Category: Diagnonistic Test

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Diagnonistic Test

Endoscopic Retrograde Cholangiopancreatography (ERCP)

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Definition:
Endoscopic retrograde cholangiopancreatography  (ERCP) enables the physician to diagnose problems in the liver, gallbladder, bile ducts, and pancreas. The liver is a large organ that, among other things, makes a liquid called bile that helps with digestion. The gallbladder is a small, pear-shaped organ that stores bile until it is needed for digestion. The bile ducts are tubes that carry bile from the liver to the gallbladder and small intestine. These ducts are sometimes called the biliary tree. The pancreas is a large gland that produces chemicals that help with digestion and hormones such as insulin.
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This procedure uses x-rays and an endoscope to see inside your digestive system and diagnose problems such as tumors, gallstones, and inflammation in your liver, gallbladder, bile ducts, or pancreas. Your doctor might use the test to investigate the cause of jaundice, upper abdominal pain, or unexplained weight loss.

Why an ERCP is Performed
ERCP is most commonly performed to diagnose conditions of the pancreas or bile ducts, and is also used to treat those conditions. It is used to evaluate symptoms suggestive of disease in these organs, or to further clarify abnormal results from blood tests or imaging tests such as ultrasound or CT scan. The most common reasons to do ERCP include abdominal pain, weight loss, jaundice, or an ultrasound or CT scan that shows stones or a mass in these organs.

ERCP may be used before or after gallbladder surgery to assist in the performance of that operation. Bile duct stones can be diagnosed and removed with an ERCP. Tumors, both cancerous and noncancerous, can be diagnosed and then treated with indwelling plastic tubes that are used to bypass a blockage of the bile duct. Complications from gallbladder surgery can also sometimes be diagnosed and treated with ERCP.

In patients with suspected or known pancreatic disease, ERCP will help determine the need for surgery or the best type of surgical procedure to be performed. Occasionally, pancreatic stones can be removed by ERCP.

If the exam shows a gallstone or narrowing of the ducts, the physician can insert instruments into the scope to remove or relieve the obstruction. Also, tissue samples (biopsy) can be taken for further testing.

Preparation
For a week before the test, don’t take aspirin or other NSAIDs because they can irritate the stomach lining and increase your chance of bleeding during the procedure. Also tell the doctor if you are taking blood-thinning medicines or any diabetes medications. People with heart valve problems may also have to take antibiotics before the procedure. Avoid eating or drinking anything for eight hours before the test because it needs to be done on an empty stomach.

Tell your doctor if you are allergic to iodine, which is used for the procedure. Arrange for someone to drive you home because the medication given during the test will make you drowsy.

Your stomach and duodenum must be empty for the procedure to be accurate and safe. You will not be able to eat or drink anything after midnight the night before the procedure, or for 6 to 8 hours beforehand, depending on the time of your procedure. Also, the physician will need to know whether you have any allergies, especially to iodine, which is in the dye. You must also arrange for someone to take you home—you will not be allowed to drive because of the sedatives. The physician may give you other special instructions.

What can be expected during ERCP
Your throat will be sprayed with a local anesthetic before the test begins to numb your throat and prevent gagging. You will be given medication intravenously to help you relax during the examination. While you are lying in a comfortable position on an X-ray table, an endoscope will be gently passed through your mouth, down your esophagus, and into your stomach and duodenum. The procedure usually lasts about an hour. The endoscope does not interfere with your breathing. Most patients fall asleep during the procedure or find it only slightly uncomfortable. You may feel temporarily bloated during and after the procedure due to the air used to inflate the duodenum. As X-ray contrast material is injected into the pancreatic or bile ducts, you may feel some minor discomfort.

What happens when the test is performed
The test is performed by a specially trained gastroenterologist either in the doctor’s office or in a hospital. You are usually given a sedative through an IV line. You wear a hospital gown for the procedure and lie on your side against a backrest on an x-ray table. If you wear dentures, remove them. A local anesthetic is sprayed into your throat to prevent you from having a gag reflex (choking feeling) when the endoscope is placed inside. The endoscope is about a third of an inch in diameter and 21/2 feet long with a light on the end. It also has holes at the end that allow your doctor to pump air into your intestine, squirt fluid, and suck out liquid or air.

