Ch. 30 Urinary/renal Flashcards
(108 cards)
1
Q
Abnormal bladder contraction and emptying due to neurologic conditions
A
Neurogenic bladder
2
Q
Lack of coordinated neuromuscular contraction of bladder
A
Dyssynergia
3
Q
With ______, as the bladder contracts, the sphincter closes
A
Dyssynergia
4
Q
Associated with spinal cord injuries above T6
A
Dyssyngergia
5
Q
A lesion above the micturition center in the pons caused from stroke or TBI causes what?
A
Dyssynergia; detrusor hyper-reflexia. Overactive reflex emptying when full
6
Q
A lesion below micturition center in pons, but above sacral causes what?
A
(dyssynergia) detrusor hyper-reflexia, like when lesions are above, but with vesicosphincter.
7
Q
OBS
A
Overactive bowel syndrome–hyperflexia but without VS dyssynergia. urgency with or without urge, incontinence, often frequency
8
Q
What happens when lesions affect the sacral micturition center
A
Detrusor areflexia. Underactive, atonic bladder with retention, stress, and overflow incontinence
9
Q
What are the common causes of bladder outlet obstruction, which blocks urine flow
A
- Urethral stricture- narrowing of urethral lumen (often due to scarring)
- Prostate enlargement- due to benign prostatic hyperplasia (BPH), acute prostatitis, or prostate cancer
- Pelvic organ prolapse–blockage to urine flow occurs when the bladder herniates into the lower vagina
10
Q
Urethral stricture causes what
A
Bladder outlet obstruction
11
Q
Prostate enlargement can cause what? (blocks urine flow)
A
Bladder outlet obstruction
12
Q
Blockage to ___ flow occurs when the bladder herniates into the lower vagina.
A
urine
13
Q
Treatment of Dyssynergia
A
Adrenergic blocking medications, urethral dilation, or surgical repair
14
Q
What is the most common renal tumor
A
Renal cell carcinoma
15
Q
Renal adenomas are benign or malignant?
A
Benign
16
Q
renal cell carcinoma are ___________, usually arising from tubular epithelium (cortex of kidney)
A
Adenocarcinomas
17
Q
Risk factors for renal tumors
A
Tobacco smoking, obesity, and HTN(uncontrolled)
18
Q
Early stages of renal tumors are symptomatic or asymptomatic?
A
Asymptomatic
19
Q
Dx of renal tumros?
A
Intravenous pyelogram (IVP), CT scans, etc. Nephrectomy with chemotherapy
20
Q
WHat is the most common bladder tumor
A
Transitional cell carcinoma
21
Q
What are the risk factors for transitional carcinoma and where are they found
A
Bladder; Males older than 60, smokers, chemical exposures
22
Q
What is the pathogenesis of bladder tumors
A
Genetic alteration in normal bladder epithelium
23
Q
Evaluation/Dx of bladder tumors
A
Cystoscopy, tissue biopsy
24
Q
Tx of bladder tumors
A
Intravesical chemotherapy, bladder resection or removal, and adjuvant chemotherapy
25
Inflammation of the urinary epithelium caused by bacteria
UTI
26
Other names for UTI
Acute cystitis and pyelonephritis
27
Another word for kidney infection (considered a UTI)
Pyelonephritis
28
Name for infection of bladder
acute cystitis
29
Risk factors for UTI
- Female (especially postmenopausal)
- Indwelling catheters
- Bladder disorders
30
what is urosepsis
Sepsis caused by prolonged, untreated bladder infection
31
Who is at risk for urosepsis
Elderly
32
Most common pathogen for UTI
Escherichia Coli
33
Inflammation of the bladder is called
Acute cystitis
34
Manifestations of acute cystitis
- Frequency
- Dysuria
- Urgency
- Lower abdominal and/or suprapubic pain
35
Dx of acute cystitis
Urinalysis or urine culture with sensitivity
36
Tx of acute cystitis
- Antimicrobial therapy
- Increase fluid intake
- Urinary analgesics
37
Acute pyelonephritis occurs in the upper or lower urinary tract
Upper
38
Acute infection of the ureter, renal pelvis, and interstitium is called
Acute pyelonephritis
39
What causes Acute Pyelonephritis
Vesicoureteral reflex, E. Coli, proteus, and psuedomonas. Reflex and E. Coli are in red
40
what is vesicoureteral reflex
when urine flows in wrong direction
41
Pathophysiology of pyelonephritis
Inflammation of urinary tract structures, renal edema, and possible abscess formation. Followed by tubular damage/fibrosis and necrosis of renal papillae
42
Clinical manifestations of pyelonephritis
Systemic signs of inflammation/infection including: fever, chills flank/groin pain, dysuria, and frequency (older adults have blunted symptoms. i.e confusion)
43
Chronic pyelonephritis leads to
scarring of tissue
44
Risk of chronic pyelonephritis increases in individuals with...
