module 10: excretory system disorders Flashcards

Question

With what does postrenal AKI usually occur? Give an example of one condition that would lead to this.

Answer 1

* urinary tract obstruction that affects both kidneys * ex: prostatic hyperplasia

Answer 2

* tubular necrosis * events: * ischemia associated with prerenal failure * sepsis * nephrotoxic effects of drugs

Answer 3

Renal damage causes reduced reabsorption of BUN

Answer 4

* vital to determine and correct the cause of the kidney injury * primary goal = maintain life until renal function had been recovered * 3 areas of concern to address: * correct fluid and electrolyte imbalances * treat infections * maintain nutrition * continuous renal replacement therapy or hemodialysis may be required

Answer 5

* kidney damage of a GFR less than 60 ml/min for 3 months or longer * risk factors: * hypertension * diabetes mellitus * chronic glomerulonephritis * obstructuve uropathies

Answer 6

* decreasing GFR, indicating increasing levels of kidney damage, ending in kidney failure

Answer 7

* proposes that the unaffected nephrons are capable of hypertrophy ad hyperfunction in their rates of filtration, reabsorption, and secretion, in order to make up for the declining GFR * renal function decline to less than 35% of normal before CKD is apparent

Answer 8

increased levels of serum urea and other nitrogenous compounds * can be asymptomatic

Answer 9

the systemic signs and symptoms associated with the accumulation of nitrogenous wastes and toxins in the plasma brought about through kidney failure

Answer 10

* the kidney loses its ability to regulate sodium and water = both retained = edema

Answer 11

in later stages, potassium is not secreted sufficiently and can increase to life-threatening levels

Answer 12

levels in the plasma increase as GFR decreases

Answer 13

the kidney's ability to secrete hydrogen ions and reabsorb bicarbonate ions is decreased

Answer 14

* less calcium is absorbed from the GIT * detected by parathyroid gland = increased levels of PTH * increased levels of PTH = loss of calcium from the bone = increases the risk of bone fracture

Answer 15

* advanced CKD causes decreases in amount of proteins * also a shift in the ratio of LDL/HDL, with more LDL = increased atherosclerosis

Answer 16

a general accumulation of fluid in body cavities and tissues

Answer 17

* major cause of death in CKD * excess sodium and water lead to hypertension * excess LDL leads to increased atherosclerosis

Answer 18

* complications associated with fluid overload * acidosis results in Kussmaul respirations

Answer 19

anemia impaired platelet function

Answer 20

overall suppression by high levels of urea and metabolic wastes

Answer 21

* numerous effects of uremic toxins, including both peripheral and central nervous systems * restless leg syndrome * muscle atrophy * headache * impaired concentration * seizures * coma

Answer 22

* anorexia, vomiting possibly due to breakdown of urea by intestinal bacteria

Answer 23

* decrease in levels of sex steroids bring symptoms such as impotence, amenorrhea * insulin resistance can occur, as well as alterations in thyroid hormone metabolism

Answer 24

* evaluated * elevated serum creatinine and BUN levels * protein in urine, particularly albumin * confirmed by renal biopsy * management * dietary control to replace/restrict appropriate factors * drugs to treat hypertension * dialysis and renal transplantation

Answer 25

* important for water balance, conduction of nerve impulses, regulation of acid-base balance, some biochemical reactions, membrane transport * regulation: * sodium is coupled with water levels in the body * sodium levels coupled with blood pressure and volume * controlled by hormones that control reabsorption of water and sodium in the kidneys

Answer 26

intracellular dehydration

Answer 27

* retention or therapeutic infusion of sodium * retention can be caused by oversecretion of aldosterone or ACTH * not usually caused by increased intake: higher amount of dietary sodium are eliminated by kidneys * decreased intake or increased loss of water * increased loss from respiratory tract * normally would stimulate thirst and drinking

Answer 28

* if due to sodium retention * hypervolemia * weight gain * bounding pulse * increased blood pressure * if due to water loss * headache * thirst * dry skin and mucous membranes * increased temp * weight loss * hypovolemia * tachycardia * weak pulse * for both * thirst * alterstions in membrane potential * shrinking of nerve cells * confusion, coma, and convulsions

Answer 29

* decreased concentration of sodium ions in the blood

Answer 30

* loss of sodium * burns * vomiting * diarrhea * excessive renal loss from diuretics * insufficient aldosterone levels * inadequate intake of sodium (rare) * retention of water * **dilutional hyponatremia** (most common cause)