You are asked to swallow at the moment the tube is placed into your throat. This helps guide the endoscope into your esophagus.You are likely to feel pressure against your throat while the tube is in place and you might experience a “full” feeling in your stomach. The doctor or doctor’s assistant gently advances the tube until it reaches your duodenum, the first part of the small intestine.

Next, the doctor inserts a slender tube, called a cannula, through the endoscope, and places the tip of the cannula into the bile duct or the pancreatic duct. These ducts are natural tubes of tissue that drain liquids out of the liver and pancreas. Once the tip of the cannula is lodged inside one of these ducts, the doctor injects contrast dye (usually iodine) through the cannula. The dye can be seen by x-rays, so it lights up the ducts clearly on an x-ray image, showing any obstruction (such as from gallstones or cancer) or unusual widening of the ducts (indicating an obstruction in the past). It also can light up the gallbladder, which connects to the bile duct, and helps the doctor to visualize the liver and pancreatic tissue around the ducts.

Depending on what the x-rays show, the doctor may undertake different interventions using tools operated through the endoscope. The doctor can remove gallstones or take biopsies of suspicious tissue. He or she can prop open narrowed bile ducts with a stent, a tube-shaped object that can be inserted through the scope. Depending on what is done, the test can take from 30 minutes to two hours.

Risk Factors:Complications are rare. One possibility is aspiration-accidentally inhaling saliva into the lungs – which can cause pneumonia. Other risks include inflammation of the pancreas, infection, and bleeding. Injury to the lining of the stomach, esophagus, or intestine, as well as abdominal pain and fever, can also occur.

Possible complications of ERCP include pancreatitis (inflammation of the pancreas), infection, bleeding, and perforation of the duodenum. Except for pancreatitis, such problems are uncommon. You may have tenderness or a lump where the sedative was injected, but that should go away in a few days.

Time required to do the test:
ERCP takes 30 minutes to 2 hours. You may have some discomfort when the physician blows air into the duodenum and injects the dye into the ducts. However, the pain medicine and sedative should keep you from feeling too much discomfort. After the procedure, you will need to stay at the hospital for 1 to 2 hours until the sedative wears off. The physician will make sure you do not have signs of complications before you leave. If any kind of treatment is done during ERCP, such as removing a gallstone, you may need to stay in the hospital overnight.

What happens after the Test is over
You will be monitored in the endoscopy area for 1-2 hours until the effects of the sedatives have worn off. Your throat may be a little sore for a day or two. You will be able to resume your diet and take your routine medication after you leave the endoscopy area, unless otherwise instructed.

Your surgeon will usually inform you of your test results on the day of the procedure. Biopsy results take several days to return, and you should make arrangements with your surgeon to get these results. The effects of sedation may make you forget what you were instructed after the procedure. Call your surgeon’s office for the results.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/endoscopic-retrograde-cholangiopancreatography.shtml
http://digestive.niddk.nih.gov/ddiseases/pubs/ercp/
http://www.alabangmedicalcenter.ph/patientscorner/ERCP.htm

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Diagnonistic Test

Endometrial Biopsy

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Introduction:An endometrial biopsy is a way for your doctor to take a small sample of the lining of the uterus (endometrium). The sample is looked at under a microscope for abnormal cells. An endometrial biopsy helps your doctor find any problems in the endometrium. It also lets your doctor check to see if your body’s hormone levels that affect the endometrium are in balance.

Doctors take biopsies of areas that look abnormal and use them to detect cancer, precancerous cells, infections, and other conditions. For some biopsies, the doctor inserts a needle into the skin and draws out a sample; in other cases, tissue is removed during a surgical procedure.

The lining of the uterus changes throughout a woman’s menstrual cycle. Early in the menstrual cycle, the lining grows thicker until a mature egg is released from an ovary (ovulation). If the egg is not fertilized by a sperm, the lining is shed during normal menstrual bleeding.

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There are several ways to do an endometrial biopsy. Your doctor may use:

*A soft, straw-like device (pipelle) to suction a small sample of lining from the uterus. This method is fast and is not very painful.

*A sharp-edged tool called a curette. Your doctor will scrape a small sample and collect it with a syringe or suction. This is called a dilation and curettage (D&C). A D&C may be done to control heavy uterine bleeding (hemorrhage) or to help find the cause of bleeding. This is done with general or regional anesthesia.

