Chyluria

Introduction The saponified liquid of the chyle from the intestinal tract can not be drained to the blood according to the normal lymphatics, but flows back into the lymphatics of the urinary system, causing the intra-lymphatic pressure to increase, varicose, and rupture. The chyle overflows into the urine, making the urine color milky white, clinically called chyluria. Due to the difference in the amount of chyle containing liquid, the urine color can be milky white thick cheese or slightly turbid; if the milk contains more pink, it is clinically called chylorrhea; if the infection is called chyle pyuria. The chyluria is divided into three layers after standing in vitro, the upper layer of fat; the middle layer is milky white, with small particle clots suspended therein; the lower layer is red or pink, containing red blood cells or pus cells. The chyle and diethyl ether are mixed thoroughly, and the urine is turned into clarified as true chyluria. Otherwise, it is called pseudo-milk urinary urine. It is found in the urine containing too much salt, or fat droplets or a large number of pus balls.

Cause

First, the cause classification

It can be roughly divided into two major categories: parasitic and non-parasitic. The former is mostly caused by the filariasis; a small number can be due to abdominal tuberculosis, tumor, chest, abdominal trauma or major surgery. Primary lymphatic system diseases, mainly seen in congenital malformations, are rare in clinical practice. Pregnancy, pyelonephritis, and nephrotic syndrome are also seen.

Second, the mechanism

Chyluria is caused by chylothorax or thoracic duct obstruction due to various reasons, distal lymphatic hypertension, varicose veins, rupture and urinary tract traffic. The varicose lymphatic vessels can pierce the human renal pelvis, ureter and bladder. There are two major types of chyluria, one is due to extensive abdominal lymphatic obstruction, and the chyle that is normally absorbed from the intestine passes through the intestinal lymphatics to the anterior lymph nodes of the abdomen to the chyle pool. When the anterior abdominal aortic lymph node or the intestinal trunk is blocked, the dam chyle can not enter the chyle and pass through the pathway between the anterior abdominal aortic lymph node and the para-aortic lymph node, and the lymphatic trunk can flow to the chyle pool. If the lymphatic trunk of the waist is also blocked, the chyle solution will flow back to the urinary lymphatic vessels, causing the internal pressure to increase, varicose, and eventually rupture to produce chyluria. Another type of thoracic duct obstruction, when the lower end of the thoracic duct is blocked, the internal pressure of the chyle pool is increased, and the chyle solution is regurgitated to the urinary lymphatics via the lumbar lymph node, so that the internal pressure is continuously increased, eventually causing rupture to form chyluria. The location of the rupture of the lymphatic tract in the urinary system is most common in the renal pelvis, followed by the ureter, sometimes in the bladder and in the posterior urethra.

an examination

Related inspection

Urine routine urine specific gravity urinary alanine urinary alanine aminopeptidase urinary oxalate

Filaria caused by filaria, pay attention to the investigation of epidemic areas, find microfilaments in blood and urine, and find microfilaria in blood at night; those who cause tuberculosis, pay attention to find tuberculosis, find acid-fast bacilli in chest and ascites Can be diagnosed. Primary in the abdominal cavity, retroperitoneal. Malignant tumors in the mediastinum and other parts, the disease is heavy, progress is fast, and the tumor cells can be diagnosed by the serosal cavity. At the time of examination, attention should be paid to superficial lymphadenopathy, liver and splenomegaly; filariasis caused by long disease, lower limbs like leather legs, and even mossy.

The laboratory examination firstly identified the true chyluria and urinary pseudo-milk urine. The Sudan dish staining method: take 0.5ml of urine, add 1 drop of Sudan III solution and mix it under the microscope. If the urine fat is dyed red, it is positive. For the real milk and urine. Ether extraction method: take 10ml of urine, add 2~3ml of ether, add stopper, repeatedly shake and shake, and then stand still for a while. After the layer of ether is layered, the urine becomes clear, then the ether layer is taken out, and the evaporating dish is placed. Evaporation dried, oily residue appeared, and the Sudanese dish was stained red to be positive.

Device examination, X-ray, CT, MRI examinations have great diagnostic value for tuberculosis and tumors.

Differential diagnosis

It should be distinguished from the following:

1. White urine: White urine means that the urine discharged from the human body appears white.

2. White mucus-like urine: When white mucus-like urine is often discharged, it may be a symptom of prostatitis, non-gonococcal urethritis or gonorrhea. It should be treated as soon as possible, otherwise it will be transmitted to the spouse, causing inflammation of the reproductive organs. .

3. Milky white urine: milky white urine, also known as chyluria, is milky white like milk. This is due to the inability to absorb sputum from the intestines, causing the chyle to flow back into the urine. Causing urinary fistula has congenital factors, such as congenital lymphatic valve dysfunction, there are secondary factors, such as common filariasis and urinary system of purulent infection.

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