زائر
Mispi Examinatin f ine
Sediment
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ine nde the Mispe
As pat f a inaysis, the ine sediment is entifged and examined mispiay f ystas, asts, ed bd es, white bds es, and bateia yeast. Bease examinatin f inay sediment pvides a diet samping f inay tat mphgy, it pvides imptant infmatin sef f bth diagnsis and pgnsis. Mispi examinatin f ine sediment is say pefmed in additin t tine pedes. This examinatin eqies a degee f ski aqied thgh patie nde the immediate spevisin f an expeiened tehniian. The speimen sed f mispi examinatin shd be as fesh as pssibe. ed es and many fmed sids tend t disintegate pn standing, patiay if the speimen is wam akaine.
Hw t Pepae the ine f Mispi Examinatin
et intepetatin f the mispi inaysis depends n ppe speimen etin and pepaatin. The patient shd be instted n the ppe tehniqe f ean ath ine etin. D nt assme that the patient knws what t d fm pevis expeiene. eview hw t eanse the genitaia and instt the patient t et a midsteam speimen. P five t ten miiites f ine int a test tbe. nia bttm test tbes ae pefeed bease they aw f bette peet fmatin. Pease the tbe in the entifge and baane with a send tbe fied with wate ( anthe ine speimen) f eqa vme. Spin the ine f abt five mintes. emve the tbe and deant the spenatant int the sink. esspend the sediment in the esida ine that ings t the bttm f the tbe by tapping the tbe against a had sfae sevea times. Pae a dp f the esspended sediment n a gass mispe side sing a pipette by hding the tbe pside dwn and aefy tapping it the side nti ne dp fas nt the side. Pae a vesip ve the dp and pae nde the mispe. Athgh mmeia stains ae avaiabe t highight ea eements, examinatin f nstained ine is say adeqate.
Hw t San the Side
eview the peating insttins f y mispe if y ae nfamiia with its peatin. Pae the side nde the spe and begin the examinatin nde w pwe. Be se t se a w ight se (adjst he iis and ndense). T mh ight makes the ea and ystaine eements hade t see. San the side nde w pwe t ate aeas f inteest. k f asts jst inside the peimete f the ve sip. Then swith t high dy magnifiatin and examine ten andm fieds in the enta pat f the vesip . nt the nmbes f ed es and white es in eah and ept the ange f findings. If the fied is veed with es, ept as "TNT" (t nmes t nt) "paked." Add t the ept an estimate f bateia density, any asts seen and the sttes nted. Sampe mispi inaysis ept 5-10 BHPF, 15-25 WBHPF, few bateia, asina hyaine ast, n epitheia es.
inia Signifiane f Mispi Examinatin
In heathy pepe, the ine ntains sma nmbes f es and the fmed eements fm the entie inay tat, and epitheia es fm the kidney, ete , badde, and etha. In ena disease, the ine ften ntains ineased nmbes f sbstanes dishaged fm an gan that is thewise aessibe ny by bipsy sgey. A mispi examinatin f ine sediment detets the pesene and amnts f:
* ed bd es
* White bd es
* Bateia and yeast
* asts
* Epitheia es
* ystas
ine sediment is assessed nde a high pwe fied (HPF) f the pesene f ed and white bd es. Nmay, thee shd be ny an asina ed bd e in the ine (2-3 pe high pwe fied). Hematia , the pesene f abnma nmbes f ed bd es in the ine may be de t:
* Gmea disease
* Tms that ede any pat f the inay tat
* Kidney tama
* ena infats
* Ate tba nesis
* ppe and we inay tat infetins
* Nephtxins
* Tamati atheteizatin
* Passage f ena stnes
* Physia stess
In wmen, it is imptant t make se that the ine speimen was nt ntaminated by the mensta fw. Inseting a tampn and eting ine midsteam ae ways t pevent ntaminatin. ed bd es may stik tgethe and fm ed bd e asts. The pesene f ddy shaped ed bd es in the ine sggests a gmea disease sh as gmenephitis, as the dd shape is ased by the passage f the es thgh a distted and abnma gmea stte. White bd es ae nmay nt pesent in the ine. The pesene f white bd es indiates infetin infammatin within the inay tat.
