實(shí)驗(yàn)六 尿液理學(xué)檢查（Experiment six urine physical examination）

1、實(shí)驗(yàn)六 尿液理學(xué)檢查Experiment six urine physical examinationData worth havingFrom the usual accumulation of learning summaryWhere there's a problem, there must bePlease criticize and correct it!Experiment six urine physical examinationPhysical Examination of urine(1) appearance examination of urineExperi

2、mental principleIn normal circumstances, the depth of urine color mainly comes from the urine pigment and urine bileIt was also affected by the factors such as medicine, food and urine volumeThe transparency of urine is related to the content of visible components and insoluble substances in urineTh

3、e examination of urine appearance mainly depends on the naked eyeAnd truthfully describe the reportReagent equipmentDisposable urine cup or 100ml colorless transparent glass bottleOperation steps1. collect the specimen and collect urine in the urine cup2. the results report the appearance of the nak

4、ed eye under natural light or white lightThen report the color and transparency directlyThe color is light yellow, dark yellow and light redDark red, milky or brownTransparency can be expressed by clarity, transparency, slight turbidity, turbidity, etc.If sediment and / or clots are present in the s

5、pecimen, special mention should be givenMatters needing attention1. the appearance examination of urine should be based on fresh specimen2. fresh urine samples contain too high salt concentration when it is coldEasily precipitated salts (especially urate) and turbid urineThe turbid urine can be prel

6、iminarily identified according to the program shown in Figure 5-1Fig. 5-1 schematic diagram of identification procedure for turbid urineReference rangeLight yellow, clear and transparentClinical significance1. red urine in the urine, Hemoglobin Urine; white fat more urine, chyluria, pyuria and bacte

7、riuria; brown urine in methemoglobinuria etc.A lot of drugs can also affect the urine color; when the acidity is highDarker colorsLow acidityThe color is light; the urine is too small and the color is very paleIt suggests renal dysfunction2. the reason of normal urine turbidity is mainly caused by c

8、rystallizationThe cause of pathological turbid urine is white blood cell, red blood cell and bacteria in urineMucin and nucleoprotein in urine can also be precipitated by pH changeThe 3. part of the urine of young women is often mixed with mucin secreted by the vaginal mucosa, a small number of epit

9、helial cells or leukocytesAfter a period of time, it can be slightly cloudyNo clinical significance4. urine color is susceptible to drugs or foodTake vitamin B2, rhubarb, Coptis chinensis, furazolidone, and eat a lot of carrots and so onCan make the urine bright yellow or dark yellowBut the foam pro

10、duced after oscillation is colorlessThe yellow foam produced by bilirubin oscillation is yellowIn alkaline urine phenol, phenolphthalein or application of aminopyrine whenUrine appearance is bright redIt is not difficult to distinguish the red turbid appearance of hematuriaThinking question1. what c

11、auses hematuria?2. how to identify turbid urine?(two) urine volume determinationExperimental principleCollect all the urine in 24hThe volume was measured with a calibrated containerThat is, 24h urine volumeReagent equipmentClean containers, cups or cylinderOperation steps1. prepare the morning to le

12、t the patient empty the urine2. collect specimens and collect urine in the subsequent 24h with a clean container3. the urine volume was measured accurately after mixing urine samplesUrine outputMatters needing attention1. must empty the bladder afterYou can start clockingEmpty the bladder every time

13、 you take the specimen2. when the temperature is high, attention should be paid to urine specimen antisepsisReference range16 year old children: (3001000) ml/24h712 year old children: (5001500) ml/24hAdults: (10002000) ml/24hClinical significanceThe amount of urine mainly depends on glomerular filtr

14、ation rate, tubular reabsorption and concentration dilution functionNormallyThere was a positive correlation between urine volume and water intake and water content in foodIn addition, the amount of urine is also affected by many other factors, such as age, mental factors, activity, food, climate, e

15、tc.Pathological increase: common in diabetes, diabetes insipidus, chronic nephritis and neurogenic polyuriaPathological reduction is common in shock, dehydration, severe burns, acute and chronic nephritis, acute and chronic renal failure, cardiac insufficiency, ascites due to cirrhosisEpidemic hemor

16、rhagic fever, oliguria stage, uremia and so onThinking questionThe concept and causes of polyuria, oliguria, and oliguria(three) determination of urine pH (pH test paper)Experimental principleThe broad pH test strip is a mixed test band with various indicatorsColor can be obtained after dipping the

17、urine into the test bandThe urine pH approximation was then compared with the standard shade guideTest and equipmentDisposable urine cup or clean glass tube, extensive pH test paperOperation steps1. dip sample wear gloves or wash hands after dryingTake one of the test stripsThe other end of the hand

18、 is immersed in urine for about 0.5s removed2. the judgment result reads pH value in comparison with the standard shade under natural lightMatters needing attention1. read the value should be completed within the specified time2. reagent strip should be sealed, dried and kept away from lightMore awa