*An electronic suction device (Vabra aspiration). This method can be uncomfortable.

*A spray of liquid (jet irrigation) to wash off some of the tissue that lines the uterus. A brush may be used to remove some of the lining before the washing is done.

When a woman is having a hard time becoming pregnant, an endometrial biopsy may be done to see whether the lining of her uterus can support a pregnancy.

An endometrial biopsy may also be done to find the cause of abnormal uterine bleeding, to check for overgrowth of the lining (endometrial hyperplasia), or to check for cancer.

An endometrial biopsy is sometimes done at the same time as another test, called hysteroscopy, which allows your doctor to look through a small lighted tube at the lining of the uterus.

Why It Is Done
An endometrial biopsy is done to:

*Check for cancer. For example, an endometrial biopsy may be done to help determine the cause of some abnormal Pap test results.
*Find the cause of heavy, prolonged, or irregular uterine bleeding. It is often done to find the cause of uterine bleeding in women who have gone through menopause.

*See whether the lining of the uterus (endometrium) is going through the normal menstrual cycle changes.

How To Prepare
Tell your doctor if you:

*Are or might be pregnant. An endometrial biopsy is not done during pregnancy.

*Are taking any medicines.

*Are allergic to any medicines.

*Have had bleeding problems or take blood-thinners, such as aspirin or warfarin (Coumadin).

*Have been treated for a vaginal, cervical, or pelvic infection.

*Have any heart or lung problems.
Do not douche, use tampons, or use vaginal medicines for 24 hours before the biopsy. You will empty your bladder just before your biopsy.

If you are not bleeding heavily, you might want to take an NSAID medicine such as ibuprofen one to two hours before the test, to reduce the possibility of uterine cramps during the procedure. Ask your physician for a recommendation ahead of time.

You will need to sign a consent form that says you understand the risks of an endometrial biopsy and agree to have the test done. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results may mean. To help you understand the importance of this test, fill out the medical test information form (What is a PDF document?) .

If you are having a dilation and curettage (D&C) and will go to sleep (general anesthesia) for the test, do not eat or drink anything for 8 hours before the test. If you are taking any medicines, ask your doctor what medicines you can take the day of the test.

How It Is Done
An endometrial biopsy is usually done by a gynecologist, a family medicine physician, or a nurse practitioner who has been trained to do the test. The sample will be looked at by a pathologist. The biopsy can be done in your doctor’s office.

Your cervix may be numbed with a spray or injection of local anesthetic.

You will need to take off your clothes below the waist. You will be given a covering to drape around your waist. You will then lie on your back on an examination table with your feet raised and supported by foot rests (stirrups).

Your doctor will put an instrument with smooth, curved blades (speculum) into your vagina. The speculum gently spreads apart the vaginal walls so your doctor can see inside the vagina and the cervix. See a picture of a pelvic examination with a speculum. The cervix is washed with a special solution and may be grasped and held in place with a clamp called a tenaculum.

The tool to collect the sample is guided through the cervix into the uterus. The tool may be moved up and down to collect the sample. Most women have some cramping during the biopsy.

An endometrial biopsy takes 5 to 15 minutes.

Dilation and curettage (D&C)
A D&C is usually done in a hospital or clinic. Most women do not need to stay overnight but can go home the same day.

Your doctor will put an instrument with smooth, curved blades (speculum) into your vagina. The speculum gently spreads apart the vaginal walls so your doctor can see inside the vagina and the cervix. Your cervix will be gently spread open (dilated). Depending on the reason for the D&C, your doctor may use a tool called a hysteroscope to look inside the uterus. A small spoon-shaped instrument (curette) is then guided through the cervix and into the uterus. The top layer of the lining of the uterus is carefully scraped off and removed (along with any other tissue that looks abnormal) for biopsy.

If you have general anesthesia, you will be watched by a nurse in the recovery room until you are fully awake.

You can do most of your normal activities in a few days. Do not lift anything heavy for a few days after the test. Do not douche or have sex for one week after the test.

How It Feels
If you have not had any pain medicine, you may feel a sharp cramp as the tool is guided through your cervix. You may feel more cramping when the biopsy sample is collected. Most women find that the cramping feels like a really bad menstrual cramp.

Some women feel dizzy and sick to their stomachs. This is called a vasovagal reaction. This feeling will go away after the biopsy.