It is imptant that ine is examined f bateia, asts, ystas, and epitheia es. ine sted in the badde is nmay fee f bateia yeast. Hweve, bateia ae mmny fnd in ine speimens bease f the abndant nma mibia fa f the vagina extena inay meats and de t the abiity f bateia t mtipy apidy in ine standing at m tempeate. Bateia nted n a mispi examinatin shd be intepeted in view f inia signs and symptms f inay tat infetin. Diagnsis f bateiia in a patient with a sspeted inay tat infetin eqies a ine te and sensitivity. A ny nt may as be dne t detemine if signifiant nmbes f bateia ae pesent. Geneay, me than 100,000 bateia f ne ganism pe miiite f ine indiates a inay tat infetin. A finding f mtipe ganisms say efets speimen ntaminatin.
asts ae etins f ptein, es, and debis that ae fmed in the tbes f the kidneys. ast width is desibed as naw (ne t tw ed bd es in width), medim bad ( thee t f ed es in width), and bad (five ed bd es in width). asts that fm in the eting tbes tend t be vey bad. Bad asts say indiate a signifiant edtin in the fntina apaity f the nephn and indiate sevee ena damage "end stage" ena disease. A few hyaine asts ae nma, bt a the asts need t be evaated. When ea asts emain in the nephns f sme time befe being fshed int the badde ine, the es may degeneate t a asey gana ast, ate t a finey gana ast, and eventay, t a waxy ast. Gana and waxy asts ae beieved t be deived fm ena tba asts. The nmbe f asts ae epted as "nmbe and type seen pe w pwe fied (PF)". An exampe f a ept might ead: "5-10 hyaine astsPF."
Sme epitheia es fm the skin sfae fm the te etha an appea in the ine. Sme fms f ystas appea in the ine f heathy individas. Abnma ystas an indiate ive disease sme fms f geneti abnmaities.
Smmay f inia Signifiant Findings
ekytes, eythytes, and asts may a be f inia signifiane when fnd in ine sediment.
ekytes—Nmay, 0 t 3 ekytes pe high-pwe fied wi be seen n mispi examinatin. Me than 3 es pe high-pwe fied pbaby indiates disease smewhee in the inay tat. Estimate the nmbe f ekytes pesent pe high-pwe fied and ept it as the "estimated nmbe pe high-pwe fied."
Eythytes—ed es ae nt say pesent in nma ine. If eythytes ae fnd, estimate thei nmbe pe high-pwe fied and ept it. Eythytes may be diffeentiated fm white es in sevea ways:
* White es ae age than ed es.
* When fsing with the high-pwe ens, the ed es shw a distint ie; the white es tend t appea gana with a visibe nes.
* ne dp f 5% aeti aid added t the ine sediment disintegates any ed es, bt it des nt affet the white es (exept that the nei beme me distint).
asts—These inay sediments ae fmed by agatin f abmins mateia in the kidney tbes. asts ae yindia and vay in diamete. The sides ae paae, and the ends ae say nded. asts in the ine aways indiate sme fm f kidney disde and shd aways be epted. If asts ae pesent in age nmbes, the ine is amst se t be psitive f abmin.
Thee ae seven types f asts. They ae as fws:
* Hyaine asts ae the mst feqenty ing asts in ine. Hyaine asts an be seen in even the midest ena disease. They ae ess, hmgenes, tanspaent, and say have nded ends.
* ed e asts indiate ena hematia. ed e asts may appea bwn t amst ess and ae say diagnsti f gmea disease. White e asts ae pesent in ena infetin and in nninfetis infammatin. The majity f white es that appea in asts ae hypesegmented netphis.
* Gana asts amst aways indiate signifiant ena disease. Hweve, gana asts may be pesent in the ine f a sht time fwing stens exeise. Gana asts that ntain fine ganes may appea gey pae yew in . Gana asts that ntain age ase ganes ae dake. These asts ften appea bak bease f the density f the ganes.
* Epitheia asts ae aey seen in ine bease ena disease that pimaiy affets the tbes is infeqent. Epitheia asts may be aanged in paae ws haphazady.
* Waxy asts est fm the degeneatin f gana asts. Waxy asts have been fnd in patients with sevee hni ena faie, maignant hypetensin, and diabeti disease f the kidney. Waxy asts appea yew, gey, ess. They feqenty as sht, bad asts, with bnt bken ends, and ften have aked seated edges.
* Fatty asts ae seen when thee is fatty degeneatin f the tba epitheim, as in degeneative tba disease. Fatty asts as est fm ps and txi ena pisning. A typia fatty ast ntains bth age and sma fat dpets. The sma fat dpets ae yewish-bwn in .
