Wk 3 Chemical Analysis - Chemical Examination of Urine...

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Chemical Examination of Urine Dipstick More Advanced Tests
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Chemical Analysis Chemical reagent strip Enzymes Hormones Metabolites Protein and protein metabolites Pigments Sugars, ketones, and mucopolysaccarides Minerals
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Urobilinogen Formation RBC lyses in spleen Hemoglobin = heme + globin Globin = recycled amino acids Heme = iron + porphyrin ring Porphyrin ring opened = bilirubin Bilirubin is unconjugated and transported to liver via albumin Bilirubin becomes conjugated in liver
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Urobilinogen Formation Conjugated bilirubin is then transported via albumin to the colon In colon, 10% of bilirubin is converted to urobilinogen (a urochrome) 90% urobilinogen excreted through feces 10% urobilinogen reabsorbed into blood and returned to liver
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In liver most urobilinogen gets into biliary system The rest is excreted in urine Therefore urobilinogen is normally found in urine
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Urobilinogen Normal excretion is .5-2.5 mg/day in urine Gives urine its yellow color Tubular reabsorption is decreased in alkaline pH (after meal)(Alkaline Tide) Elevation is due to hemolytic anemia Increased production of bilirubin
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Clinical presentation of low urobilinogen: Clay coloured stools Results from two conditions: Complete obstructive jaundice Right scapular pain (gall stones) Jaundice/ ictarus Treatment with broad spectrum antibiotics Low Urobilinogen
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High Urobilinogen Clinical presentation of high urobilinogen: Hemolytic anemia: Tiredness, constant fatigue Jaundice / ictarus b/c of lots of circulating bilirubin Normal colored stools
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Glucose Hallmark of diabetes mellitus Polyuria and polydipsia Renal threshold for glucose is 180 mg/dl Should not be in urine specimen Can be found in urine if you eat after a fast Further testing required unless its presence can be explained
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Ketones Incomplete fat metabolism Ketones should not be present in urine Following conditions produce ketones in urine: Uncontrolled diabetes mellitus Starvation, anorexia, bullimia Vomiting and diarrhea Cachexia - wasting High fat diet Adkins diet
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Bilirubin Conjugated form Unconjugated not water soluble therefore cannot get through basement membrane Theoretically conjugated bilirubin should never get into the plasma All conjugated bilirubin should be in biliary system Bilirubin is not normally found in urine
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Bilirubin High bilirubin in urine will produce dark urine with a yellow foam Bilirubin in urine occurs because of the following conditions: Biliary obstruction (stone) Cancer of pancreatic head Malaria (low or no urobilinogen) Hepatitis Not present with hemolytic anemia
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Bilirubin This patient will have jaundice and clay colored feces Correlate the serum levels of conjugated to unconjugated bilirubin and fecal urobilinogen levels to identify the cause An early indicator of liver disease, before clinical symptoms appear
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This note was uploaded on 11/23/2011 for the course DIAG 2735 taught by Professor Josephr.forese during the Winter '11 term at Life Chiropractic College West.

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Wk 3 Chemical Analysis - Chemical Examination of Urine...

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