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CLINICAL
PATHOLOGY
INSIDE
Blood glucose report
Kidney function report
Liver function report
Blood report
Urine report
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250
200
150
renal threshold
100 normal
diabetic
50
diabetic
0 normal
renal threshold
2 hours
In diabetic: ascends above 200 mg/dl after meal & descends slowly but not to normal value
N.B
o D.M
o Normal blood glucose
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Jaundice
D.D of hypoalbuminemia
Decreased intake
o Malnutrition
o Malabsorption
Decreased synthesis
o Severe liver failure
Increased loss
o Nephritic syndrome
o Severe burn
Increased catabolism
o Infection
o Thyrotoxicosis
o Cushing syndrome
Haemodilution
o Late stages of pregnancy
o During I.V therapy
Total protein
Increased Normal Decreased
With acute diseases 6-8 gm% With chronic diseases
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Summary
↑direct bilirubin + ↑alkaline phosphatase = obstructive jaundice
↑direct & indirect bilirubin + ↑ALT,AST + ↓albumin = hepatocellular jaundice
only abnormality in protein
- ↑total protein →D.D of hyperprotenemia
- ↓total protein →D.D of hypoprotenemia
- ↓total albumin →D.D of hypoalbuminemia
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Blood report
Includes
o Type of anemia
o D.D
o Investigations required
1- type
if Hb is decreased : anemia
microcyic normocytic macrocytic
hypochromic normochromic normochromic
normal normal
↓MCH ↓MCV ↑MCH ↑MCV
MCH MCV
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Hb electrophoresis
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normocytic normochromic
anemia
normail
reticulocytosi reticulocytop
reticulocytic count s enia
reticulocytic
count
↑WBC pancytopenia
WBCs & platelets pancytopenia
↓platelets
hyper splenism
Investigations
- Pancytopenia→ BM aspiration
- Thalassemia → mentioned before
- Normocytic normochromic anemia , leucocytosis & thrombocytopenia
According to differencial leukocytic count
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Urine report
1- volume
normally: 600-2400 cc/day
increased → polyurea due to
o drugs
caffeine
alcohol
thiazide diuretics
o pathologic
D.M
Diabetes incipidus
Chronic renal failure
Decreased →oligurea due to
o Dehydration (severe diarrhea or vomiting)
o Renal ischemia (heart failure, shock)
o Oligurea stage of chronic nephritis
o Acute tubular necrosis
o Acute glomerulonephritis
o Obstruction of urinary tract : may lead to anurea
2- Aspect
Normally: clear and yellow or transparent
o Phosphate precipitation
o Urate precipitation
o Presence of pus cells
o Bacterial growth
o Mucus
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o Red cells
o Chylurea
3- Colour
Normally: amber yellow (urobilin & uroerythrin, small amount)
Abnormal may be:
o Watery
o Diabetes incipidus
o Diuretics
o Excess fluid intake
o Red urine
o After eating beets
o Haemoglobinurea
o Haematurea
o Porphrinurea
o Yellow brown or green brown
o Bile pigment (as obestructivejaundice)
o Orange red
o Excess urobilin →oxidized →urobilinogen
o Dark brown or black urine
o Alkaptonurea
o Melanurea
o Drugs
o Milk urine
o Presence of lymph and chylmicrons(due to rupture of lymphatics into urinary
tract)
o Foamy (frothy) urine
o Proteinurea
o Bile salts
o Concentrated urine
o haematurea
o 2m methyldopa , metronidazole
o 2n nitrate , nitrofurantoin
o F ferrous salts
o S sulphonamides
o C chloroquine
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o Q quinine
4- Sugar
Normally very small amount of glucose
Sugar in urine
Glucosurea
Indicates :
o Presence of glucose in urine
o Its serum level is > 180 mg/dl (renal threshold)
If fructose , pentose , galactose & lactose are present
o D.M
o certain poisons: CO , morphine
o increased ingestion of sugar or carbohydrates (aliemientary glucosurea)
renal glucosurea
o glucose in urine
o normal bl. Glucose level
o due to incomplete reabsorption of glucose by renal tubules
5- protein
normally < 150 mg/day
proteinurea
orthostatic (postural)
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functional (transient)
o fevers
o severe exercise
o heat stroke
o severe cold atmosphere
o congestive heart failure
o calculi
o infection
6- specific gravity
normally : 1015 -1025
increased in
o D.M
o Nephritic syndrome
Decreased in
o 1010→ renal failure
o Other→ diabetes incipidis
7- RBCs
Normally:
o In male→ 0-3/hpf
o In female→ 1-5/hpf
Increased in:
o Trauma
o Pyelonephritis
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Increased in
o Urinary Tract infection
o TB
o Renal tumours
o Acute glomerulonephritis
o Interstitial nephritis
o Analgesic abuse
o Steril pyorea
o TB
o Analgesic nephropathy
o Interstitial nephritis
o Nonspecific inflammation of the bladder
9- Casts
Hyaline casts
o Benign hypertension
o Nephritic syndrome
o After exercise
Red cell casts
o Acute glomerulonephritis
o Lupus nephritis
o Subacute bacterial endocarditis
o Good pasture’s disease (immune disease of the kidney)
o After streptococcal infection
o Malignant hypertension
WBCs casts
o Pyelonephritis
Epithelial casts
o Tubular damage
o Nephrotoxins
o Viraemia
Granular casts
o Acute tubular necrosis
Waxy casts
o Severe chronic disease
o Amyloidosis
Fatty casts
o Nephritic syndrome
o D.M
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