renal infections and some type of obstructive pathologic condition
45
Interstitial cystitis is also known as
Painful bladder syndrome
46
What are the two types of interstitial cystitis
1. Nonbacterial infectious cystitis, and noninfectious
47
List what causes nonbacterial infectious cystitis
Viruses, chlamydia, and fungi
48
List what causes noninfectious cystitis
Chemical, autoimmune, radiation, hypersensitivity
49
What is the pathogenesis of painful bladder syndrome (IC)
Uncertain...perhaps a defet in the bladder epithelium, autoimmune reaction triggering inflammation, or inflammation that caused fibrosis with hemorrhagic ulcers
50
Manifestations of interstitial cystitis (painful bladder syndrome)
- common in women 20-30 yrs
| - Bladder fullness/pressure, frequency, small urine volume, chronic pelvic pain
51
Tx of Painful bladder syndrome (IC)
- no single treatment is effective. Strategies for symptom relief include:
- oral medications such as nsaids, or bladder instillations of a variety of substances
52
What is the glomerulus
bundle of capillaries that filters plasma; where urine is made
53
What is glomerulonephritis
inflammation of the glomerulus
54
What is the most common cause of glomerulonephritis
immunologic abnormalities such as acute post-streptococcal glomerulonephritis...damage caused by immune complexes...antibodies against . the group A beta hemolytic
55
antibiotics, drugs, toxins, vasculitis, HIV, and diabetes mellitus can all be causes of _____nephritis
Glomerulonephritis
56
Type III hypersensitivity along with deposition of circulating soluble antigen-antibody complexes (immune complexes) and nonimmunes such as drugs, toxins, and ischemia, are all mechanisms of what
Glomerular injury
57
Manifestations of glomerulonephritis: the two major symptoms
Hematuria with red blood cell casts, and proteinuria exceeding 3-5 days with albumin as the major protein
58
Other more minor manifestations of glomerulonephritis
Oliguria (not enough urine) hypertension, edema
59
What are the two types of glomerulonephritis
Membranous and rapidly progressing. Membranous is an autoimmune response to renal antigen, idiopathic, or secondary to systemic diseases. Rapidly progressing: immune complexes leak into bowman space, form crescent shaped lesions
60
Chronic glomerulonephritis is an umbrella for several glomerular diseases, it is progressive, and leads to what?
Chronic renal failure ):
61
Which type of glomerulonephritis is associated with crescent shaped lesions
Rapidly progressing
62
Antiglomerular basement membrane disease (goodpasture syndrome) is associated with which type of glomerulonephritis
Rapidly progressing
63
Which type of glomerulonephritis is associated with an autoimmune response to a renal antigen, is idiopathic, or secondary to a systemic disease
Membranous nephropathy
64
Nephrotic syndrome: _______: degenerative disease of the tubules (non-inflammatory)
Nephrosis
65
Nephrotic goes with ______ and Nephritic goes with ______
Nephrotic=nephrosis
| Nephritic=nephritis
66
Nephrosis is the degenerative disease of tubules and is caused by ____ ____
glomerular injury
67
Is nephrosis non-inflammatory?
Yes
68
Inflammation of the kidneys: _______
nephritis
69
Nephritis is the inflammation of the kidneys. It is caused by increased permeability of the _____ ____
glomerular membrane
70
Nephrotic is an ______ to the glomerular basement membrane and podocytes, whereas nephritic is an ______ injury to the glomerulus
Nephrotic is an injury, and nephritic is an immune injury
71
Clinical manifestations of nephrotic syndrome?
Massive proteinuria: excretion of 3.5g or more of protein in urine per day. And edema
72
Clinical manifestations of nephritic syndrome?