An endometrial biopsy usually causes some vaginal bleeding. You can use a pad for the bleeding or spotting.

Dilation and curettage (D&C)
If general anesthesia is used during a D&C, you will be asleep and feel nothing. After the test, you will feel sleepy for a few hours. You may be tired for a few days after the test. You may also have a mild sore throat if a tube (endotracheal tube, or ET) was placed in your throat to help you breathe during the test. Using throat lozenges and gargling with warm salt water may help relieve your sore throat.

Risks Factors:
You might have pelvic cramps (sometimes intense) during the procedure and sometimes for a day or two afterward; you may also experience a small amount of vaginal bleeding. It is extremely rare to have heavy bleeding or to develop an infection that needs treatment.There is also a small risk of disturbing a very early pregnancy. To guard against this, your doctor might order a pregnancy test before performing the biopsy.

After the test:
You may feel some soreness in your vagina for a day or two. Some vaginal bleeding or discharge is normal for up to a week after a biopsy. You can use a sanitary pad for the bleeding. Do not do strenuous exercise or heavy lifting for one day after your biopsy. Do not douche. You may have to avoid sex or using tampons for several days. Ask your doctor when you can have sex or use tampons again.

Follow any instructions your doctor gave you. Call your doctor if you have:

*Heavy vaginal bleeding (more than a normal menstrual period).

*A fever.

*Belly pain.

*Bad-smelling vaginal discharge.

Results:
Time to know the results:
An endometrial biopsy is a way for your doctor to take a small sample of the lining of the uterus (endometrium). Lab results from a biopsy may take several days to get back.


Endometrial biopsy  Normal: No abnormal cells or cancer is found. For women who have menstrual cycles, the lining of the uterus is at the right stage for the time in the menstrual cycle when the biopsy was done.

Endometrial biopsy  Abnormal:

*A noncancerous (benign) growth, called a polyp, is present.

*Overgrowth of the lining of the uterus (endometrial hyperplasia) is present.

*Cell changes that may lead to cancer are present.

For women who have menstrual cycles, the lining of the uterus is not at the right stage for the time in the menstrual cycle when the biopsy was done. More tests may be needed.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/endometrial-biopsy.shtml
http://women.webmd.com/endometrial-biopsy

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Thyroid Scan

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Introduction:-
A thyroid scan uses a radioactive tracer and a special camera to measure how much tracer the thyroid gland absorbs from the blood. A thyroid scan is done to find problems with the thyroid gland. A thyroid scan may be done to check for thyroid nodules, or it may be done with a radioactive iodine uptake test (RAIU) to check how well the thyroid gland is working.

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A thyroid scan can show the size, shape, and location of the thyroid gland. It can also find areas of the thyroid gland that are overactive or underactive. The camera takes pictures of the thyroid gland from three different angles. The radioactive tracer used in this test is either iodine or technetium.

A radioactive iodine uptake test measures the amount of radioactivity in your thyroid after you’ve been given a relatively small dose of radioactive iodine in pill form. Your thyroid gland absorbs iodine and uses it to make hormones. Therefore, the amount of radioactive iodine detected in your thyroid gland corresponds with the amount of hormone your thyroid is producing.

Another type of thyroid scan, a whole-body thyroid scan, may be done for people who have had thyroid cancer that has been treated. The whole-body scan can check to see if cancer has spread to other areas of the body.

Why It Is Done:-
A thyroid scan is done to:

*See whether thyroid nodules are present.
*Find the cause of an overactive thyroid gland (hyperthyroidism).
*See whether thyroid cancer has spread outside the thyroid gland. A whole-body thyroid scan will usually be done for this evaluation.

How To Prepare:-
For about a week before a thyroid scan, your doctor may ask you to avoid certain foods and medicines that can interfere with the results, including thyroid hormones and shellfish (which contain iodine). You might have to fast entirely for several hours beforehand if you’ll be given a radioactive iodine pill for the test.You might also need to have blood tests that check thyroid function.

The preparation for a radioactive iodine uptake test is almost the same as for a thyroid scan. However, because you are given radioactive iodine in pill form for an uptake test, you need to wait four to six hours, and possibly as long as a day, before having the scan. (This gives the radioactive iodine time to reach your thyroid.)

