GROUP 1- Sweat and Urine

CASE 1
A 55-year old obese housewife complains of perineal itching and soreness which
prompted her OB-Gyne. Upon pelvic examination, Dr. Smith noted the presence of
white vaginal discharge which she promptly collected and sent to the lab for
culture and sensitivity. To facilitate her diagnosis, she also instructed her patient
to collect “clean-catch” urine for culture and routine urinalysis.

Parameter Result Confirmatory Test

Color Yellow NA
Clarity Cloudy NA
Odor NA NA
Glucose 500 Clinitest
Bilirubin Negative Ictotest
Sp. Gravity 1.105 Refractometry
Blood Negative Benzidine Test
Ketone Negative Acetest
pH 5.0 No confirmatory
Protein Negative Sulfosalicylic acid
Urobilinogen Normal Ehrlich test
Nitrite Negative Colorimetric test
LE Positive
RBCs 0 to 2 phase microscopy for
dysmorphic cells
WBC 10 to 20; clumps phase microscopy for
dysmorphic cells
Casts 0 to 10 hyaline phase microscopy;
staining for cellular and
other inclusion casts
Bacteria Negative gram stain on wet mount;
cytocentrifugation; urine
culture
Crystals Few urates acid/base or heat
solubility; polarizing
microscope; chemical
tests for amino acids or
drugs (e.g. diazo for
sulfonamide)
Epithelial Cells Few Squamous Epithelial Vaginal Swab for clue
cells

1. Identify abnormal findings?

 Cloudy urine can be caused by pus (white blood cells), and (red blood
cells).

The cloudy urine may also due to the presence of the amorphous salts
which is non-pathologic.

 Glucose
The presence of glucose in the urine is influence by blood glucose
level, a condition of the patient (being an obese person) could be a
factor. In obesity, sugar levels tend to spike to unhealthy high level
causing an increase in presence of the glucose in the urine. Another
influencing factor is old age.

 Leukocyte Esterase (LE) is a sign of inflammation and presence is

influence by vaginal secretions but provides an indirect evidence for
the presence of bacteria.
  White Blood Cells an increased in urinary WBCs is called pyuria and
indicates the presence of infection or inflammation in the genitourinary
system.

 Casts (hyaline) greater amount of this indicates an abnormal amount of

protein in urine (proteinuria).

2. Identify discrepancies

 In the laboratory findings the patient has a positive LE wherein it has a

negative presence of bacteria.
 There is also a greater number of hyaline casts which is associated with
proteinuria.

3. Identify correlations

 A pH of 5.0 will correlate to the presence of urates(crystal) in the urine.

Although they may seen in acid urine, their formation is favored in neutral
to alkaline urine.

 Bacteria free urine does not contain any nitrite so test result in nitrite
correlates with the negative presence of bacteria.

4. Which is the most likely cause of the patient’s vaginitis?

Atrophic vaginitis typically caused by a decrease in estrogen. Estrogen
levels normally drop after menopause. Symptoms are itching, soreness and slight
vaginal discharge.

5. Which two microscopic findings suggest that the urine tested is not from a
midstream “clean-catch” specimen?
 Squamous epithelial cells and bacteria are common in lower numbers in
voided specimens and generally represent contamination from the genital
tract.

6. Is the patient showing signs of renal damage or dysfunction?

 No. Based on the result findings, the urine chemical examination fall under
a normal level except for a high glucose level due to obesity.

7. Explain the physiologic mechanism most likely responsible for the presence of
glucose in the patient’s urine.
 Glucose is a prime commodity of the body. It is the source of energy for all
cells. This is why glucose is never present in the urine. Glucose that
passes through the filters of the kidney (glomeruli) and bound to be passed
out with urine are reabsorbed by the kidney tubules and returned to the
blood. This reabsorption of glucose keeps this valuable substance out of
the urine.
 The obesity of the patiet greatly affects the presence of glucose in the
urine.

