GU/ Renal Disorders Flashcards by Gabriella Jordan

What are the components of a nephron?

Bowmans capsule/Glomerulus = Renal corpuscle
renal tubule:
3.Proximal Convoluted Tubule
4.Lope of Henle / nephron loop
Distal Convoluted Tubule
Collecting duct

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What are the functions of the Renal System

Filters wast products
Regulates ion levels in plasma
Regulates blood pH
Conserves valuable nutrients
Regulates blood volume
Regulates RBC production (erytripoietin)

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Where is the nephron

Between the cortex and medulla

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Filtration in the kidney

Blood from the renal a. is filtered in the glomerulus. Blood comes in to the afferent artery 1/5 of blood is filtered and exits the efferent arteriole to get move to the tubule

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Tubular reabsorption

solutes taken out ( Glucose; Na +; K+; Cl-and H2O) and returned to circulation via capillaries surrounding Proximal tubule, loop of henle, and distal tubule

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Tubular secretion

Capillaries surrounding the distal convoluted tubule move waste products into the DCT and then eventually transfered to bladder for storage and illemination

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Urinary excretion

filtrate /urine is transported from the collecting duct to the bladder for elimination

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Dark yellow urine, pale yellow urine, cloudy urine, Hematuria, redish brown urine , foamy urine

Normal pale yellow I/O of 2 L per day

dark yellow: dehydration
cloudy urine: white blood cells/infection UTI-AKI
Hematuria: blood RBC in urine / pink / red color- AKI
Redish brown: myoglobin happens in Rhabdo, AKI
Foamy urine: proteins stay in blood chronic renal failure

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Polyuria

Abnormal amounts of diluted urine

ex: Diabetes

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Urinary frequency

Need to urinate many times of day or night

ex: UTI

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Nocturia

excessive urination at night

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Acute kidney disfunction causes Oliguria and Anuria what does that mean

Oliguria: reduced volume of urine (<400 mL)

Anuria: no urine production

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Causes of Acute Renal Failure and what is the most common??

pre-renal most common : 55%
Conditions that decrease renal blood flow
-HF,sepsis,hypovolemia

Intra-renal: 40%
injury or inflammation in the kidney
-nephritis, tubular necrosis

Post-renal: 40%
Conditions that obstruct blood flow
-kidney stones, blood clots

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Pyelonephritis

When UTI progresses to involve the upper urinary system including the kidneys and ureters

Special test: Mental status change

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How are kidney stones managed

Pain management
pain
Cystoscope: snare and sucking out (removal) of stone
Lithotripsy:ultrasound to breakdown stone

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Rhabdomyolysis

Breakdown of skeletal muscle fibers resulting in release of myoglobin -can cause AKI /renal failure

Cause: traumatic /compression
Non-traumatic : exertion

Triad: muscle pain, weakness, dark urine

Creatine kinase 5x the ULN

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Top 3 causes of Chronic Renal Failure

Diabetic
Hypertension
Glomerulonephritis

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Signs and symptoms of CKD

Wight loss , poor appetite , edema, SOB, DOE,Fatigue, Nocturia, Hematuria, Protenuria , insomnia , Pruritis, Muscle cramps, Headaches, Erectile dysfunction

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Lab Values of Renal Function

GFR Glomerular Fultration Rate
Great measure kidney function , but difficult to measure
As GFR goes down, kidney damage goes up -inverse relationship
Creatinine
Most common measure
as C goes up , kidney damage also goes up -direct relationship
Albumin

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What is the role of Dialysis ?

Try’s to filter and clean blood and do the role of the kidney

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Differences between Peritoneal Dialysis … Hemodialysis … CRRT?

Hemodialysis: placed in arm passes blood across a semi-permeable membrane (dialyzer) allowing the metabolic waste to diffuse into correction fluid (dialysate)
via AV fistula /AV graft or temporary access via catheter in IJV

Continuous Renal Replacement Therapy (RRT): continuous removal of solutes and fluid : used for patients that are critically ill

Peritoneal Dialysis: uses the peritoneum as semipermeable membrane, several hours of infusion prior to drainage

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Lab values of CRD

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High Creatinine
high potassium hyperkalemia
high calcium hypercalcemia
metabolic acidosis

Signs and symptoms of AKI:

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Pain with urination
Nausea vomiting
Blood in urine: hematuria
Cloudy or foul smelling urine
Increasing frequency of urination
Confusion / Mental status change (in older adults esp.)
Fever /chills
Feeling sick

