Diseases Focus Flashcards
(25 cards)
Disease Focus
Causes of urinary system disorders include congenital anomalies, infectious diseases, trauma, and conditions that secondarily involve the urinary structures. Asymptomatic urinary diseases are commonly found when a routine urinalysis identifies abnormalities. When symptoms are present, they usually include changes in urination pattern, changes in output, or pain during urination (dysuria). Endoscopic tests, radiological evaluations, and laboratory tests that evaluate renal function typically identify disorders of the urinary system.
For diagnosis, treatment, and management of urinary disorders, the medical services of a specialist may be warranted. Urology is the branch of medicine concerned with urinary disorders and diseases of the male reproductive system. The physician who specializes in diagnosis and treatment of genitourinary disorders is known as a urologist. However, the branch of medicine concerned specifically with diseases of the kidney, electrolyte imbalance, renal transplantation, and dialysis therapy is a nephrology. Physicians who practice in this specialty are called nephrologists.
Glomerulonephritis
Glomerulonephritis is an inflammation of the glomerular membrane in the nephrons, causing it to become “leaky” (permeable). Red blood cells and protein, which normally remain in blood, pass through the inflamed glomerular membrane and enter the tubule. Urinalysis reveals protein in the urine (proteinuria), blood in the urine (hematuria), and bacteria in the urine (bacteruria), indicators of infection or inflammation. Other signs and symptoms include high blood pressure (hypertension), edema, and impaired renal function.
Causes of glomerulonephritis include bacterial endocarditis, viral infections, and autoimmune diseases. Another cause of glomerular inflammation is a reaction to the toxins produced by pathogenic bacteria, especially streptococci that have recently infected another part of the body, usually “strep throat.” Most patients with acute glomerulonephritis associated with a streptococcal infection recover with no lasting kidney damage. Because most forms of glomerulonephritis are a consequence of another disorder, treatment of the underlying cause is important in the management of this disease.
Nephrolithiasis
Stones (calculi) may form in any part of the urinary tract (urolithiasis), but most arise in the kidney (nephrolithiasis). (See Fig. 11-3, page 368.) They commonly form when dissolved urine salts begin to solidify. As the stones become larger, they commonly lodge in the ureters (ureterolithiasis), causing an intense, throbbing pain (colic). Because urine has difficulty passing into the bladder, it flows backward (refluxes) into the renal pelvis, causing it to dilate.
Treatment includes pulverizing the stone using concentrated ultrasound shock waves, generated from a machine outside the body (extracorporeal shock-wave lithotripsy [ESWL]). (See Fig. 11-4.) For patients who have contraindication to ESWL, an alternative minimally invasive surgery is available. In this procedure, the surgeon makes a small incision through the skin to create an opening into the kidney to remove the stone (percutaneous nephrolithotomy [PCNL]). If the stone is large, the surgeon breaks it into smaller fragments using an ultrasonic or electrohydraulic probe (lithotriptor) to remove the smaller fragments more easily. The surgeon may also insert a nephrostomy tube to drain urine from the kidney during the healing process.
Acute Tubular Necrosis
In acute tubular necrosis (ATN), the tubular portion of the nephron is injured after the ingestion of toxic drugs (nephrotoxic ATN) or by a decrease in blood supply (ischemic ATN). Circulatory collapse, severe hypotension, hemorrhage, dehydration, or other disorders that affect blood supply are the common causes of ischemic ATN. Because specific signs and symptoms are not associated with ATN, the diagnosis relies on a positive history of risk factors. Nonspecific signs and symptoms of ATN commonly include scanty urine production (oliguria), fluid retention, mental apathy, nausea, vomiting, and increased blood levels of calcium (hypercalcemia). When tubular damage is not severe, the disorder is usually reversible.
Oncology
Bladder cancer is the fourth most common cancer in men and the eighth most common cancer in women. Two types of bladder cancer are transitional cell carcinoma and adenocarcinoma. Transitional cell carcinoma accounts for 95% of bladder cancers in the United States. Transitional cells line the bladder and the inside of the ureters and urethra. They are able to expand when the bladder is full and contract when it is empty. As bladder cancer progresses, malignant tumors invade the bladder, ureters, and urethra.
Adenocarcinoma, a less common type of bladder cancer, accounts for only 1% of bladder cancers in the United States. This malignancy arises from mucus-secreting glands in the bladder and generally tends to be invasive.
Signs and symptoms of bladder cancer include hematuria, frequency, dysuria, and abdominal or back pain. Diagnostic tests include cystoscopy with biopsy of suspicious lesions and urine cytology, in which malignant cells appear in a urine sample.
Treatment depends on the type, stage, and grade of the malignancy. In the early stages when the malignancy is confined to the bladder lining, the practitioner employs an electric current or high-energy laser using a device passed through the urethra (transurethral resection of bladder tumor [TURBT]) to destroy malignant tissue. Advanced cancers require the removal of the bladder (cystectomy). Surgery combined with treatments that stimulate the immune response (biological therapy; immunotherapy), chemotherapy delivered intravenously or directly into the bladder (intravesical), and radiation therapy are other treatment options.
