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Medical Conditions 2 > Renal and urologic systems > Flashcards

Renal and urologic systems Flashcards

1
Q

Micturition

A
  • mostly reflexive with som volitionally control
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2
Q

innervation of the bladder

A
  • sympathetic nerve supply: L1-L3 → hypogastric nerve
  • parasympathetic nerve supply: S2-S4 → pelvic nerve
  • somatic nerve supply: S2-S4 → pudendal nerve supply
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3
Q

Sympathetic nerve effect on bladder

A
  • relax bladder
  • no urination
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4
Q

Parasympathetic nerve supply effect on bladder

A
  • contraction of bladder
  • urination occurs
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5
Q

Pudendal nerve

A
  • controls external sphincter
  • contracts with sympathetic NS
  • relaxes with parasympathetic NS
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6
Q

Describe the renin-angiotensin-aldosterone system.

A
  • Decrease in BP/blood volume detected
  • liver secretes angiotensin and kidneys secrete renin
  • renin converts angiotensin to angiotensin 1
  • ACE enzyme (secreted by lungs) converts angiotensin 1 to angiotensin 2
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7
Q

What does angiotensin 2 do?

A
  • increase sympathetic activity
  • increase NA, Cl reabsorption
  • increase K excretion
  • increase Water retention
  • increase aldosterone secretion
  • arteriolar vasoconstriction
  • ADH secretion to retain water
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8
Q

What does a urinalysis look at

A
  • acidity (normal = pH of 4.5-8)
  • concentration of ions
  • protein
  • glucose (0-0.8 mmole /L)
  • ketones
  • bilirubin
  • evidence of infection (WBCs/Blood in urine)
  • blood
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9
Q

Blood tests to evaluate kidney function

A
  • BUN: 6-24; 2.1 to 8.5 mol/L
  • Creatinine
  • GFR v eGFR >90 is normal
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10
Q

Aging and the urologic system

A
  • gradual reduction of blood flow to the kidneys
  • reduction in nephrons
  • kidneys become less efficient at removing waste from the blood
  • changes in urine production and voiding
  • tendency toward greater renal vasoconstriction
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11
Q

UTI

A
  • Most commonly involve bladder and urethra
  • fecal associated gram-negative organisms
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12
Q

UTI clinical manifestations

A
  • frequency an urgency to use bathroom
  • dysuria (pain/difficulty urinating)
  • nocturne
  • children enuresis (bedwetting)
  • fever, chills malaise
  • confusion can be a sign in the elderly
  • cloudy, bloody or foul smelling urine
  • burning or painful sensation during urination or intercourse
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13
Q

Risks factors for UTI

A
  • age
  • immobility/inactivity
  • urinary retention
  • frequent catheterization
  • atonic bladder
  • increase sexual activity
  • spermicide
  • uncircumcised penis
  • renal calculi
  • prostatic hyperplasia
  • malformations
  • constipation
  • women > men
  • kidney transplant
  • diabetes M
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14
Q

Pyelonephritis

A
  • infection process involving the kidneys or a chronic inflammatory disease involving the kidney parenchyma and renal pelvis
  • typically treated with an appropriate antibiotic medication
  • typically results from bacteria ascending from bladder to infect kidneys
  • chronic pyelonephritis is a tubulointerstitial disorder characterized by scarring with deformity of the calyces
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15
Q

Renal cancers:

A
  • renal cell carcinoma
  • wilms tumor
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16
Q

Renal cell carcinoma

A
  • most common in adults
  • may be linked to hereditary disorders
  • kidney disease associated with ESRD
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17
Q

Risk factors for renal cell carcinoma

A
  • tobacco smoking,
  • moderate to heavy drinking (alcohol)
  • obesity
  • HTN
  • barbecued meat
  • occupational exposure to substances such as dust, organic solvents, and asbestos and acquired cystic kidney disease associated with ESRD
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18
Q

Renal cell carcinoma triad of symptoms and treatment

A
  • flank pain
  • hematuria
  • palpable abdominal mass
  • surgery is principle treatment
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19
Q

Wilms tumor

A
  • most common malignant kidney neoplasm in children
  • hereditary syndromes can predispose children
  • molecular genetic link
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20
Q

Signs and treatment for Wilma tumor

A
  • palpable abdominal mass that is identified typically once it gets large enough to cause pain
  • multimodality therapy with surgery, while abdomen radiotherapy and three drug chemotherapy
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21
Q

Renal cystic diseases types

A
  1. polycystic disease (PKD) - leading cause of ESRD, frequently requiring dialysis and renal transplantation
  2. cystic diseases of renal medulla
  3. acquired cyst disease
  4. single cysts
  5. cystic renal dysplasia
  6. other
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22
Q

PKD

A
  • autosomal dominant or autosomal recessive (ARPKD)
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23
Q

PKD risk factors and treatment

A
  • HTN
  • multiple pregnancies
  • males
  • expression of genetic mutation are linked to rapid progression
  • tx: BP management and pain management
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24
Q