Functions of the GI Tract

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Digestion: physical/ chemical breakdown, GI motility /enzymes
Absorption: movement of nutrients
Excretion: food residue
Host defense: largest lymphoid organ in body , gut microbiome

Contributing factors of GERD

1. Non functional lower esophageal sphincter 2. Impaired gastric emptying 3. Hiatal hernia 4.Alcohol abuse 5. developmental delays in kids

Functions of the stomach

Reservoir -controlled release of chyme Mechanical digestion Motility: peristalsis Chemical digestion -pepsin , lipase enzymes Hydrochloric acid - chemical digestion, immune defense Intrinsic factor -binds Vit. b12 for absorption in small intestine -deficiency leads to pernicious Anemia

Gastric defense

1. Compact epithelial cell lining 2. Mucus covering 4. Bicarbonate ions 4. Blood flow

Gastritis

inflammation of the inner lining of the stomach (the mucosa) due to 1. excessive acid production > gastric defense (NSAIDS , ASA, ETOH) 2. Stress induced common in critically ill patients

Peptic Ulcer Disease (PUD)

increase acid secretions and digestive enzymes erode gastric mucosa OR helicobactor pylori infection can lead to hemorrhage, perforation , peritonitis, scarring defend by site of origin

NSAIDS Non steroidal anti inflammatory drugs

3 types: Acetylsaclic acid (ASA) : ex asprin Traditional: ex : ibprofen Cox-2 inhibiters (off marked)

ASA and traditional NSAIDS

pain relief with increase in GI bleed risk

Cox 2 inhibiters

pain relief with decrease risk of GI bleed but increase risk of CVA /MI risk

50% of GI bleeding due to what?

NSAID use in elderly

Continued GI bleeding and re-bleeding are high predictors of what ?

mortality and morbidity in older adults

Syncope Hypotension Pallor Diaphoresis Tachycardia all red flags and are suggestive of what?

Shock (GI bleed)

Hematemesis and coffee ground emesis usually originated from what?

an upper GI bleed

Melena is a result of what?

Lower OR upper GI bleed

In a GI bleed what do you need to be concerned about

Decrease in hematocrit , hemoglobin

Functions of small intestine

Segmentation Peristalsis Digests and absorbs nutrients Secretes regulatory hormones

What type of hormones aide in chemical digestion in the small intestine

Endocrine cells, exocrine enzymes -regulate gastric pancreatic and gallbladder function Cholecystokinin (CCK): increases pancreatic enzymes and bile release

Villi and microvelli in small intestine

Increase SA for absorption

Lacteals (lymphatic capillaries)

for fat absorption (chyle)

Main role of colon

re-absorption of water and ions , some vitamins

Crohns Disease

Crohn's : Patchy inflammation that may occur anywhere in the Digestive Tract -entire bowel wall -pain in lower R abdomen Ulcerative Colitis: continuous inflammation affected through the large intestine -mucosa -pain in lower L abdomen

Crohn’s Disease & Ulcerative Colitis medical management and presentation

presentation: joint pain , anemia abdominal cramping, pain, diarrhea, malabsorption leading to weight loss & malnutrition medications: immunosuppressents biologics Anti-inflammatory agents

IBS: Irritable bowel syndrome

disturbed bowel without structural abnormalities spastic motility pattern malabsorption : nutrient deficiency + loose stools related to colonic sensitivity

Types of hernia

Ventral : incision related where abdominal contents protude through the linea alba Hiated hernia: gastroesophageal junction moves above the diaphragm with some of the stomach Inguinal: abbdominal contents through induinal canal

Acute Abdomen

Medical emergency : palpation reveals rigidity, rebound tenderness , bowel sounds absent Also known as peritonitis sudden severe abdominal pain

Colorectal cancers

Progression starts with benign polyp bleeding , pressure/pain with defecation 3rd most common Cancer , 3rd leading COD

Types of abdominal surgery

Ileectomy: resection of Small I. Colectomy: resection of Large I Ostomy: surgical opening for discharge of body wastes Stoma : end of the intestine protruding through abdominal wall

Common post operative complications (POC) and PT role

pain pulmonary issues bleeding infection Ileus Bowel leakage Post surgical adhesions PT role: bowel motility

Bariatric Surgery benefits

weight loss remission of type 2 DM improve CR risk factors and CV health improve mental health better sleep decrease hip and knee pain improve fertility

Meds for GI issues

Antibiotic therapy: pylori PUD antiflammatory agents " presone anti-emetics : nausea and vomiting laxatives: short term relief of constipation antidirrheal

GU/ Renal Disorders Flashcards

(53 cards)