Tell your doctor if you:

*Take any medicines regularly. Be sure your doctor knows the names and doses of all your medicines. Your doctor will instruct you if and when you need to stop taking any of the following medicines that can change the thyroid scan test results.

*Thyroid hormones

*Antithyroid medicines

*Medicines that have iodine, such as iodized salt, kelp, cough syrups, multivitamins, or the heart medicine amiodarone (Cordarone, Pacerone)

*Are allergic to any medicines, such as iodine. But even if you are allergic to iodine, you will likely be able to have this test because the amount used in the tracer is so small that your chance of an allergic reaction is very low.

*Have ever had a serious allergic reaction (anaphylaxis) from any substance, such as the venom from a bee sting or from eating shellfish.

*Have had bleeding problems or take blood thinners, such as aspirin or warfarin (Coumadin).

*Have had any test using radioactive materials or iodine dye 4 weeks before the thyroid scan. These other tests may change the results of the thyroid scan.

*Are or might be pregnant.

*Are breast-feeding.

Before a thyroid scan, blood tests may be done to measure the amount of thyroid hormones (TSH, T3, and T4) in your blood.

To prepare for a thyroid scan:

*Do not eat for 2 hours before the test.

*Do not take any antithyroid medicine for 5 to 7 days before the test.

Your doctor may ask you to eat a low-iodine diet, especially if this test is being done to check for thyroid cancer.

Just before the test, you will remove your dentures (if you wear them) and all jewelry or metal objects from around your neck and upper body.

Before a thyroid scan, you need to sign a consent form that says you understand the risks of the thyroid scan and agree to have it done. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form .

How It Is Done
A thyroid scan is done in the nuclear medicine section of a hospital’s radiology department by a person trained in nuclear medicine (nuclear medicine technologist).

A radionuclide is either injected into a vein or given to you as a pill. Timing of the test then depends on the type of radionuclide your doctor uses, and whether you will also have an uptake test. If you are having only a thyroid scan and your doctor prefers to give a radionuclide by intravenous injection, the scan can be done within 30-60 minutes. If you are given radioactive iodine in pill form, you need to wait four to six hours, and possibly as long as a day, before having the scan. (This gives the radioactive iodine time to reach your thyroid.) If you’re having both a scan and the uptake test, you are likely to receive radioactive iodine in pill form. This allows one radionuclide to be used for both the scan and uptake test, instead of two, and eliminates the need for an injection.

After you’ve received the radionuclide and have waited the appropriate amount of time, a technician places a radioactivity detector-a camera specially designed to take pictures of radioactive objects – against your neck and takes several images. The camera itself doesn’t expose you to any radiation. This portion of the test usually takes about half an hour.

An uptake test only takes several minutes and is performed while you are sitting up. Using a device that resembles a Geiger counter, the doctor or technician places a probe several inches in front of your neck, where the thyroid gland is located, and measures the percentage of radioactivity that is retained by the thyroid gland. You return the next day for follow-up testing to obtain a second set of uptake readings, which are then compared with the first set to determine how much hormone has been formed and secreted in the interim.

If you get technetium, you may feel warm, flushed, and nauseated when it is given. Taking deep breaths to relax may relieve these feelings.

For this test, you will lie on your back with your head tipped backward and your neck extended. It is important to lie still during this test. A special camera (called a gamma scintillation camera) takes pictures of your thyroid gland from three different angles 4 to 6 hours after you took the iodine. The test takes about 10 minutes. Another scan is done again in 24 hours.

After a thyroid scan, you can do your regular activities. But you will be asked to take special precautions when you urinate. This is because your body gets rid of the radioactive tracer through your urine. This takes about 24 hours. It is important to flush the toilet and wash your hands thoroughly after each time you urinate.

How It Feels
You may find it uncomfortable to lie still with your head tipped backward.

Results:–
How long is it before the result of the test is known?
For the thyroid scan, it takes an hour or more for the pictures to be developed and additional time for a radiologist to examine them. Your doctor will probably receive a report within a day or two. The scan will show the outline, shape, and position of your thyroid so that the doctor can determine whether it is enlarged and whether there are any suspicious growths or nodules. The scan also provides a rough measure of thyroid activity, although this has to be confirmed with a radioactive iodine uptake test.