Renal calculi
- what is it and risk factors

A
  • urinary stone disease or nephrolithiasis
  • over excretion and hyper saturation of calcium or oxalate
  • risk factors: acidic urine pH, gout, dehydration
25
classic presentation of renal calculi
- acute colicky flank pain radiating to the groin or perineal areas - hematuria/dark colored during g - severe pain in back and with urination - size is typically less than 5mm in diameter
26
Chronic kidney disease
- kidney dysfunction that lasts 3 months or longer GFR<60
27
Most common causes of Chronic kidney disease
- diabetes - HTN - glomerulonephritis
28
Pathogenesis of chronic kidney disease (CKD)
- diabetes: damage to nephron by hyperglycemia - Diabetes and HTN: release of angiotensin 2 damage nephron - long term glomerular inflammation will impede flow
29
Normal GRF rate
- 90- 120
30
Stage 1 of CKD
- protein in urine but GRF normal or increased - prephase
31
Stage 2: CKD
- increased albumin in urine - GFR 89-60 - important to control HTN to limit progression - can stay in stage 2 for years
32
Stage 3 CKD
- increased albumin in urine, decreased in blood - GRF: 59-30 - increase in BUN, creatinine - azotemia = accumulation of waste products in blood - confusion can occur
33
stage 4 CKD
- proteinuria - GRF 29-15 - BUN and creatinine increase - renin production increase and causes HTN
34
Stage 5 CKD
- kidney failure - kidneys do not excrete toxins - imbalances of fluids and electrolytes - uremia - lethargy, pruritic - sensory an motor neuropathy - pericarditis, impaired heart function - seizures and asterisks - dialysis and transplant
35
Clinical manifestations of CKD
- anemia: changes in hemoglobin/hematocrit - cardiovascular: HTN - MSK: arthralgia - GI systems: nausea, vomiting - renal osteodystrophy - extraskeletal calcification (changes with breaking down bone and increase calcium deposits in areas) - neurological system: confusion and seizures
36
Medical management of CKD
- HTN: ACE Inhibitors, alpha blockers - Diet: limit protein, K, and Na - restricted fluid intake - may need diuretics - Renal replacement therapy: dialysis/transplant (stage 5)
37
Hemodialysis
- AV (artery and vein) fistula put in - blood taken from artery through machine - machine removes waste, excessive fluids, adds electrolytes and return to vein - usually preformed at a center 3 times/week for 3-4 hour treatments
38
Peritoneal dialysis
- dialysis complete via catheter in peritoneal cavity - dialyzing solution put in catheter then drained - this causes a flooding of system and it filters things out - completed at home - 4 times per day or overnight - complications: peritonitis, hyperglycemia
39
Transplantation of a kidney
- limited by available donors - living donor preferred - risk of rejection - long term immunosuppressive meds/antirejection meds
40
- examples of anti-rejection meds and their side effect
- Cyclosporin, azathioprine Side effects - opportunistic infections - osteoporosis - nausea, vomiting, rash - renal disease
41
Nephogenic systemic fibrosis | what is it and signs and symptoms
- Fibrotic CT that disrupts normal cells - illness occurs with kidney disease - presents as firm, erythematous, indurated plaques of the skin associated with subcutaneous edema
42
Glomerular disease
- group of conditions - damage the kidneys filtering units - most common cause of ESRD world wide
43
Bladder cancer Common types
- transitional cell carcinomas - squamous cell carcinomas - adenocarcinomas
44
Clinical manifestations of bladder cancer
- painless hematuria - clots in urine. - incontience issue - increase frequency or urgency - dysuria: difficult to empty fully
45
- Urinary incontinence
- involuntary loss of urine that is sufficient to be a problem an occurs most often when bladder pressure exceeds sphincter resistance
46
Types of urinary incontinence
- functional - stress - urge - overflow
47
Functional incontinence
- not of the bladder but rather an inability to get to the bathroom in time
48
stress incontinence
- lifting, holding breath, coughing, sneezing caused - increase in abdominal pressure pushes urine out
49
urge incontinence
- feel urge to go premature - cannot stop it - problem with controlling the muscle sphincter
50
overflow icontinence
- full bladder - bladder doesn't empty fully and body gets use to resting level - bladder gets full and the person doesn't realize
51
Neurogenic bladder
- voiding dysfunction associated with neurological pathology - anything that affects the pathway to the bladder - may need to be put on a voiding schedule - clinical manifestations vary based on cause
52
causes of neurogenic bladder
- cerebrovascular accident - dementia - parkinsons disease - MS - brain tumors - Spinal cord lesions
53
Interstitial cystitis (painful bladder syndrome) - Diagnosis - etiology/risk factors
- diagnosed by cystoscopy - risk factors not clear
54
Pathophysiology of interstitial cystitis
- permeability of the bladder wall - exchange in layer of the bladder - overactivity of the pelvic floor muscles - visceromuscular reflex - hypersensitivity and neurologic irritation
55
Clinical manifestations of interstitial cystitis
- urgency and frequency increase - nocturia - pain in the bladder, urethra or vagina (can happen in males but more common in females) - supra pelvic pain - dull low back pain
56
treatment for interstitial cystitis
- symptoms management - stress relief - PT
57
Common side effects of diuretics/HTN medication
- orthostatic hypotension - vasodilators/diuretics - dyspnea- beta blockers (blunted exercise) - negative chronotropic effects - beta blockers - negative inotropic effect = decrease strength of contraction - altered potassium levels
58
Altered potassium levels with HTN drugs and hyperkalemia
- potassium sparing diuretics Beta blockers, drugs that affect RAAS
59
Altered potassium levels from HTN drugs causing hypokalemia
- loop and thiazide diuretics

Medical Conditions 2 (22 decks)

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