Module 3- Health Assessment of the Urinary and Digestive Systems Flashcards Preview

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Flashcards in Module 3- Health Assessment of the Urinary and Digestive Systems Deck (77):

Identify the main functions of the urinary system

- Regulation of:
> Blood volume and Blood Pressure
> Chemical composition of body fluids including:
(Removal of wastes,
Removal of excess solutes,
Adjustment of pH)


When assessing urine, what are the four main components you should assess?

1. Appearance - inspect
2. Content - urinalysis
3. Flow - pt. hx
4. Volume - measuring jug


How should urine appear in terms of appearance, content, flow, and volume

1. Appearance-
Transparent - yellow - amber

2. Content
Uric acid

3. Flow

4. Volume
varies (1-2 L)


Define polyuria

- Excess urine production


Define oliguria

- Abnormally low urine production


Define anuria

- Absence of urine production


Define nocturia

- Urgency and need to urinate frequently at night


Define glucosuria

- Glucose in urine


Define dysuria

- Pain/difficulty urinating


Draw a diagram indicating the path of arterial blood flow through the kidneys to the efferent arterioles of the nephron

- Descending (abdominal) aorta
- Renal artery
- Segmental artery
- Interlobar artery
- Arcuate artery
- Interlobular artery
- Afferent arteriole
- Glomerulus
- Efferent arterioles:
> Peritubular capillaries
> Vasa recta


Draw a diagram indicating the path of venous blood flow through the kidneys from the efferent arterioels

- Efferent arterioles
- Interlobular vein
- Arcuate vein
- Interlobar vein
- Segmental vein
- Renal vein
- Inferior superior vena cava


Draw a diagram indicating:
> The kidneys
> Ureter
> Urinary bladder
> Urethra

And identify their functions

- The kidneys: urine formation
- Ureters: urine transport
- Urinary bladder: urine storage
- Urethra: urine elimination


Draw a diagram of the kidney indicating:
> Renal artery and vein
> Renal cortex
> Renal medulla
* Renal lobe
- Renal pyramid
- Renal column
> Minor calyces
> Major calyces
> Renal pelvis



What is the functional unit of the kidney? How many are there approximately per kidney and what is their function?

- Nephron
- ~1.25 million nephron units
- Filter blood and produce urine


Draw a diagram of the nephron and indicate the passage of blood/production of urine

- Blood enters the nephron via the afferent arteriole which then enters the glomerular capsule and is passed at high pressure through the glomerulus.
- The high pressure forces all of the molecules and substances in the blood (excl. large proteins) out of fenestrations in the capillary into the glomerular capsule.
- Blood then passes through the efferent arteriole.
- Proximal convoluted tubule - reabsorption and secretion into/from the peritubular capillaries
- Nephron loop - reabsorption of materials by vasa recta
- Distal convoluted tubule - reabsorption and secretion by peritubular capillaries
- Collecting duct- " "


Identify which structures are involved in filtration, reabsorption, and secretion

- Filtration- glomerulus
- Secretion- PCT, DCT, collecting tubule
- Reabsorption- " " + nephron loop


How much of what is filtered is reabsorbed back into the capillaries from the nephron?



Draw a diagram of the organs involved in production of urine, transport and storage of urine, and elimination of urine

- Collecting duct
- Minor calyces
- Major calyces
- Renal pelvis
- Ureters
- Urinary bladder
- Urethra


How does urine pass through the ureters?

- Gravity
- Peristaltic contractions


Describe the urinary bladder

- Smooth, collapsible, muscular sac
- Stores urine temporarily (400-800 mL - urge felt at 250 mL)
- Posterior to pubic bone


Describe the position of the bladder and urethra in men and women in terms of urinary dysfunction

* Prostate gland surrounds neck inferiorly
--> As prostate enlarges with age this causes issues with urinary retention
* Urethra- 25-30 cm long - decreased risk of UTI

* Bladder anterior to vagina and uterus
--> In pregnant women this causes issues with incontinence as the uterus presses on the bladder
* Urethra 3-4 cm long- risk of UTI increases


What is the rate of urine production?

