Case studies

Case #8

Urinalysis results for 23-year-old mother of two, with back pain, chills, fever and vomiting. She is pregnant. There are no abnormalities detected in the urine although it appears cloudy. Turbidity in urine signifies the presence of the defect in the urine. Maybe due to the presence of leukocytes or nitrites or even cast cells. It could also be due to the presence of red blood cells or an indication of urinary tract infection. Urinary tract infections are regular in pregnant women due to their immunocompromised systems that make it easier to predispose them to infections. The consequential occurrences will involve a marked rise in the production of white blood cells that appear as leukocyte esterase in urinalysis tests. There are two primary forms of urinary tract infections that distinguish themselves by their symptoms. The first, lower urinary tract infection is located in the bladder, prostate or urethra. The upper urinary tract infection infects the kidney.

The abnormal results in her urine were leukocyte esterase and nitrite results that were both positive. There are also cast cells seen, a few red blood cells, both epithelial and squamous cells can be seen. There is the notable presence of bacterial rods. Infections of the lower urinary tract cause dysuria, frequency and urgency to urinate. Upper urinary tract infection (kidney) comes with symptoms like fever, chills and may be vomiting due to disease of the kidney. In some instances, infection penetrates the upper urinary tract from the bladder. The infection then accesses the collecting tubules and results in interstitial nephritis. There is localized ischemia that results in altered imaging and necrosis and scarring.

The presence of white blood cell casts indicates renal-origin pyuria (painful urination) enhancing the diagnosis of acute pyelonephritis, where cast cells are seldom seen.

Case #9

The second case is a 23-year-old male. He had acute abdominal pain and was previously on admission for psychiatric care. The urine is purple in color and hazy in turbidity. All parameters are normal apart from urobilinogen that shows 8EU in Ehrlich’s reaction, typical of diazo strip and active in both Hoesch and Watson-Schwartz tests. The test results showed the presence of urobilinogen in Ehrlich’s response. Watson-Schwartz test is useful in the differentiation between urobilinogen and porphobilinogen. Presence of urobilinogen in urine is an indicator of a hemolytic process like hemolytic anaemia. It would also be high in infectious hepatitis and cirrhosis. Comparison between bilirubin results and urobilinogen results give an insight into the cause of the disease.

 When urobilinogen is positive and the bilirubin test is negative, then hemolytic anaemia can be concluded. Watson-Schwartz tests yield more concise results and are more sensitive and concrete for porphobilinogen. It is very significant when testing for hepatic porphyrias. The abnormal color in the urine is caused by the presence of porphobilinogen that gives urine to have “red wine” color. Hoesch screening test does not show the reaction with urobilinogen. Drawing from the above observations the conclusive result is that the patient suffers from hemolytic anaemia.

The results analysis using Watson- Schwartz test is quite qualitative and concrete for the diseases. Since laparotomy is for the doctor to examine the inner parts of the abdomen to establish the cause of illness, then it will no longer be necessary. The patient suffers from hemolytic anaemia.

Case #10

The patient is suffering from sickle cell anaemia with chronic anaemia and jaundice. The color of his urine is abnormally amber with the active urobilinogen test. All other parameters are standard. Urobilinogen is produced in breaking down bilirubin in the intestines. Half of it is secreted in faeces while the other portion circulates back to the liver and the remaining portion released in urine. Ehrlich test alone is not enough because even healthy patients have urobilinogen in the urine that is detectable using Ehrlich’s test. An additional test using Diazo reaction is, therefore, significant. Hemoglobin is not positive in the test because in chronic hemolysis, red blood cells are destroyed. Then the products are broken down into other forms which are then released into the urine. Bilirubin is also broken down in the intestines and transformed to urobilinogen.

Someone with jaundice but absence of bilirubin shows the presence of either hemolysis or a hepatic dysfunction. Leukocytosis and neutrophilia are not common in viral hepatitis but common in alcoholic hepatitis. Urobilinogen is released at high levels in the case of hemolytic jaundice as in the event of this patient. Normally, bilirubin forms from the breakdown of aged erythrocytes by the reticuloendothelial cells. They lead to the formation of biliverdin. Increased levels of red blood cells breakdown result in hemolytic anemia that is characterized by high biliverdin levels and consequently high bilirubin levels. Indirect bilirubin is secreted by the liver and conjugated to direct bilirubin with glucuronic acid. Somehow, the bilirubin finds its way to the small intestine where it is further broken down into urobilinogen and a portion of it goes back to circulation. That is precisely why patients with jaundice will never test positive for bilirubin even when it is high in circulation. Moreover, bilirubin reacts very fast with air and all results will turn out negative if care is not taken.

There is a high degree of bilirubin in the case of the primary bile duct obstruction, intrahepatic cholestasis and in other instances such as infection with hepatitis.

Carolyn Morgan is the author of this paper. A senior editor at MeldaResearch.Com in write my nursing research paper services. If you need a similar paper you can place your order from essay already written services.