19、y from acidic or alkaline substancesTo prevent failure3. the sample must be freshOtherwise, the increase in pH may be due to bacterial reproduction or loss of volatile acids4. samples can not be used preservativesOtherwise it may affect the result of the testReference rangeAverage 6Clinical signific

20、anceThe acidity of normal fresh urine is often weak acidityIt is mainly affected by the secretion of H + and reabsorption of HCO3- in renal tubules, as well as the secretion of NH3 and the formation of ammonium saltsIt's also affected by diet, exercise, hunger, medication and diseaseAmong them,

21、dietary factors have great influenceSuch as eating more proteinUrine pH value is lower; while eating more vegetables, the urine pH is often more than 6; the alkaline tide after eatingThe urine pH showed a transient increaseUrine is too longThe contaminated bacteria can decompose urea in the urine to

22、 produce ammoniaSo that the urine becomes alkalineFang Xue evaluationThere are two kinds of test paper: broad pH and precision pHThe wide pH test strip has wide measuring rangeThe results are more roughThe range of precision pH is narrowBeyond the range, the result is inaccurateA broad pH test strip

23、 can be used to measure a rough pHThe accurate pH value was determined by the precision pH of the corresponding rangeTwo kinds of test paper are easy to damp failureThe pH of urine can also be detected by dry chemical band testThe range is between pH4.5 and 9Dry chemical tape test has been widely us

24、ed in clinical practiceThe results can be visually measuredIt can also be measured by instrumentsVery convenient and quickIn addition, the determination of urine pH, indicator method, pH method and titration method, etc.A color indicator method, phenol red stamens and bromothymol blueReagents are no

25、t easy to preserve and transportResults it was easy to be affected by jaundice, hematuria and so onPH counting methodIts accuracy and precision are higherSpecial instruments are neededNo use of clinical popularizationTitration method can be used to determine the content of titratable acid in urineTh

26、e method is tedious and time-consumingMore unfavorable to clinical applicationreflectionsWhy is the pH value of urine in the morning too acidic?(four) urine concentration determination1. concentration meter methodExperimental principleFor the direct determination of the concentration of urineWill be

27、 immersed in urine concentration meterThe greater the concentration of urineThe sealing part immersed in urine lessThe greater the reading, the vice versaThe more immersed partThe smaller the readingReagent equipmentHydrometer 1100ml conical cupOperation steps1. fresh urine sampling placed in a 100m

28、l conical beaker2. place buoys to gently place and buoy the hydrometer buoyMake it vertically suspended in urineDon't make the cup close to the wallThreeThe results are stable after the hydrometer is suspendedRead the scale tangent to the concave surface of the urineAnd record itMatters needing

29、attention1. urine hydrometer should be used after correction2. the amount of urine should be sufficient to ensure that the hydrometer floats at the center of the liquid surface without hitting the wallUrine surface and hydrometer readings should be accurateFoam should be eliminated when measuring 3.

30、4. to determine the temperature, proteinuria, diabetes correctionIf the temperature of the measurement is not consistent with the calibrated temperature on the hydrometerEach increase is 3 degrees centigradeIf the temperature is lower than the standard temperatureUrine should be heated to the standa

31、rd temperature to be re determinedCannot correct the correction value relative to the rising temperature mechanicallyUrinary protein increased by 10g/L each timeWe need to subtract 0.003 from the result; urine glucose is increased by 10g/LYou need to subtract 0.004 from the resultWhen 4. urine speci

32、mens contain contrast agentsThe urine concentration increased significantlyClinical significanceUrine concentration and factors of water intake, sweating and age and other physiological conditions relating toLow urinary gravity in infantsBimikeyin urine urine volume decreased under pathological cond

33、itionsOr can be increased by increasing the protein, glucose and cell componentsTo reduce the proportion of 1. patients with chronic nephritis due to renal tubule dysfunction and the concentration decreasedWhen renal parenchyma is destroyed and lost concentration functionDiabetes insipidus can be re

34、duced by antidiuretic hormone secretionOr the sensitivity of renal tubular epithelial cells to antidiuretic hormone is decreasedA large amount of water is expelled from the body to reduce the specific gravity2. increased proportion of patients with diabetes, although urine, but because the urine con

35、tains a lot of glucoseUrine specific gravity can be increased obviouslyAcute glomerulonephritis due to visible components and protein found in urine specimens and the concentration increaseBesidesBimishenggao urine was also found in dehydration, fever, peripheral circulatory failure, heart failure,

36、such as the use of contrast agentsMethod evaluationUrine concentration determination method of buoy method, refractometer method, ultrasonic method and weighing method and testAmong them:Buoy method is the classic method of detecting urine concentrationEasy operationNo special instrument neededEasy to popularizeThe disadvantage is that the amount of specimen is largeThe results were affected by temperature and contentFor example, protein, glucose, contrast medium and