Blockage at the base of the bladder that reduces or prevents urine from passing into the urethra
Causes include an enlarged prostate, bladder stones, bladder tumors, and tumors in the pelvic cavity.
bladder neck obstruction (BNO)
Prolapsing or downward displacement of the bladder due to weakening of the supporting tissues between the bladder and vagina (See Fig. 11-5.)
Cystocele is commonly the result of vaginal childbirth, frequent straining with constipation, or lifting of heavy objects.
cystocele
SĬS-tō-sēl
cyst/o: bladder
-cele: hernia, swelling
Any type of kidney disease in which there is little or no remaining kidney function, requiring the patient to undergo dialysis or kidney transplant for survival
The two most common causes of ESRD are diabetes and hypertension.
end-stage renal disease (ESRD)
RĒ-năl
ren: kidney
-al: pertaining to
Involuntary discharge of urine; also called incontinence
Enuresis that occurs during the night is called nocturnal enuresis; during the day, diurnal enuresis.
enuresis
ĕn-ū-RĒ-sĭs
en-: in, within
ur: urine
-esis: condition
Abnormal passage from a hollow organ to the surface or from one organ to another
The most common type of urinary fistula is vesicovaginal fistula, in which a passage forms between the bladder and vagina. Its causes include previous pelvic surgery, such as hysterectomy; difficult, prolonged labor; and reduced blood supply to the area
Fistula
Abnormal dilation of the renal pelvis and the calyces of one or both kidneys caused by pressure from accumulated urine that cannot flow past an obstruction in the urinary tract
The causes of hydronephrosis are enlargement of the prostate, urethral strictures, and calculi that lodge in the ureter. When dilation affects the ureter, it is called hydroureter. (See Fig. 11-6.
hydronephrosis
hī-drō-nĕf-RŌ-sĭs
hydr/o: water
nephr: kidney
-osis: abnormal condition; increase (used primarily with blood cells)
Chronic inflammation of the bladder wall that is not caused by bacterial infection and is not responsive to conventional antibiotic therapy; also called painful bladder syndrome
Two common symptoms include urinary frequency and bladder or pelvic pain ranging from mild to severe. Medications and physical therapy may help some patients, but other patients are unresponsive to treatment.
interstitial cystitis (IC)
ĭn-tĕr-STĬSH-ăl sĭs-TĪ-tĭs
cyst: bladder
-itis: inflammation
Loss of large amounts of plasma protein, usually albumin, through urine due to an increased permeability of the glomerular membrane
Hypoproteinemia, edema, and hyperlipidemia are commonly associated with nephrotic syndrome.
nephrotic syndrome
nĕ-FRŎT-ĭk SĬN-drōm
nephr/o: kidney
-tic: pertaining to
Impairment of bladder control as a result of brain, spinal cord, or nerve damage
Because the nervous system controls how the bladder stores and empties urine, neurogenic bladder leads to incontinence, difficulty in urinating, or the inability to urinate.
neurogenic bladder
nū-rō-JĔN-ĭk
neur/o: nerve
gen: forming, producing, origin
-ic: pertaining to
Inherited disease in which sacs of fluid called cysts develop in the kidneys
If cysts increase in number or size or if they become infected, kidney failure may result. Dialysis or kidney transplant may be necessary for renal failure caused by PKD.
polycystic kidney disease (PKD)
pŏl-ē-SĬS-tĭk
poly-: many, much
cyst: bladder
-ic: pertaining to
Infection of the kidney, usually the result of an infection that begins in the urethra or bladder and ascends the ureters to the kidney
Pyelonephritis requires prompt attention to avoid permanent damage to the kidneys or from spreading to the bloodstream.
pyelonephritis
pī-ĕ-lō-nĕ-FRĪ-tĭs
pyel/o: renal pelvis
nephr: kidney
-itis: inflammation
Sensation of the need to void immediately
Urinary urgency commonly occurs in urinary tract infection (UTI).
Urgency
An infection, typically of bacterial origin, in any part of the urinary tract, including the kidneys (acute pyelonephritis), bladder (cystitis), or urethra (urethritis)
Dysuria, although a symptom associated with numerous conditions, is commonly associated with UTI, especially cystitis and urethritis
urinary tract infection (UTI)
Ū-rĭ-nār-ē
urin: urine; urinary tract
-ary: pertaining to
Disorder caused by the failure of urine to pass through the ureters to the bladder, usually as a result of impairment of the valve between the ureter and bladder or obstruction in the ureter
VUR may result in hydronephrosis if the obstruction is in the proximal portion of the ureter or hydroureter and hydronephrosis if the obstruction is in the distal portion of the ureter.
vesicoureteral reflux (VUR)
vĕs-ĭ-kō-ū-RĒ-tĕr-ăl RĒ-flŭks
vesic/o: bladder
ureter: ureter
-al: pertaining to