Answer 31

* changes in sodium concentration across the membrane alters the cell's ability to depolarize and polarize normally * causes neurological alterations * lethargy * apprehension * confusion * depressed reflexes * seizures * coma * muscle twitching * weakness

Answer 32

drinking too much water in too short a period of time leads to neurological symptoms

Answer 33

* fluid balance * nerve impulse conduction * some biochemical reactions

Answer 34

* by the kidney (main source of loss from the body) * negative feedback release of aldosterone occurs in relation to serum potassium levels * H+/K+ transporter that responds to increased serum potassium levels * shifts across body cell membranes * H+/K+ transporter in body cell membranes causes exchange of these ions * ECF levels rise with acidosis/fall with alkalosis * insulting also causes the uptake of K+

Answer 35

* usually by renal disease * increased intake (more likely through too rapid IV) * a shift from intracellular to extracellular acidosis * insulin deficits * under secretion of aldosterone

Answer 36

insulin promotes the entry of potassium into cells

Answer 37

Aldosterone causes potassium to be excreted into the lumen by principal cells

Answer 38

* decrease in neuromuscular excitability has several effects * paresthesia with mild attacks * loss of muscle tone * paralysis with more severe attacks * most serious effect is on the heart * the decrease in membrane excitability produces changes in the conduction and repolarization of electrical signals in the heart * severe hyperkalemia can cause ventricular fibrillation or cardiac arrest

Answer 39

* excessive loss of potassium * diuretics * metabolic acidosis * increased aldosterone and cortisol (activates aldosterone receptors) * inadequate intake * increased entry into cells

Answer 40

* mild losses usually asymptomatic * manifestations reflect body's attempt to regulate ECF potassium levels, as well as potassium's effect om excitable tissues * urine output is increased - thirst and polyuria are common * weakness, fatigue and muscle cramps * most serious effects involve the heart

Answer 41

* major cation of bones and teeth * many enzyme reactions * muscle contraction * release of neurotransmitters * blood clotting

Answer 42

reduces the sodium permeability

Answer 43

* through vitamin D and parathyroid hormone * absorption/secretion by bones * kidney * GIT

Answer 44

* increased bone resorption * due to neoplasms or hyperparathyroidism

Answer 45

* fatigue * weakness * lethargy * hypoactive reflexes * depression * bizarre behaviour * bradycardia/arrythmias * nausea * vomiting * constipation

Answer 46

* decreased parathyroid hormone * kidney disease * alkalosis * alkaline pH in plasma causes increased binding of calcium ions to proteins = decrease the amount of free calcium

Answer 47

* increased excitability of both muscles and nerves * spasms * tetany * increased gi motility * cardiovascular dysrhythmias

Answer 48

* cofactor in many intracellular enzymatic reactions * role in nerve conduction * role in smooth muscle contraction and relaxation

Answer 49

high levels of magnesium inhibit calcium transport into the cell and release from SR

Answer 50

* decreased excitability of both muscle and nerves * hypoactive reflexes * muscle weakness * brachycardia * respiratory distress * nausea * vomiting

Answer 51

* increased excitability of both muscles and nerves * increased reflexes * muscle cramps and convulsions * tachycardia * behavioural changes * irritability

Answer 52

* hydrogen ion concentration is very important for the proper shape and function of proteins * involved in metabolic reactions

Answer 53

* decreasing pH depresses the nervous system * increasing pH overexcites the nervous system

Answer 54

* increase in H+ * concentrations of acids increase through increased production or ingestion, or kidneys can't secrete excess H+ * decrease in HCO-3 * excessive bicarbonate is lost through Gi tract or kidney, or can't be regenerated by the kidney

Answer 55

* nervous system depression * headache * lethargy * Kussmaul respirations * deep and fast, as with exercise * anorexia * nausea * vomiting * diarrhea * abdominal discomfort

Answer 56

* nervous system depression * kussmaul respirations * anorexia * nausea * vomiting * diarrhea * abdominal discomfort

Answer 57

* anion gap = an expected value that represents miscellaneous anions that are present due to miscellaneous anions that are present due to miscellaneous metabolic acids (H+) * subtract the concentration of the anions (largest amounts of CI- and HCO-3) from the cations (largest amount of Na+) * there may be metabolic acidosis, but the anion gap is normal = loss occurring of HCO-3 from the body

Answer 58

* excessive loss of metabolic acids * gain in bicarbonate

Answer 59

* weakness * muscle cramps * hyperactive reflexes * confusion * convulsions * hypopolarized cells * shallow/slow respirations

