CLINICAL VARIETIES 283 



(4) Peritoneum causing chylous ascites. 



These four conditions will now be dealt with scrialini. 



(i) Chyluria and Lyviphuria. 



The dilated lymphatic vessels of the urinary tract rupture owing to 

 obstruction in or below the thoracic ducts and may discharge : — 



Chyle, when the condition is called chyluria. 



Chyle plus blood, hence ha^mato-chyluria. 



Lymph, hence lymphuria. 



Lymph plus blood, hence luenialu-l\ inphuria. 



The only difference between lymph and chyle is that the latter, 

 which is derived from the lacteals, contains 65 per cent, of fat, while 

 lymph contains about 35 per cent, of fat. 



SYMPTOMATOLOGY. 



The onset is usually abrupt, with \'ague jjains in the perineum, 

 thighs and back, rarely fever; more often the passage of milky or 

 bloody urine is the first sign. 



(A) The urine 7nay pass out without effort. 



The urine generally clears, then milky or bloody urine occurs 

 intermittently for years, less frecjuently it is continuous, and 

 may last days, months, or even years. Exertion or emotion 

 may increase the symptoms or precipitate another attack. 



(B) The urine may clot into a semi-transparent, gelatinous, pinky 



mass in the bladder, causing severe pain and strangury. 

 There may be considerable pain in passing small clots, efforts 



lasting some hours. 

 On standing the urine separates into three layers : — 



(i) A creamy upper layer of fat. 



(2) A whitish fluid with a floating coagulum. 



(3) A reddish sediment. 



This sediment contains fat and oil globules, fatty granular 

 matter, a coagulum of fibrin entangling microfilaria, free 

 microfilaria, white corpuscles, especially Ivmph cells, red 

 cells, and calcium oxalate crystals. 



The specific gravity is 1015 to 1020. 



The reaction is acid. 



To estimate the fat, shake with ether, separate, evaporate the 

 etheF, and weigh the fat. This latter is from o*6 to 2>'3 P^r 

 cent. 



Albumin is present, o'6 to o'9 per cent, in the resultant urine. 



If the fat is not in excess, it is lymphuria or hsemato-lymphuria 

 if blood is present. 



The amount of fat and blood may vary in the same patient. 



