المحاضرة 3 - مختبرات عملي

Examination of urine 

A urinalysis is a test of urine. It is often done to check for urinary tract infections (UTI), kidney problems and help detect metabolic and systemic disease.

Methods of urine collection:

Urine collected in clean, dry container and should examined fresh, bacterial contamination causes alkaline of urine due to conversion of urea to ammonia and loss of glucose.

درجة حموضة البول الطبيعية وغير الطبيعية

  •  يكون البول ذا حموضة أعلى بقليل في الصباح، 
  • ليصبح أكثر قاعدية في المساء بعد هضم الطعام وإنتاج الكهارل، 
  • وتتراوح النسبة الطبيعية لحموضة البول ما بين 5.5-7 والمتوسط هو 6.2

The general characteristics of normal urine: 

Normal urine is a clear solution ranging from colorless to pale yellow (due to urochrome) to a dark yellow color based on the urine concentration and chemical composition. The average volume of urine, normal adult will excrete approximately 700 - 2,000 ml of urine each day (every 24 hours). 



This will vary with fluid intake and fluid loss. Polyuria means amount of urine more than 2000 ml as in D.M, intravenous saline / glucose, while oligouria less than 500 ml as in dehydration due vomiting, diarrhea and to excessive sweating. Specific Gravity (SG): Specific gravity measures urine density or the ability of the kidney to concentrate or dilute the urine, SG measured by apparatus called urinometer. The normal SG is (1.003-1.035). Any deviations may be associated with urinary disorders.

مقطع الـ meter : يعني الة قياس مثل

جهاز يقيس الكثافة النوعية للبولل



The odor of normal urine can reflect what has been consumed or specific diseases. For example, an individual with diabetes mellitus may present a sweetened urine odor. This can be due to kidney diseases as well, such as kidney stones.

The PH normally is within the range of 5.5-7 with an average of 6.2 .

  •  Among the (UTI), E. coli caused acidic urine, 
  • while Proteus caused alkaline urine. 
  • Meat protein diet cause acidification of urine - صارت عندي حموضة : يعني اكل لحم اهواي
  • consumption of citrus fruits makes the urine alkaline لاحظ ان فاكهة الحامض تتحول الى قاعدية ( القاعدة تقطع ستة رؤوس )

  • الاشريكية القولونية \ اشر قشر الحامض ههه
  • المتقلبة - proteus  \ قاعدية او قلوية ( القاعدة كليوم كالبين شكل

 Characteristic                             normal range

  Color                                               pale yellow

Appearance                                     clear

 اكل الثوم غير اكل التشريب: Odor                                      Varies with composition

Volume                                        700-2000 ml/day

 7-PH                                            (  average of 6.2) 5.5

Specific gravity                              1.003-1.035

.;. First urine in the morning most concentrate used for pregnancy test and microscopic test.

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There are three ways to analyze urine:


هناك ثلاث طرق لفحص البول
١- فحص فيزيائي
٢- فحص مجهري
٣- فحص كيميائي

• A physical (visual) exam: This checks the color, clarity, odor, and volume. 

  • If urine has blood in it, it might be red or 
  • dark brown due to food (fresh beet), drug - فيتامين ب12 بني داكن
  • or foam can be a sign of kidney disease, - يعني هناك تسرب ابروتيني
  • while cloudy urine may be an infection.

  • الرغوة - foam \ شي اشبه بالفقاعة ومقصدها وجود مشكلة في الكلى , كما الماطور عندما توجد فيه فقاعات دليل على وجود هواء او مشكلة تسريب

• A microscopic exam includes:

• Cells (RBCs and pus cells). These are a sign of infection or inflammation, either in the kidneys or anywhere else along urinary tract.

• Casts

• Crystals (clumps of minerals - a possible sign of kidney stones). 

• Bacteria

• Parasites such as Trichomonas vaginalis, ova of S. haematobium






Waxy cast

Trichomonas vaginalis


Schistosoma haematobium 

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3. Chemical examination or the dipstick test (which is a thin plastic strip treated with chemicals. It's dipped into urine, and the chemicals on the stick react and change color if levels are above normal).

فحص الـ dipstick


• Acidity or pH: If the acid by using litmus paper if it is abnormal 
under 4.5, means have kidney stones, UTI, fever, dehydration or another condition. 
But if over 8.0 means UTI, or respiratory alkalosis. Or by using dipstick.



Protein: This mean, kidneys are not working right. It is done either by using dipstick or by using 20% of sulphosalicylic acid test by adding 3 drops to 1ml urine and see the cloudiness.


• Glucose: High sugar content is a marker for diabetes. It is done by using dipstick or by using Benedict's test (blue color) by add 8 drops of urine to 5ml of benedict, heating the tube until boiling and examine the color:

فحص benedict

 

  • Blue color: Negative (-ve) - لا يوجد سكر في الدم
  • Green: +
  • Greenish yellow: ++
  • Yellow: +++
  • Orange to red: ++++
. Nitrites. This means that there is an infection with certain kinds of bacteria by using dipstick or chemical method.

نترة عميقة \ ينتر بية = يعتدي علي - عدوى

Bilirubin. If this waste product, which is normally eliminated by liver, shows up, it may mean the liver isn't working properly by using dipstick or chemical
method. •

البيليروبين : مادة صفراء تنتج عن تكسير أو تحلل خلايا الدم الحمراء من مادة الهيموغلوبين التي تكسب خلايا الدم الحمراء لونها الأحمر


 
Blood in urine. Sometimes this is a sign of infections( inflammation ) or certain illnesses.

notes

  •  مهم - a. Random collection- for routine screening💛
  •   b. Fasting and postprandial - for diabetes mellitus
  •  مهم - c. 24 hrs. sample- for quantitative tests💛
  • مهم - d. Midstream clean catch urine- for culture as well as routine💛
  • التقاط البول في الوسط ⬆_ يعني في وسط طرحك للبول خذ العينة : وهكذا عينات تفيد في الزرع وايضا في الفحوصات الروتينية 
  •  e. Catheterized- for culture
  • f. Suprapubic aspiration - for bladder culture

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