8. What diagnosis best accounts for the glucosuria observed in this specimen?
The result findings in the specimen has an increased level of glucose this
implies that the patient is acquiring glucosuria.
CASE 2

Dr. Art Lambino, examined the four-month-old infant that had been admitted to the
regional hospital earlier in the day. The baby's parents, Alyssa and Jake Keppler,
had brought young Allan to the emergency room becau se he had been suffering
from a chronic cough and diarrhea for almost a week. In addition, they said that
Allan sometimes would "wheeze" a lot more than they thought was normal for a
child with a cold. Their pediatrician had told them that Allan had a cold and would
be better in a few days.

Upon arriving at the emergency room, the attending pediatrician detected a

possible ear infection and noted that salt crystals were present on Allan's skin.
Chest auscultation revealed the presence of bronchi in the right upper lobe (RUL)
of the lung. The attending pediatrician had Allan admitted immediately and called
Dr. Lambino, a pediatric pulmonologist. After Dr. Lambino completed his
examination and concluded that Allan has cystic fibrosis.

1. What tests and results could have obtained that lead Dr. Lambino to this
diagnosis?

 Sweat test. This test is necessary to confirm a diagnosis of cystic fibrosis. A

sweat-producing chemical is applied to a small area of skin, which is then
stimulated with a very weak and painless electric current. The collected sweat
is then tested to see if it's saltier than most people's sweat

Result: 60 mEq/L or greater, cystic fibrosis is present

 Fecal fat test. The fecal fat test measures the amount of fat in the stool, and the
percentage of dietary fat that is not taken in by the body.

Normal Result: Less than 7 grams of fat per 24 hours

Result: Decreased fat absorption

 Immunoreactive trypsinogen (IRT) test is a standard newborn screening test

for CF. A high level of IRT suggests possible CF and requires further testing

2. What do scientists currently believe is the cause of CF? In other words, how is
the faulty gene inherited and what direct effect does that have on the affected
cells?

 Cystic fibrosis is caused by mutation in the CFTR gene (cystic fibrosis

transmembrane conductance regulator) that code for CFTR protein.

 The inherited CF gene directs the body's epithelial cells to produce a

defective form of a protein called CFTR (or cystic fibrosis transmembrane
conductance regulator) found in cells that line the lungs, digestive tract,
sweat glands, and genitourinary system.

3. Draw a flow chart/concept map that illustrates the mechanism whereby the
faulty CF gene causes the production of thick mucus with less water in it than
normal.

Mutation in the CFTR gene

 ↓

Production of defective CFTR protein

defective CFTR protein in cell membrane or no protein at all

defective CFTR protein in cell membrane or no protein at all

Impaired ion transport across the cells

Cells secrete less chloride

leads to more reabsorption of sodium and water into the cells

↓
decreased hydration of mucus present outside the cells as more water is absorbed into
the cells
↓

thick viscous mucus.

4. Why does Alvin have salt crystals forming on his skin? Explain the mechanism
for this.
The cause of salt crystals on Alvin skin was cause by the extensive
sweating on his skin.

5. What is the accepted treatment for children with cystic fibrosis? Make sure to
list at least three and explain why they work (i.e., what is the purpose of each
individual treatment).

 Nutritional Therapy (a high-calorie, high-fat diet with vitamin supplements).

Kids with CF can also take oral doses of pancreatic enzymes to help them
digest food better. They may also occasionally need oral or inhaled
antibiotics to treat lung infections and mucolytic medication (a mucus-
thinning drug) to keep mucus fluid and flowing.

 Chest physical therapy (CPT) is the term for a group of treatments

designed to improve respiratory efficiency, promote expansion of the
lungs, strengthen respiratory muscles, and eliminate secretions from the
respiratory system. Chest physical therapy can be used with newborns,
infants, children, and adults. People who benefit from chest physical
therapy exhibit a wide range of problems that make it difficult to clear
secretions from their lungs.

 Medications used to help breathing are often aerosolized (misted) and can
be inhaled. These medicines include bronchodilators (which widen the
breathing tubes), mucolytics (which thin the mucus), and decongestants
(which reduce swelling of the membranes of the breathing tubes).