Answer 60

* decrease in H+ = increased pH - increased binding of Ca2 to c=plasma proteins = decrease Ca2 concentration = more Na allowed to cross membrane = hypopolarized cells

Answer 61

increase in plasma pCO2

Answer 62

causes * depression of respiratory center * disorders of respiratory muscles or lung tissue, etc results * CO2 easily crosses blood brain barrier and decreases pH of brain tissue * headache * blurred vision * restlessness * lethargy * tremors * convusions * coma

Answer 63

causes * pulmonary disease * congestive heart failure * high altitudes that increase breathing rate manifestations: * nervous system is stimulated * dizziness * confusion * paresthesias * convulsions * coma

Answer 64

* CO2 & HCO3- * respiratory system controls the levels of CO2 and therefore H+ levels * excretory system controls the levels of HCO3-

Answer 65

what is done to maintain the pH in response to disturbances

Answer 66

one or the systems (respiratory or excretory) is attempting to rectify the disturbance but has not yet been successful, resulting in values for that system that are outside normal ranges * action, but not fixed yet

Answer 67

pH levels are within normal limits but values for both systems are outside of normal limits (in opposite directions) * normal value, but there is still compensation

Answer 68

all values are within normal limits

Answer 69

occasionally, two imbalances arise in the same person

Answer 70

Higher than normal BUN and creatinine

Answer 71

No protein in the urine

Answer 72

Information is given only for 6 hours, therefore, can make decision for only in “Risk” category, or not. She should be making at least 0.5 ml of urine for every kg of body weight every hour over the course of 6 hours

Answer 73

* Prerenal (a problem in blood delivery to the kidney). * The diarrhea that she had for four days has left her dehydrated (supported by observation of poor skin turgor and dry mucous membranes). The dehydration resulted in a drop in blood volume, which caused a drop in blood pressure, which resulted in pre-renal AKI.

Answer 74

* The BUN / creatinine ratio is 40 mg/dl /1.9 mg/dl = 21. This is above the normal value of 20, which means the BUN is elevated more than values seen with other types of kidney injury. * This is due to a pre-renal cause: lower blood delivery to the kidney = lower production of filtrate = slower flow of filtrate through the nephron = greater opportunity to reabsorb urea = elevated levels of BUN more than with other types of injury.

Answer 75

She has hypernatremia. With more than normal amounts of sodium in the ECF, water moves out of cells, causing shrinking. The results of this is most easily seen in the nervous system.

Answer 76

Metabolic acidosis

Answer 77

* Na+ - (HCO3- + Cl- ) = 12 mEq/L. * This is within normal anion gap levels, therefore she must be losing bicarbonate from the body. * This is consistent with her history of 4 days of diarrhea.

Answer 78

The carbon dioxide level is decreased, indicating that the respiratory system is trying to compensate (or by the arrow method, both the bicarb and the CO2 are low). However, the pH is not yet returned to a normal level. The system is only partially compensated.

Answer 79

Kidney. The urea and creatinine are elevated and there is protein in the urine (only due to renal cause). The GFR value gives a level of Stage 3 CKD. Reduction in size of both kidneys.

Answer 80

Hypertension. The glomeruli, not performing job perfectly, as protein is passing through into the filtrate.

Answer 81

* Fatigue - anemia – lack of erythropoietin, so RBC production is decreased. * Difficulty concentration – could be due to build-up of nitrogenous waste products in blood (azotemia) due to kidney’s inability to rid the blood of these. Also metabolic acidosis and anemia. * Hyperkalemia – caused by the inability of the kidneys to get rid of potassium. * Metabolic acidosis – caused by the hyperkalemia and the inability to get rid of hydrogen within the nephron. * Hypocalcemia – caused by decreased production of calcitriol by kidney, which causes absorption of calcium in the GIT * Increased respiratory rate – compensation for the acidosis

Answer 82

Intact nephron hypothesis – functions no longer performed by damaged nephrons is taken over by healthy nephrons.

Answer 83

145 – (107 + 20) = 18, which equals elevated anion gap. This fits with metabolic acidosis caused by excess of H+, and can be caused by inability of kidney to secrete H+

Answer 84

11.5 / 0.300 = 38. This is less than 40, which suggests an intra-renal cause (which fits with damage within the kidney, caused by at least the hypertension). It does not point to a pre-renal cause (decreased perfusion), or post-renal (obstruction).

module 10: excretory system disorders Flashcards

(109 cards)