question about blood in urine UW

[250256]

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a 65 ys male with painless bloody urine.
no other disease or symptome
TIA in the past
takes baby aspirine and hydrochlorothiazide daily
physical examniation including Bp is normal
which of the following is the most likely cause of his symptoms?

the answer is bladder cancer

My question is whether papillary necrosis should also be considered because of the history of aspirin taken. The is not lised on the choice

I think the papillary necrosis might have pain in flank so even it is lised in the choice, it should not correct. I am not sure about this.

Thank you!

 

[link2swim06]

a 65 ys male with painless bloody urine.
no other disease or symptome
TIA in the past
takes baby aspirine and hydrochlorothiazide daily
physical examniation including Bp is normal
which of the following is the most likely cause of his symptoms?

the answer is bladder cancer

My question is whether papillary necrosis should also be considered because of the history of aspirin taken. The is not lised on the choice

I think the papillary necrosis might have pain in flank so even it is lised in the choice, it should not correct. I am not sure about this.

Thank you!

Painless bloody urine is a buzz term for bladder cancer.

Also would a baby aspirin (81mg) really be enough to cause papillary necrosis?

 

[250256]

Painless bloody urine is a buzz term for bladder cancer.

Also would a baby aspirin (81mg) really be enough to cause papillary necrosis?

I don't know whether that is enough. I just read that taking NSAID would be a risk for papillary necrosis~ 🙁

 

[AndyRSC]

Papillary necrosis presentation is pyelo-like, with flank pain, fever, and hematuria/pyuria. Necrotic material (slughed-off papillae) are seen on UA. The analgesic use is usually quite extensive, and since stereotypical cases are usually painted on boards, look for someone with migraines, arthritis, etc., who has been going overboard with pain meds for a long time. Tylenol > ASA and NSAIDs, but they can all do it. Being on a ton of opioids can do it too. Certain conditions predispose to an occurence, including sickle cell, DM, chronic renal diseases, etc.

As link said, painless bloody urine in older person, especially a smoker, is a tip off for bladder cancer. These are diagnosed with cystoscopy. Another strong consideration in same population is renal cell carcinoma. These may further present with flank discomfort and/or mass, hypercalcemia, and erythrocytosis. The diagnosis is CT scan. If you are given a choice of tests for painless hematuria in older person and no further symptoms/labs, do CT + cystoscopy.

Even further considerations would be prostate cancer, which would likely have BPH symptoms, and glomerulonephritis, with attendant history/symptoms of the disease causing it. Realistically, the lesion can be anywhere from kidney to pisser.

 

[250256]

Hi, link2swim06 and AndyRSC, thank you for your help! Understood now!~~ 🙂