Sediment
*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*-*
ine nde the Mispe
As pat f a inaysis, the ine sediment is entifged and examined mispiay f ystas, asts, ed bd es, white bds es, and bateia yeast. Bease examinatin f inay sediment pvides a diet samping f inay tat mphgy, it pvides imptant infmatin sef f bth diagnsis and pgnsis. Mispi examinatin f ine sediment is say pefmed in additin t tine pedes. This examinatin eqies a degee f ski aqied thgh patie nde the immediate spevisin f an expeiened tehniian. The speimen sed f mispi examinatin shd be as fesh as pssibe. ed es and many fmed sids tend t disintegate pn standing, patiay if the speimen is wam akaine.
Hw t Pepae the ine f Mispi Examinatin
et intepetatin f the mispi inaysis depends n ppe speimen etin and pepaatin. The patient shd be instted n the ppe tehniqe f ean ath ine etin. D nt assme that the patient knws what t d fm pevis expeiene. eview hw t eanse the genitaia and instt the patient t et a midsteam speimen. P five t ten miiites f ine int a test tbe. nia bttm test tbes ae pefeed bease they aw f bette peet fmatin. Pease the tbe in the entifge and baane with a send tbe fied with wate ( anthe ine speimen) f eqa vme. Spin the ine f abt five mintes. emve the tbe and deant the spenatant int the sink. esspend the sediment in the esida ine that ings t the bttm f the tbe by tapping the tbe against a had sfae sevea times. Pae a dp f the esspended sediment n a gass mispe side sing a pipette by hding the tbe pside dwn and aefy tapping it the side nti ne dp fas nt the side. Pae a vesip ve the dp and pae nde the mispe. Athgh mmeia stains ae avaiabe t highight ea eements, examinatin f nstained ine is say adeqate.
Hw t San the Side
eview the peating insttins f y mispe if y ae nfamiia with its peatin. Pae the side nde the spe and begin the examinatin nde w pwe. Be se t se a w ight se (adjst he iis and ndense). T mh ight makes the ea and ystaine eements hade t see. San the side nde w pwe t ate aeas f inteest. k f asts jst inside the peimete f the ve sip. Then swith t high dy magnifiatin and examine ten andm fieds in the enta pat f the vesip . nt the nmbes f ed es and white es in eah and ept the ange f findings. If the fied is veed with es, ept as "TNT" (t nmes t nt) "paked." Add t the ept an estimate f bateia density, any asts seen and the sttes nted. Sampe mispi inaysis ept 5-10 BHPF, 15-25 WBHPF, few bateia, asina hyaine ast, n epitheia es.
inia Signifiane f Mispi Examinatin
In heathy pepe, the ine ntains sma nmbes f es and the fmed eements fm the entie inay tat, and epitheia es fm the kidney, ete , badde, and etha. In ena disease, the ine ften ntains ineased nmbes f sbstanes dishaged fm an gan that is thewise aessibe ny by bipsy sgey. A mispi examinatin f ine sediment detets the pesene and amnts f:
* ed bd es
* White bd es
* Bateia and yeast
* asts
* Epitheia es
* ystas
ine sediment is assessed nde a high pwe fied (HPF) f the pesene f ed and white bd es. Nmay, thee shd be ny an asina ed bd e in the ine (2-3 pe high pwe fied). Hematia , the pesene f abnma nmbes f ed bd es in the ine may be de t:
* Gmea disease
* Tms that ede any pat f the inay tat
* Kidney tama
* ena infats
* Ate tba nesis
* ppe and we inay tat infetins
* Nephtxins
* Tamati atheteizatin
* Passage f ena stnes
* Physia stess
In wmen, it is imptant t make se that the ine speimen was nt ntaminated by the mensta fw. Inseting a tampn and eting ine midsteam ae ways t pevent ntaminatin. ed bd es may stik tgethe and fm ed bd e asts. The pesene f ddy shaped ed bd es in the ine sggests a gmea disease sh as gmenephitis, as the dd shape is ased by the passage f the es thgh a distted and abnma gmea stte. White bd es ae nmay nt pesent in the ine. The pesene f white bd es indiates infetin infammatin within the inay tat.