- 2-3/ kg mL in children under 2
- 0.5-1 / kg in children over 2
- 1 ml/kg in adults


What is considered reduced urinary output? What is this termed and why is it a problem?

- Less than 30mL per hour for adults
- Oliguria

- Build-up of toxins if less than 470 mL/day (uraemia)
- Fluid retention in blood
(Increased BV/BP + oedema)
- If due to decreased bl. flow this can cause ischaemia and necrosis of the kidneys


What are the three division of the male urinary system?

-Prostatic urethra (from bladder through prostate to external urethral sphincter)
- Membranous urethra (external urethral sphincter to start of corpus spongiosum)
- Spongy urethra (through penis)


What is part of a comprehensive renal health history?

- Chief complaint
- Usual urinary pattern and fluid intake
- Volume, colour, frequency, urgency, smell
- Change/disturbance to urinary tract function
- Pain or burning
- Blood in the urine
- Past history
> Renal/urinary problems
> Hypertension
> Diabetes
> Trauma to abdomen, back or the kidney
> Urinary incontinence
> Surgery
> Lifestyle factors
> Diet
> Smoking
> Exercise
> Sexual practices


When assessing urinary system what should you do?

1. Abdominal assessment
* Inspection – incl. abdomen and urethral meatus
* Auscultation – incl. renal arteries
* Percussion – bladder (should be tympanic) , kidneys for any tenderness
* Palpation – bladder (firm and smooth), kidneys for any masses, lumps, tenderness, counter and size of urinary organs

2. Vital signs
* Temperature
* Blood pressure

3. Examination of urine
* Volume
* Colour
* Clarity
* Odour

4. Urinalysis (ward urinalysis test)
* Non-sterile specimen collected
* Uses reagent stripes to detect abnormalities in urine


Define urinary incontinence

involuntary release of urine


List some causes of urinary incontinence

- Gender (1/3 women have some degree of incontinence)
- Ageing
- Delirium
- Excess urine production
- Immobility
- Stool impaction


List some risk factors for UTI

- Female
- Obstruction
- Urinary catheter
- Poor bladder emptying
- A recent surgical procedure
- Abnormal anatomy
- Immune system
- Menopausal women
- People engaging in sexual intercourse
- Birth control methods – e.g. spermicidal foam and diaphragms


List the stages of a UTI

1. Colonisation in urethra
2. Uroepithelium penetration- bacteria penetrates bladder
3. Ascension- bacteria travels up to kidneys via ureters
4. Pyelonephritis- infection of the renal parenchyma (inflammation)
5. Acute kidney injury- bacteria goes up to the kidneys


List some symptoms of a UTI

- Frequency but little comes out
- Dysuria
- Haematuria
- Urgency
- Urinary incontinence
- Cloudy, foul smelling urine


How do the kidneys conserve/promote water loss?

- When dehydrated- produce small volume of concentrated urine
- When overhydrated- produce large volume of diluted urine


Describe urinary retention

- Inability to completely empty bladder when urinating
- Two types:
> Acute
> Chronic

- Risk factors:
> Older males (prostate enlargement)


What is the main function of the digestive system?

- Contributes to homeostasis by:
1) Providing body with water, nutrients, and electrolytes
2) Eliminating wastes


List the main organs of the digestive system

1. Oral cavity (mouth)
2. Pharynx
3. Oesophagus
4. Large intestine
5. Small intestine
6. Rectum


List the accessory organs of the digestive system

1. Teeth
2. Tongue
3. Salivary glands
4. Pancreas
5. Liver
6. Gallbladder


Describe the location of the organs of the digestive system

- Located within abdominopelvic cavity
- Most are contained within the peritoneum


What is the peritoneum and what does it do?

- Extensive, folded serous membrane which lines the peritoneal cavity
- Responsible for
> Supporting abdo organs
> Allowing freedom of movement along GI tract

- Consists of:
> Visceral: covers anterior surface of abdo organs
> Parietal- lines inner surface of body wall


List abdominopelvic organs that are retroperiotoneal

Suprarenal (adrenal) glands
Aorta/inferior vena cava
Duodenum (2nd and third segments)
Colon (ascending and descending only)


Where does the process of digestion begin, and with what process?