Uptake test results are available immediately, but because the initial and follow-up readings must be compared, it may take your doctor a day or two to get back to you. To obtain results, your doctor determines an uptake value, which is the net result of how much iodine is picked up by the thyroid, how much is converted to hormone since the time of administration, and how much is either leaked or secreted into the bloodstream. (The thyroid normally secretes hormone in an orderly fashion based on physical needs; leakage is less controlled and indicates that the gland is damaged.) A low reading of radioactivity suggests that your thyroid gland has retained only a small amount of iodine. This generally indicates that the thyroid gland is not producing excess thyroid hormone, but has become inflamed and is unable to properly store the hormone, which then leaks into the bloodstream. A high reading suggests that your thyroid is overactive, producing an excessive amount of thyroid hormone.

A thyroid scan uses a radioactive tracer and a special camera to make a picture of the thyroid gland. The radioactive tracer used in this test is usually iodine or technetium. A thyroid scan is done to help find problems with the thyroid gland.

Thyroid scan  Normal: A normal thyroid scan shows a small butterfly-shaped thyroid gland about 2in. long and 2in. wide with an even spread of radioactive tracer in the gland.

Thyroid scan Abnormal: An abnormal thyroid scan shows a thyroid gland that is smaller or larger than normal. It can also show areas in the thyroid gland where the activity is less than normal (cold nodules) or more than normal (hot nodules). Cold nodules may be related to thyroid cancer.

A whole-body scan will show whether iodine is in bone or other tissue (iodine uptake) after the thyroid gland has been removed for cancer. The whole-body scan can check to see if cancer has spread to other areas of the body.
Resources:
https://www.health.harvard.edu/fhg/diagnostics/thyroid-scan.shtml
http://www.webmd.com/a-to-z-guides/thyroid-scan

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Urinalysis

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Definition :
Urinalysis is the physical, chemical, and microscopic examination of urine. It involves a number of tests to detect and measure various compounds that pass through the urine.

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It is a routine examination of the urine for cells, tiny structures, bacteria, and chemicals that suggest various illnesses. A urine culture attempts to grow large numbers of bacteria from a urine sample to diagnose a bacterial urine infection.


How the Test is Performed
A urine sample is needed. Your health care provider will tell you what type of urine sample is needed. For information on how to collect a urine sample, see:

*24-hour urine collection
*Clean catch urine specimen

There are three basic steps to a complete urinalysis:

1. Physical color and appearance:

*What does the urine look like to the naked eye?
*Is it clear or cloudy?
*Is it pale or dark yellow or another color?

The urine specific gravity test reveals how concentrated or dilute the urine is.

2.Microscopic appearance:

The urine sample is examined under a microscope. This is done to look at cells, urine crystals, mucus, and other substances, and to identify any bacteria or other microorganisms that might be present.

3,Chemical appearance:

A special stick (“dipstick”) tests for various substances in the urine. The stick contains little pads of chemicals that change color when they come in contact with the substances of interest.

Click to See : Urine chemistry

How to Prepare for the Test:
For a regular urinalysis, you are asked to urinate briefly into a plastic cup. When urine is collected for a urine culture, you must provide a “clean catch” sample – one that is not contaminated by skin cells and skin bacteria. This is so the doctor can obtain a sample of urine from inside your bladder, where normally there should be no bacteria. In contrast, there are many bacteria on the skin of a penis or in a vagina. The trick (harder for a woman than a man) is to pee directly into a sterile container without having the stream of urine first touch your skin or the nonsterile tissues of the vagina.

To collect a clean catch sample, you are given a sterile plastic container and asked to wipe off the area around your urethra (where urine exits) with an antiseptic cloth. For women, it’s also helpful to hold the two labia (outer walls) of the vagina apart with one hand when you urinate, so that the stream of urine passes directly into the sterile container. Since the first flow of urine is most likely to be contaminated by bacteria from around the opening of the urethra, first urinate for a moment into the toilet and then use the cup to collect the “middle” portion of your urine stream.

Certain medicines change the color of urine, but this is not a sign of disease. Your doctor may tell you to stop taking any medicines that can affect test results.