Microscopic hematuria, and mild, mild, mild proteinuria
73
Tx of nephrotic syndrome?
Restrictions on protein
74
Tx of nephritic syndrome?
High-dose corticosteroids
75
Pathophysiology of acute kidney injury
Ischemic injury due to decreased renal blood flow. Hypovolemia. Sepsis induced injury
76
Most common cause of acute KI?
Prerenal. Due to decreased RBF, and glomerular filtration rate decreases as well
77
What is the most common cause of intrarenal AKI?
Acute tubular necrosis (ATN). Post-ischemic--inflammatory response with necrosis along any part of nephron
78
_______ AKI occurs with urinary tract obstructions that affect the kidneys bilaterally
Postrenal
79
What are the three phases of AKI
Initiation, maintenance(oliguric), and recovery (polyuric)
80
Which AKI phase is this:
| -Kidney injury is evolving, and prevention of injury is possible
Initiation phase
81
Which AKI phase is this:
-Established kidney injury and dysfunction. Urine output is lowest during this phase (hence oliguric),and serum, creatine, and blood urea nitrogen both increase
Maintenance (oliguric)
82
Which AKI phase is this:
| -Injury repaired and normal renal function reestablished. Diuresis common. Decline in serum creatine and urea.
Recovery (polyuric)
83
Prevention of AKI is kinda important, not a big deal, or paramount
paramount
84
Tx of AKI
Correct fluid and electrolyte disturbances
85
Progressive loss of renal function that affects nearly all organ systems is
Chronic Kidney Disease
86
What is CKD associated with
HTN, diabetes, intrinsic kidney disease
87
What is the initial adaptation to the loss of nephron mass
Hypertrophy and hyperfunction.
88
Is the initial adaptation of CKD enough to compensate the loss of nephron mass?
No. Compensatory capacity fails.
89
Clinical manifestations of CKD if damage is primarily vascular or glomerular
Proteinuria, hematuria, nephrotic syndrome, and uremia
90
Clinical manifestations of CKD if damage is primarily to tubules
-Renal tubular acidosis, salt wasting, and difficulty regulating urine concentration
91
What happens as glomerular filtration rate declines?
Plasma creatine level increases. Plasma urea level also increases. However, the level of urea in the plasma is a less sensitive indicator of GFR
92
Is an increased level of urea in the plasma a strong enough indicator of GFR?
No.
93
Explain the sodium and water balance due to CKD
Sodium excretion increases, with obligatory (bc water follows salt) water excretion leading to sodium deficit and volume loss
94
Explain the potassium balance due to CKD
Tubular secretion increases early (hypokalemia, so the potassium in blood decreases) However, once oliguria sets in, potassium is retained
95
Explain the acid-base balance due to CKD
Metabolic acidosis occurs when glomerular filtration rate declines to 30-40%
96
Explain the calcium and phosphate balance due to CKD
Decreased renal synthesis of 1,25-(OH)v2, Vitamin D3, and hypocalcemia (due to decrease calcium in gut). The parathyroid released pthormone to compensate
97
CKD causes an increased risk of _____
Fractures
98
Altered protein is another metabolic disruption due to CKD. Dyslipidemia. T or F
True (dyslipidemia: increased amount of carbs and fat in blood)
99
Risk factors of the CV system when pt is diagnosed with CKD
HTN, dyslipidemia, risk for heart failure, and pericarditis
100
Pulmonary risk for patients with CKD
Pulmonary edema, compensation for metabolic acidosis (kussmauls respirations=deep in an attempt to release excess CO2)
101
Hematologic issues with CKD?
Anemia (decreased EPO)
102
Immune issues with CKD?
Suppression of phagocytosis, decreased antibody production, decreased T-cell function
103
Neuro issues with CKD?
Elevated nitrogenous wastes
104
GI issues with CKD
Uremic gastroenteritis, anorexia
105
Endocrine and reproductive issues with CKD
Insulin resistance: big one. others: decreased sex hormone, hypothyroidism
106
Skin issues with CKD
Uremic frost. d/t deposition of nitrogenous wastes = itching
107
Dx of CKD
Serum creatinine, BUN, GFR. CT scan
108
Tx of CKD
Dialysis :( which is renal replacement therapy. Treatment is supportive, and prevention is important.
