Ch. 39 Flashcards
(49 cards)
a blockage that inhibits the flow of urine through its normal path (the urinary tract), including the kidneys, ureters, bladder, and urethra.
Urinary Tract Obstruction (UTO)
- Hydroureter: Dilation of the ureters
- Hydronephrosis: Dilation of the renal pelvis and calyces
- Ureterohydronephrosis: Dilation of both the ureters and the renal pelvis and calyces
- Tubulointerstitial fibrosis: Deposition of excessive amounts of extracellular matrix by activated fibroblasts.
Kidney stones
Upper UTO complications
- Neurogenic bladder
* Overactive Bladder Syndrome •Underactive Bladder Syndrome •Anatomic Obstructions to Urine Flow
Lower UTO
- Renal Tumors
* Bladder Tumors
Tumors
Partially counteracts the negative consequences of unilateral obstruction.
➢ Compensatory growth of glomeruli
Compensatory hypertrophy and hyperfunction
➢ Due to relief of the obstruction.
➢≈ 10 L/ Day!
➢ May→ fluid and electrolyte imbalance
Postobstructive diuresis
Are also called renal calculi or urolithiasis.
Masses of crystals, protein, or mineral salts form
in the UT and may→ obstruction.
Kidney Stones
Risk factors
➢ Male > female
➢ Most develop < 50 years of age
➢ Inadequate fluid intake: Most prevalent
➢ Geographic location: Temperature, humidity, rain fall
➢ Genetic
➢ Dietary patterns
➢ Infection
➢ Insulin resistance, T2DM, HTN, atherosclerosis, obesity,..
Risk factors of kidney stones
a. Calcium oxalate and calcium phosphate: 70-80%
• idiopathic calcium oxalate urolithiasis
b. Struvite (Mg ammonium phosphate): 1-5%, females
c. Uric acid: 5-10%, Gout
Mineral stones
Supersaturation
Precipitation
Crystallization or agglomeration (aggregation)
Presence or absence of stone inhibitors
Kidney stone Pathophysiology
➢ Renal colic ➢ Hematuria (gross or microscopic) ➢ Urgency ➢ Frequency ➢ Urge incontinence ➢ Nausea and vomiting
Clinical manifestations of kidney stones
➢ Bladder dysfunction caused by neurologic disorders→
problems with urine storage or voiding
Neurogenic bladder
Overactive or hyperreflexive bladder.
Dyssynergia
Uninhibited or reflex bladder:
Urine leakage and incontinence.
Detrusor hyperreflexia
Both the bladder and the sphincter are contracting at the same time → functional obstruction of the bladder outlet
↓bladder relaxation→ ↑pressure→ overactive bladder- below
Detrusor hyperreflexia + vesicosphincter (detrusor sphincter)
dyssynergia
Underactive, hypotonic, or atonic bladder→ stress and overflow incontinence.
Detrusor areflexia
- Frequent daytime voiding: > every 2 hours while awake
- Nocturia: Night-time voiding
- Urgency: Often combined with hesitancy
- Dysuria
- Stream: poor force; intermittency
- Feelings of incomplete bladder emptying, despite micturition
Clinical manifestations of a lower UTO
A problem with bladder function that causes the sudden need to urinate.
Overactive bladder syndrome
↓ strength and/or duration of bladder contraction→ prolonged or incomplete emptying within a notmal time span.
Underactive Bladder Syndrome
➢ Spinal cord injury
➢ Stroke
➢ Multiple sclerosis
➢ Parkinson disease ➢ Diabetic neuropathy ➢ Aging
Causes of underactive bladder syndrome
➢ Narrowing of lumen that occurs with infection, injury, or
surgical manipulation
Urethral stricture
➢ Caused by acute inflammation, BPH, or prostate cancer
Prostate enlargement
➢ Pessary: Rubber or silicone device designed to compensate
for vaginal wall prolapse
Pelvic organ prolapse
➢ 4th most common in white men > 55 yrs
➢ Transitional cell carcinoma is the most common
Bladder tumors