Medicines that can change your urine color include:

*Chloroquine
*Iron supplements
*Levodopa
*Nitrofurantoin
*Phenazopyridine
*Phenothiazines
*Phenytoin
*Riboflavin
*Triamterene

Why the Test is Performed :-

A urinalysis may be done:

As part of a routine medical exam to screen for early signs of disease
If you have signs of diabetes or kidney disease, or to monitor you if you are being treated for these conditions
To check for blood in the urine
To diagnose a urinary tract infection
Additional conditions under which the test may be performed:

*Acute bilateral obstructive uropathy
*Acute nephritic syndrome
*Acute tubular necrosis
*Acute unilateral obstructive uropathy
*Alkalosis
*Alport syndrome
*Analgesic nephropathy
*Anorexia nervosa
*Atheroembolic renal disease
*Atrial myxoma
*Bladder stones
*Chronic bilateral obstructive uropathy
*Chronic glomerulonephritis
*Chronic or recurrent urinary tract infection
*Chronic renal failure
*Chronic unilateral obstructive uropathy
*Chronic urethritis
*Complicated UTI (pyelonephritis)
*Congenital nephrotic syndrome
*Cystinuria
*Delirium
*Dementia
*Dementia due to metabolic causes
*Diabetes insipidus — central
*Diabetic nephropathy/sclerosis
*Enuresis
*Epididymitis
*Failure to thrive
*Focal segmental glomerulosclerosis
*Goodpasture’s syndrome
*Heart failure
*Hemolytic-uremic syndrome (HUS)
*Henoch-Schonlein purpura
*Insulin-dependent diabetes (IDD)
*IgA nephropathy (Berger’s disease)
*Injury of the kidney and ureter
*Interstitial nephritis
*Irritable bladder
*Left-sided heart failure
*Lupus nephritis
*Malignant hypertension (arteriolar nephrosclerosis)
*Medullary cystic kidney disease
*Membranoproliferative GN I
*Membranoproliferative GN II
*Membranous nephropathy
*Myelomeningocele (children)
*Necrotizing vasculitis
*Nephrotic syndrome
*Noninsulin-dependent diabetes (NIDD)
*Orchitis
*Ovarian cancer
*Paroxysmal nocturnal hemoglobinuria (PNH)
*Polycystic kidney disease
*Post-streptococcal GN
*Prerenal azotemia
*Primary amyloid
*Prostate cancer
*Prostatitis, acute
*Prostatitis, chronic
*Prostatitis, non-bacterial
*Pyelonephritis; acute
*Rapidly progressive (crescentic) glomerulonephritis
*Reflux nephropathy
*Renal papillary necrosis
*Renal tubular acidosis; distal
*Renal tubular acidosis; proximal
*Renal vein thrombosis
*Retrograde ejaculation
*Rhabdomyolysis
*Right-sided heart failure
*Secondary systemic amyloid
*Stress incontinence
*Systemic lupus erythematosus
*Systemic sclerosis (scleroderma)
*Thrombotic thrombocytopenic purpura
*Traumatic injury of the bladder and urethra
*Ureterocele
*Urethral stricture
*Urethritis
*Wegener’s granulomatosis
*Wilms’ tumor

RESULTS:

Normal Results
Normal urine may vary in color from almost colorless to dark yellow. Some foods (like beets and blackberries) may turn the urine a red color.

Usually, glucose, ketones, protein, bilirubin, are not detectable in urine. The following are not normally found in urine:

*Hemoglobin
*Nitrites
*Red blood cells
*White blood cells
Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean
For specific results, see the individual test article:

*Bilirubin – urine
*Glucose – urine
*Protein – urine
*Red blood cells in urine test
*Urine ketones
*Urine pH
*Urine protein
*Urine specific gravity

How long is it before the result of the test is known?
Your doctor might be able to do a urinalysis in his or her office and can give you the results within 10-15 minutes. If the urine is sent to a separate laboratory, it usually takes several hours to get results, so you may not hear from your doctor until the next day. A urine culture takes 24 to 72 hours to complete, so you may not hear results for several days.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/urinalysis.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/003579.htm

http://www.hallvet.com.au/services/urinalysis.html

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Diagnonistic Test

Radionuclide Scan of the Kidneys

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Definition
A radionuclide scan of the kidneys shows a picture of your kidneys while they are at work making urine.A kidney radionuclide scan, also called a kidney scan or renal scan, is a diagnostic imaging test that involves administering a small amount of radionuclide, also called a radioactive tracer, into the body and then imaging the kidneys with a gamma camera. The images obtained can help in the diagnosis and treatment of various kidney diseases and conditions. This test can be useful to evaluate infection, blockages, injury to the kidneys, and some causes of high blood pressure.