6. List and explain the mechanism of at least two experimental treatments that are
currently being tried to help patients with cystic fibrosis.

 Protein Repair therapy. Another new therapy, it aims at repairing the

defective CFTR protein. This therapy involves taking medicines that help
 the defective protein work more normally to allow a small amount of salt
and water to move out of cells.

 Gene transfer/Gene therapy is the insertion of genes into an individual's

cells and tissues to treat a disease, and hereditary diseases in which a
defective mutant allele is replaced with a functional one.
Atrophic vaginitis

Atrophic vaginitis is an inflammation of the vagina due to thinning and

shrinking tissues and a decrease in lubrication.

Causes

Atrophic vaginitis is typically caused by a decrease in estrogen. Estrogen levels

normally drop after menopause. The disorder may occur in younger women who
have had surgery to remove their ovaries. Some women develop the condition
immediately after childbirth or while breastfeeding, since estrogen levels are
lower at these times.

Symptoms

 Burning on urination
 Light bleeding after intercourse
 Painful sexual intercourse
 Slight vaginal discharge
 Vaginal soreness -- itching or burning sensation

Exams and Tests

A pelvic examination reveals thin, pale vaginal walls. A wet prep test of vaginal
discharge may be done to rule out other causes for the condition. Hormonal
studies may be done to determine if you are in menopause.

Treatment

 Estrogen replacement therapy may be recommended. Estrogen may be

given as a cream, tablet, or ring placed into the vagina, as a skin patch, or
in a pill that you take by mouth.
 Women may want to discuss the risks and benefits of estrogen
replacement therapy with their health care provider.

 A water-soluble vaginal lubricant may help relieve pain during intercourse.

Cystic fibrosis

Cystic fibrosis is a life-threatening disorder that causes severe lung

damage and nutritional deficiencies.

An inherited condition, cystic fibrosis affects the cells that produce mucus,
sweat and digestive juices. Normally, these secretions are thin and slippery, but in
cystic fibrosis, a defective gene causes the secretions to become thick and sticky.
Instead of acting as a lubricant, the secretions plug up tubes, ducts and
passageways, especially in the pancreas and lungs.

Tests and diagnosis

Laboratory tests

 Newborn screening test. Within the past decade, most states have begun to
routinely screen newborns for cystic fibrosis. This test checks a blood
sample for a particular component that is commonly elevated in babies
who have cystic fibrosis. Other tests are needed to confirm the diagnosis.
  Sweat test. This test is necessary to confirm a diagnosis of cystic fibrosis.
A sweat-producing chemical is applied to a small area of skin, which is
then stimulated with a very weak and painless electric current. The
collected sweat is then tested to see if it's saltier than most people's sweat.

 Genetic testing. If the sweat test results aren't clear-cut, DNA samples from
blood or saliva can be checked for specific mutations on the gene
responsible for cystic fibrosis.

 Sputum tests. If it appears that you have a lung infection, your doctor may
ask you to cough up a sample of the mucus (sputum) so it can be tested to
see what types of germs are in it. Your doctor can then choose an
antibiotic that works especially well for that specific variety of germ.

 Organ function tests. During the course of cystic fibrosis treatment, your
doctor may order blood tests that help measure the health of your
pancreas and liver.

Imaging tests

Damage to your lungs or intestines can be monitored with:

 X-rays. This painless test can reveal overinflation of the lungs and clogged
bronchial tubes or sinuses.

 Computerized tomography (CT). CT scans combine X-ray views taken from

many different directions to produce more detailed images of internal
structures.

 Magnetic resonance imaging (MRI). MRI machines use radio waves and a
strong magnetic field to produce very detailed images of internal organs.