- Oral cavity - ingestion


Describe the process of ingestion

- Food enters ORAL CAVITY (via ingestion) and is broken down:
> Mechanically - by chewing action of TEETH
> Chemically - by saliva produced by SALIVARY GLANDS

- This results in the formation of a bolus, increasing SA of the food to facilitate further digestion and absorption.


Describe saliva and identify where it is produced

- Substance which consists mostly of water, but also contains salivary amylase (enzyme which breaks down carbohydrates/starch)

- Salivary glands:
> Parotid - back upper molars
> Submandibular- under tongue
> Sublingual- under tongue


Identify the process by which food moves from the oral cavity to the oeosphagus?

- Deglutition (swallowing)


Describe the process of swallowing

- The TONGUE elevates, forcing the bolus up against the HARD PALATE and then back towards the OROPHARYNX.
- As the bolus enters the oropharynx:
> The soft palate elevates to seal off the nasopharynx
> The epiglottis lowers to seal off the trachea
To prevent aspiration
> The upper esophageal sphincter opens to permit the passing of the bolus


Identify the process by which the bolus travels from the oral cavity to the stomach

- Peristalsis - alternating contractions of smooth muscle layers of GI tract walls


Describe the anatomy of the oesophagus

- Collapsible muscular tube which lies behind the larynx/trachea
- Approximately 25 cm long


Identify the sphincter through which the bolus must travel to exit the oesophagus and arrive in the stomach?

Lower oesophageal sphincter


Describe what occurs during the stomach

- Mechanical digestion
> Muscular contractions of the stomach wall churns the food together with gastric juices to form chyme

> Chemical digestion
Stomach acid (HCI) produced by cells of the stomach wall:
1) Denature proteins
2) Destroy pathogens
Enzymes begin protein digestion


Describe the anatomy of the stomach

- Enlargement of the Gi tract responsible for storage and digestion of food
- Has four main regions
> Fundus
> Cardia
> Body
> Pyloric region


Describe the general tissue arrangement of the digestive tract and its functions

- Mucosa - has 3 layers
> Epithelium
> Lamina propria- connective tissue
> Muscularis mucosae - thin layer of smooth muscle.

- Submucosa- connective tissue (either DICT or LCT) which binds the epithelium to the muscular layer
--> Contains lymphatic, nervous, and vascular structures.

- Muscularis externa- 2 layers of smooth muscle:
> Circular
> Longitudinal

- Serosa- connectie tissue


List specialisations found in the tissue of the estomach

1. Additional layer of oblique muscle in the stomach to improve efficiency of stomach at churning food
2. Gastric pits containing cells to produce gastric juices and HCI


How does chyme pass from the stomach into the small intestine?

- Ejected in small increments onto the duodenal wall via the pyloric sphincter.


List the three divisions of the small intestine and their approximate lengths

1. Duodenum (25cm)
2. Jejunum (2.5 m)
3. Ileum (3.5 m)


What happens in the duodenum?

- Receives:
> chyme from stomach
> bile from liver/gallbladder
> pancreatic juice from pancreas

- The bile and pancreatic juice are released into the duodenum via the duodenal papilla.


List the three main features which aid digestion in the small intesinte

1. Pancreatic juice
2. Bile
3. Intestinal brush border enzymes


Describe the composition/function of pancreatic juice, and how/where it is produced

- Contains NaHCO3 (neutralises chyme and protects duodenum)
- Also contains enzymes which digest proteins, proteins, and lipids.

- Produced by lobules of the pancreas
- Secreted into the main pancreatic duct which enters the duodenum and the duodenal papilla


Draw a diagram of the pancreas and identify its other key function in GI homeostasis

- Include:
> Pancreas lobules
> Main pancreatic duct
> Accessory pancreatic duct
> Common bile duct
> Duodenal papilla
> Duodenum

- Also responsible for secreting insulin and glucagon to maintain BG homeostasis


Describe the composition/function of bile and how/where it is produced

- Contains water (97%), bile salts (0.7%), bilirubin (0.51%), and inorganic salts.
- Separates fat globules into smaller fat droples.

