - test within 6 days: bring or mail
- horse radish, turnips, aspirin will cause false negatives. Any anti inflammatory reagents also, |
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Additional vaginal secretion procedures |
- preterm delivery, defined as delivery before the completion of 37 weeks gestation, is the leading cause of neonatal mortality and morbidity in the united states. - complications from vaginitis syndromes can include premature rupture of fetal membranes and a high risk of preterm labor. Fetal fibronectin enzyme test. Amnisure: amniotic flyid protein PAMG-1
- fetal fibronectin enzyme test. We might do this as a stat test in middle of night for labor and delivery. Question is where the membranes ruptured. Dont do these in doctors offices. Only in hospitals. |
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Immunochemical fecal occult blood test (iFOBT) |
- more sensitive occult blood methods. Immunologic tests specific for human hemoglobin use antihuman hemoglobin antibodies specific for globin portion of hemoglobin; no need for dietary restrictions; more sensitive to lower GI bleeding that is important for colorectal cancer. Hemoquant also tests for porphyrin from hemoglobin degradation that is not detected by guaiac
- insurance pays more for this test. - only requires an extra step compared to guaiac test |
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Quantitative fecal fat testing (Possibly ignore slide) |
- confirm steatorrhea - 3 day collection with diet, including normal amount of fats. Regulated intake of fat (100g/day) before and during the collection period - large preweighed container - refrigerating specimens slows down bacterial actions (gases) - classic is van de kamer titration, fatty acids titrated to neutral endpoint with NaOH - hydrogen nuclear magnetic resonance spectroscopy (H NMR) - rapid (5 minutes) and safe procedure for analyzing quantitative fecal fat - specimen is microwave dried and analyzed
- ignore |
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Quantitative fecal fat testing Acid steatocrit (Possibly ignore this slide) |
- provides rapid estimate of fat content - single specimen, monitor response to therapy, screen pediatric population - 5 g of specimen homogenized and acidifed; homogenized specimen spun in a regular hematocrit tube; measure the length of the fatty top layer and the length of the solid bottom layer |
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Quantitative fecal fat testing Specialized tests |
- near infrared reflectance spectrophotometry - 48 to 72 hour collection - scan surface of stool with infrared light between 14000 and 26000 nM wavelengths - calculate using prepared calibration curve - quantitates water, fat, and nitrogen in g/d
- fecal fat specialized tests. We should be involved with fat stains, and qualitative and semi quantitative fecal fat testing |
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APT test for fetal hemoglobin |
- checking bloody stools and vomit from neonates who may have swallowed maternal blood during delivery - emulsify material in water to release Hgb - centrifuge, add 1% NaOH to pink supernatant; pink color remains means alkali resistant fetal Hgb; yellow brown means maternal Hgb - maternal thalassemia major has increased Hgb
- fetal hemoglobin different from hemoglobin A or adult hemoglobin |
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APT test procedure |
- emulsify specimen in water - centrifuge - divide pink supernatant into two tubes - add 1% NaOH to one tube - wait 2 minutes - compare color with that in the control tube - prepare controls using cord blood and adult blood.
- sodium hydroxide, wait 2 minutes, simple easy to fo. |
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Vaginitis |
- one of the most common conditions in female patients. Abnormal vaginal discharge. Odor. Vaginal irritation. - secondary to bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis - can also occur with noninfectious conditions
- affects half of female population in world. - STD's, trichomonas and flagellated protozoanscan be treated. Get immediate and dramatic results. - bacterial vaginosis and yeast are harder treat. - for vaginal secretions, know yeast, trich, and clue |