Lung function tests

These tests measure:
 The size of your lungs
 How much air you can breathe in and out
 How fast you can breathe in and out
 How well your lungs deliver oxygen to your blood

Confirmatory Test

 The dipstick test for blood is based on the peroxidase-like activity of

hemoglobin. Red cells are lysed on contact with the strip, allowing free
hemoglobin to catalyze the liberation of oxygen from organic peroxide.
Tetramethylbenzidine is oxidized, producing a color change from orange to
green-blue. If intact red cells do not lyse, they may produce speckles on
the pad. The sensitivity of dipsticks for hemoglobin is 0.015 to 0.062 mg/dL.
This concentration corresponds to 5 to 21 RBCs/uL or 1 to 4 RBCs/hpf of
concentrated urine sediment.

 Clinitest is a reagent tablet that is based on the classic Benedict’s copper

reduction reaction, combining reactive ingredients with sodium hydroxide
to generate heat 2. Clinitest is used to detect the presence of reducing
substances. The method tests for the presence of reducing substances in
urine by comparing the color that is produced to the chart provided with
the Clinitest tablets. The color of the solution can range from blue
(negative) to orange (2% or more of reducing substance present).

 Ictotest uses the same chemical reaction as the bilirubin pad on the multi-
reagent dipstick, but is presented in a tablet format. The main advantage is
that observation of the true color reaction is less affected by the inherent
color of the urine itself. It is, therefore, useful in confirming or refuting
 apparently positive reactions on the dipstick in cases where the urine
sample is deeply colored.

 Refractometry is a technique that measures how light is refracted when it

passes through a given substance.

 Sulfosalicylic acid test a test for measuring protein in urine, in which

sulfosalicylic acid is added to urine; turbidity of precipitation is
approximately proportional to protein concentration.

 Acetest The Acetest is performed whenever a positive result is obtained for

ketones on the dipstick analysis. Ketones (primarily acetoacetate) are
detected by their reaction with sodium nitroprusside to form a purple
complex.

 Ehrlich test used to examine urine for the presence of urobilinogen; based
on the use of Ehrlich's diazo reagent, a sodium p-diazobenzenesulfonate
solution.

Reference:

http://kidshealth.org/parent/medical/lungs/cf.html#
http://kidshealth.org/parent/medical/lungs/cf.html#
http://www.merck.com/mmhe/sec11/ch142/ch142c.html
http://www.healthypinoy.com/health/articles/diabetes/glucosuria.html
http://www.irisdiagnostics.com/education/reference/clinsig.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/003588.htm
http://www.enotes.com/nursing-encyclopedia/chest-physical-therapy
http://www.healthnewsflash.com/conditions/cystic_fibrosis.php
http://emedicine.medscape.com/article/1001602-followup
http://www.clinlabnavigator.com/Tests/Urinalysis.html
http://diaglab.vet.cornell.edu/clinpath/modules/ua-rout/ACETEST.htm
http://www.mayoclinic.com/health/cystic-fibrosis/DS00287
 Angeles University Foundation
Angeles City

Vaginitis

And

Cystic Fibrosis

Submitted by:

GROUP 1
BSMT 3

DIMLA, Mary Kimberly

PARTOLAN, Mark Jsdrian
SALINAS, March Tracy
TORRES, Kristensen

Submitted to:

Ms. Crizelda D. Liwanag

Mrs. Eloisa Q. Singian
Sample Questions

a. Sweat Test
b. Ictotest
c. Cystic Fibrosis
d. Gene Therapy
e. Atrophic Vaginitis
f. Erhlich Test
g. Fecal Fat Test
h. Midstream Clean Catch
i. CPT
j. Leukocyte Esterase
k. NOTA

_______1.It is the confirmatory test for bilirubin.

_______2.It is the confirmatory test for urobilinogen

_______3.This test is necessary to confirm a diagnosis of cystic fibrosis.

_______4.It is caused by mutation in the CFTR gene (cystic fibrosis

transmembrane conductance regulator) that code for CFTR protein.

_______5. It is an inflammation of the vagina due to thinning and shrinking tissues

and a decrease in lubrication.

_______6.

_______7.

_______8.

_______9.

_______10.

Answers:
1. B
2. F
3. A
4. C
5. E