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Precautions
A kidney scan requires the use of a radioactive material; therefore, patients who are pregnant or suspect they may be pregnant are cautioned not to have the test unless the benefits outweigh the risks. Women should inform their doctor if they are breast feeding. The doctor will recommend the woman stop breast feeding for a specified period of time, depending on the particular tracer and dose used.

Description
Kidney scans are performed either in a hospital nuclear medicine department or in an outpatient radiology or nuclear medicine facility. The patient is positioned in front of, or under, a gamma camera—a special piece of equipment that detects the radiation emitted from the body and produces an image. An intravenous injection of the radionuclide is administered. Immediately after the injection imaging begins, and, in most studies, the flow of blood to each kidney is evaluated. Serial images of the kidneys are obtained over a specified period of time, depending upon the particular radiopharmaceutical used. Kidney scans may be performed to determine the rate at which the kidneys are filtering a patient’s blood. These studies use a radiopharmaceutical called technetium DTPA (Tc99m DTPA). This radiopharmaceutical also can identify obstruction in the renal collecting system. To establish the function of the renal tubules, the radiopharmaceutical Technetium DMSA (Tc99m DMSA) is used.

A kidney scan ranges from 45 minutes to three hours in length, depending upon the goals of the test, but the test typically takes about an hour to an hour and a half. It is important to understand that kidney scans can reveal an abnormality, but they do not always identify the specific problem. They are very useful in providing information about how the various parts of the kidneys function, which, in turn, can assist in making a diagnosis.

Typically, posterior images are obtained but images are also obtained at oblique angles. If indicated, the patient may be positioned so that mobility of the kidney is demonstrated by sitting up or lying down for the images. If obstruction or renal function is being evaluated, a diuretic (drug to induce urination), such as Lasix, may be injected. If hypertension or renal artery sterosis is being evaluated, Captopril or Enalapril (ACE inhibitors) may be injected.
Preparation
No special preparation is necessary for a kidney scan. In some instances the patient may be required to drink additional liquids and to empty their bladder before the exam. If another nuclear medicine study was recently performed, the patient may have to wait for a specified period to avoid any interference from residual radioactivity in the body. The patient is instructed to remove metal items from the area to be scanned.

Let your doctor know if you could be pregnant or if you are breast-feeding a baby. The medicine used in this test would expose your baby to radiation.

What happens when the test is performed.
You have an IV (intravenous) line placed into a vein. A slightly radioactive version of a substance called sodium pertechnetate is injected through the IV. This substance helps your kidneys and urine show up on pictures.

A camera that is specially designed to detect radioactivity is placed against your back or abdomen. A number of pictures are taken over time. The camera itself does not expose you to any additional radiation, so the number of pictures is not harmful in any way. The test is usually completed within an hour.

Risk Factors:
Many people worry when they hear that the medicine used in this test is slightly radioactive. In truth, this test exposes you to a very small amount of radiation-no greater than that of routine xrays.

Moreover, Nuclear medicine procedures are very safe. Unlike some of the dyes that may be used in x-ray studies, radioactive tracers rarely cause side effects. There are no long-lasting effects of the tracers themselves, because they have no functional effects on the body’s tissues. If pharmaceuticals are injected these can temporarily raise or lower blood pressure, or cause one to urinate.

Aftercare
Patients can resume their normal daily activities immediately after the test. Most radioactive tracers are excreted through the urinary system, so drinking fluids after a kidney scan can help flush the tracer out of the body more quickly.

Results
The scan should reveal normal kidney function for the patient’s age and medical status, as well as show normal relative position, size, configuration, and location of the kidneys. Initial blood flow images should reflect that blood circulation to both kidneys is equal. Patients whose images suggest a space-occupying lesion or obstruction may require other imaging procedures, such as CT or ultrasound, to provide more information. Also, if the kidneys appear to be abnormal in size, have an unusual contour, or are unusually positioned, other imaging procedures may be required.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/radionuclide-scan-of-the-kidneys.shtml
http://www.enotes.com/nursing-encyclopedia/kidney-radionuclide-scan

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