- Produced by the liver and concentrated/stored by the gallbladder


Draw a diagram of the liver and describe its anatomy

- R+ L anterior lobes
- Gallbladder
- Hepatic vein
- Inferior vena cava
- Hepatic artery
- Hepatic portal vein
- Common hepatic duct


Describe the function of:
> Hepatic artery
> Hepatic vein
> Hepatic portal vein
> Common hepatic duct

- Hepatic artery: delivers O2 blood to the liver
- Hepatic portal vein: delivers nutrient rich blood from GI tract to the liver for the first pass (processing)
- Hepatic vein: drains blood which has been processed by the liver
- Common hepatic duct- carries bile produced by liver


Describe the flow of bile from the liver where it is produced to the duodenum

- Liver
- L + R hepatic ducts
- Common hepatic duct
- Cystic duct
- Gallbladder
- Cystic duct
- Common bile duct
- Duodenal papilla


Describe the anatomy of the gallbladder

- Small sac which lies on posterior of liver and is responsible for storing and concentrating bile


What happens in the jejunum?

- Most active site for chemical digestion and absorption of nutrients


What happens in ileum?

- Mostly absorption of nutrients


Describe the intestinal brush border enzymes

- Enzymes produced by epithelial cells of small intestine which break down carbohydrates and proteins into their most basic monomers


Describe the first pass effect of the liver

- Most of the blood from abdo organs travels into the hepatic portal vein
- This then is delivered two the hepatocytes via capillaries of this system
- The liver processes these, removing nutrients and returning filtered blood back to the inferior vena cava via the hepatic veins


List some of the functions of the liver

1. Synthesises and secretes:
A) bile to aid lipid digestion and absorption
B) plasma proteins (albumin, clotting proteins etc)

2. Storage of absorbed products of digestion
A) Glucose/glycogen
B) Lipids
C) Fat soluble vitamins (ADEK) and iron

3. Detoxification -converts harmful chemicals into non-toxic substances which can be removed from the body


List structural adaptations of the small intestine which increase SA to facilitate digestion and absorption

1. CIRCULAR FOLDS- folds in walls
2. VILLI- small projections of cell membrane
> LACTEALS - located within villi
--> Network of capillaries and lymphatic vessels which supply each villi and facilitate absorption

3. MICROVILLI- microscopic extensions which sit on top of villi


List molecules absorbed by the small intestine and identify whether the blood or lymphatic system absorb them

1. Glucose/simple sugars
2. Amino acids
3. Water
4. Electrolytes and water-soluble vitamins

1. Fatty acids
2. Cholesterol & fat-soluble vitamins (ADEK) and iron


At what point does the chyme pass from the small intestine into the large intestine

- Ileocaecal valve

--> At this point all useful materials have been absorbed from chyme


What are the main functions of the large intestine

1. Absorption of water, electrolytes, and vitamins
2. Compacting undigested food and bacteria into faces


Draw a diagram of the colon identifying the main parts

> Appendix
> Caecum
> Ileocaecal valve
> Ascending colon
> Transverse colon
> Descending colon
> Sigmoid colon
> Rectum
> External anal sphincter


What happens when faces enter the rectum?

- Stretch receptors trigger the defecation reflex and conscious urge to poop
- This can be overridden by voluntary contraction of the external anal sphincter


Explain the physiological basis of bowel sounds

- Fluid and gasses moving through GI tract via peristalsis produce intermittent gurgling bowel sounds

- Normal= 5-30 sounds per minute
≤ 4= constipation and hypoactive bowel
≥ 30 = diarrhoea and hyperactive bowel


When examining a stool what should you look for?

1. Colour
2. Odour
3. Consistency


List the 7 types of stools according to the bristol stool scale

1. Separate hard lumps
2. Sausage shaped but lumpy
3. Like a sausage but with cracks on surface
4. Like a sausage, smooth and soft
5. Soft blobs with clear-cut edges
6. Fluffy pieces with ragged edges (mushy)
7. Water, no solid pieces (liquid)


What types according to the Bristol stool chart are healthy?

3. Sausage but w cracks on surface
4. Sausage, smooth and soft