It is imptant that ine is examined f bateia, asts, ystas, and epitheia es. ine sted in the badde is nmay fee f bateia yeast. Hweve, bateia ae mmny fnd in ine speimens bease f the abndant nma mibia fa f the vagina extena inay meats and de t the abiity f bateia t mtipy apidy in ine standing at m tempeate. Bateia nted n a mispi examinatin shd be intepeted in view f inia signs and symptms f inay tat infetin. Diagnsis f bateiia in a patient with a sspeted inay tat infetin eqies a ine te and sensitivity. A ny nt may as be dne t detemine if signifiant nmbes f bateia ae pesent. Geneay, me than 100,000 bateia f ne ganism pe miiite f ine indiates a inay tat infetin. A finding f mtipe ganisms say efets speimen ntaminatin.
asts ae etins f ptein, es, and debis that ae fmed in the tbes f the kidneys. ast width is desibed as naw (ne t tw ed bd es in width), medim bad ( thee t f ed es in width), and bad (five ed bd es in width). asts that fm in the eting tbes tend t be vey bad. Bad asts say indiate a signifiant edtin in the fntina apaity f the nephn and indiate sevee ena damage "end stage" ena disease. A few hyaine asts ae nma, bt a the asts need t be evaated. When ea asts emain in the nephns f sme time befe being fshed int the badde ine, the es may degeneate t a asey gana ast, ate t a finey gana ast, and eventay, t a waxy ast. Gana and waxy asts ae beieved t be deived fm ena tba asts. The nmbe f asts ae epted as "nmbe and type seen pe w pwe fied (PF)". An exampe f a ept might ead: "5-10 hyaine astsPF."
Sme epitheia es fm the skin sfae fm the te etha an appea in the ine. Sme fms f ystas appea in the ine f heathy individas. Abnma ystas an indiate ive disease sme fms f geneti abnmaities.
Smmay f inia Signifiant Findings
ekytes, eythytes, and asts may a be f inia signifiane when fnd in ine sediment.
ekytes—Nmay, 0 t 3 ekytes pe high-pwe fied wi be seen n mispi examinatin. Me than 3 es pe high-pwe fied pbaby indiates disease smewhee in the inay tat. Estimate the nmbe f ekytes pesent pe high-pwe fied and ept it as the "estimated nmbe pe high-pwe fied."
Eythytes—ed es ae nt say pesent in nma ine. If eythytes ae fnd, estimate thei nmbe pe high-pwe fied and ept it. Eythytes may be diffeentiated fm white es in sevea ways:
* White es ae age than ed es.
* When fsing with the high-pwe ens, the ed es shw a distint ie; the white es tend t appea gana with a visibe nes.
* ne dp f 5% aeti aid added t the ine sediment disintegates any ed es, bt it des nt affet the white es (exept that the nei beme me distint).
asts—These inay sediments ae fmed by agatin f abmins mateia in the kidney tbes. asts ae yindia and vay in diamete. The sides ae paae, and the ends ae say nded. asts in the ine aways indiate sme fm f kidney disde and shd aways be epted. If asts ae pesent in age nmbes, the ine is amst se t be psitive f abmin.
Thee ae seven types f asts. They ae as fws:
* Hyaine asts ae the mst feqenty ing asts in ine. Hyaine asts an be seen in even the midest ena disease. They ae ess, hmgenes, tanspaent, and say have nded ends.
* ed e asts indiate ena hematia. ed e asts may appea bwn t amst ess and ae say diagnsti f gmea disease. White e asts ae pesent in ena infetin and in nninfetis infammatin. The majity f white es that appea in asts ae hypesegmented netphis.
* Gana asts amst aways indiate signifiant ena disease. Hweve, gana asts may be pesent in the ine f a sht time fwing stens exeise. Gana asts that ntain fine ganes may appea gey pae yew in . Gana asts that ntain age ase ganes ae dake. These asts ften appea bak bease f the density f the ganes.
* Epitheia asts ae aey seen in ine bease ena disease that pimaiy affets the tbes is infeqent. Epitheia asts may be aanged in paae ws haphazady.
* Waxy asts est fm the degeneatin f gana asts. Waxy asts have been fnd in patients with sevee hni ena faie, maignant hypetensin, and diabeti disease f the kidney. Waxy asts appea yew, gey, ess. They feqenty as sht, bad asts, with bnt bken ends, and ften have aked seated edges.
* Fatty asts ae seen when thee is fatty degeneatin f the tba epitheim, as in degeneative tba disease. Fatty asts as est fm ps and txi ena pisning. A typia fatty ast ntains bth age and sma fat dpets. The sma fat dpets ae yewish-bwn in .
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