子宫动静脉瘘吃什么药
尿液发黄甚至发红,一定是血尿吗?肉眼可见的鲜红血尿,会是癌症吗?血尿是身体拉响的警报,肾脏、膀胱或者尿道,到底哪里出了问题?
\n本期特邀杭州市中医院、杭州市肾脏病医院肾内科主任中医师俞东容、肾外科主任医师黄亚胜,通过内外科结合,为您揪出“血尿”背后的元凶。
\n01
\n观察尿液颜色
\n辨别身体情况
\n在临床上,每个人的尿液标本的颜色可能大不相同,而不同颜色的尿液在一定程度上也反映了当时自身的身体情况。
\n如果尿液颜色发黄,那可能考虑是上火,需要适当补充水分;当颜色呈现洗肉水色或者血色时,那首先需要考虑是否存在血尿。
\n不仅如此,即使肉眼下呈现黄色的尿液,在高倍镜下也有可能看到红细胞,也就是血尿。
\n所以,当怀疑是血尿时需要结合内外科进一步检查,去判断是否存在血尿及找出出血的部位。
\n02
\n血尿与假性血尿的区别
\n在医学上,尿液外观无异常,新鲜尿离心沉渣在高倍镜视野下存在3个以上的红细胞,即可定义为镜下血尿。
\n当1000mL尿液中含血量超过1mL,尿液的颜色就会呈现红色或洗肉水色,即为肉眼血尿。
\n俞主任表示,临床上因血尿来就诊的情况并不少见。
\n但部分人经过检查后,会发现其实自己只是假性血尿。
\n假性血尿的原因有很多,可能是近期进食了含红色色素的食物,如火龙果。
\n部分药物也会导致尿液在肉眼下呈现红色。
\n而像可乐、浓茶、酱油、葡萄酒颜色的尿液,不光可能是血尿,也有可能是由于运动之后出现的肌红蛋白尿。
\n所以,肉眼下呈现红色也不一定是血尿,需排除以上这些假性血尿的情况,经由尿常规检查才能判断。
\n03
\n血尿背后的原因
\n血尿是各种疾病所导致的一种现象,其本身并非是一种疾病。
\n当尿常规检查确诊为血尿后,下一步就是判断血尿的来源。
\n从尿液生成的角度去分析,出血部位可能是肾脏、膀胱等,想要找到具体部位,可以做一个尿红细胞形态的检查。
\n当检查结果中红细胞以异形红细胞为主时,就基本可以判断其为肾小球性血尿。
\n异形红细胞的形态各种各样,有环形、球形、棘形......
\n如果尿红细胞是均一性的,并且与血管内红细胞形态一致,那往往是血管原因所导致的。
\n血管内的红细胞一般呈现圆盘状,中间凹陷且为黄色。
\n俞主任表示,异形红细胞是鉴别血尿是否与肾小球肾炎有关的一个指标。
\n当红细胞通过肾小球的滤过膜时,会发生挤压,并且受到肾小管内PH值的影响,进而导致其发生了形态学的改变。
\n所以,当尿红细胞中以异形红细胞为主时,则可以说明肾小球发生了疾病。
\n这一般属于内科疾病范畴,如肾小球肾炎,或者一些全身性疾病,还有与遗传有关的家族性血尿。
\n在外科范畴上,血尿的原因从最常见到最少见可以分为:
\n感染
\n其中最常见的就是泌尿道感染,包括女性的膀胱炎、肾盂肾炎、特异性感染如肾结核。
\n感染是血尿最常见的原因,并且往往伴有尿急、尿频、尿痛的症状。
\n结石
\n泌尿道的结石在活动过程中会对泌尿道造成一定的损伤,损伤的部位可以包括输尿管、膀胱、肾脏,进而出现血尿。
\n结石和感染导致的血尿都会伴有疼痛感,但这两种情况在外科上治疗难度并不大。
\n肿瘤
\n对于无痛性血尿来说,大于50岁的患者首先需要排除膀胱肿瘤、再排除输尿管肿瘤和肾盂肿瘤。
\n这些肿瘤一般需要经过CT、磁共振、膀胱镜、输尿管镜、病理检查来进行诊断。
\n无痛性血尿没有疼痛感,但其背后的疾病相对比较严重,需要引起更多的重视。
\n其背后可能是肾小球相关疾病,也有可能是泌尿道恶性肿瘤,这些疾病诊断和治疗都比较复杂,一般需要多学科联合会诊(MDT)。
\n畸形
\n畸形包括子宫内膜异位、动静脉瘘、血管畸形(如核桃夹),这些原因都可能会导致血尿。
\n前列腺增生
\n前列腺增生后会引起局部黏膜改变,进而出现血尿。
\n特发性血尿
\n临床上大约有10%的血尿找不到具体原因,但随着时间最终会发现其与肿瘤相关。
\n所以,不明原因的血尿必须做好定期随诊与动态监测。
\n(养生大国医)
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茹聂常1912子宫动静脉扩张怎么治疗怎么治疗呢?
胥宇邰19441749744 ______ 病情分析: 根据你诉说应考虑下肢静脉曲张.是指下肢浅表静脉发生扩张、延长、弯曲成团状, 指导意见: 避免长期站或坐,应常让脚做抬高,应养成每日穿弹力袜运动腿部一小时之习惯,保持脚及腿部清洁,并避免受外伤造成皮肤破溃.勿用大热水泡脚.根治办法仍然应手术.一般医生可确诊是否静脉曲张.反开展外科医院都可做该手术.