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PAtho > Unit 18 > Flashcards

Unit 18 Flashcards

1
Q

pyelonephritis

A

upper uti

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2
Q

what does an upper uti include

A

inflm of renal pelvis and parenchyma

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3
Q

et of pyelonephritis

A

bacteria (usually E coli)

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4
Q

Risks for pyelonephritis

A

supressed IR
cathetorization
urinary reflux
DM/infc in general

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5
Q

pattern of infc in pyelonephritis

A

ascending (urethra->bladder->uretur->kidney)

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6
Q

what does progression of bact in phyeloneph lt

A

kidney scaring

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7
Q

what type of tissue is responsible for kidney scaring

A

inc in fibrous and scar tissue

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8
Q

what is scar tissue formation in GU rt pyeloneph dependent on

A

duration of the infection

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9
Q

what does scar tissue to do renal fx

A

decreases it

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10
Q

chronic pyelonephritis

A

presistant infc or ongoing inflm -> obstr or reflux (str issue)

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11
Q

comp of chronic pyeloneph

A

renal damage -> failure

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12
Q

mnfts of pyelonep

A 
rapid onset w/o warning
those of infc
dysuria
pain
freq/urgency
pyuria
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13
Q

where does a pt feel pain in pyeloneph

A

lower back

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14
Q

what other mnft occurs in chronic pyeloneph

A

sev htn rt retention

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15
Q

dysuria

A

pain rt urine passing over areas of inflm

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16
Q

tx of pyeloneph

A

eradicate bact with abx

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17
Q

how long is the course of abx for acute pyelonep

A

10-14 days PO

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18
Q

what do we add to tx if pyeloneph is chronic

A

anti inflm drugs

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19
Q

what 5 things are defensive factors against lower UTIs

A 
local IR
mucin layer
washout
prostatic fluid
microbial antagonism
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20
Q

how does a mucin layer defend utis

A

glycoprotein that sits ontop of epith tissue forming barrier between bact and bladder wall

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21
Q

what str secs mucin

A

bladder

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22
Q

fx of washout in uti defense

A

forceful stream of urine flushes out any microbes that may have entered urethra

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23
Q

fx of prostatic fluid in uti defense

A

contain anti microbial properties

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24
Q

fx of microbial antagonism in uti defense

A

normal periurethral flora provides defense against abn flora in their niche

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25
Q

when is there inc chance for uti

A

when risks > defensive factors

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26
Q

risks for uti

A

cathertorization

obstr

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27
Q

how is cathetorization a risk for uti

A

bact attatch to cathedor surface and coat themselves with a biofilm that protects it from pts IR.

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28
Q

how is obstr a risk for uti

A

urine statsis dt no washout -> inc reflux which carries microbes

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29
Q

mnfts lower uti

A

acute onset
frequency, dysuria
lowerabdm/back pain

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30
Q

what is pain in lower uti related to

A

kidney location

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31
Q

dx of lower uti

A

mnfts

urinalysis

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32
Q

tx for lower uti

A

abx

tx underlying cause (obstr, reflux, stasis, cathedor)

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33
Q

fx of glomerulus

A

active sec, absorp, filtration, change permeability

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34
Q

5 categories of glomerular disease

A 
nephrotic syndrome
nephritic syndrome
sediment disorders
rapidly progressive glomerular nephritis
chornic glomerulonephritis
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35
Q

nephrotic syndrome

A

inc perm. inc components move out at glom lvl -> ultra filtration, inc fluid (water and lytes) and protein loss

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36
Q

nephritic syndrome

A

dec in perm. dec components move thru -> fluid retention and nitrogenous waste retention

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37
Q

sediment disorders

A

eg hematouria, proteinuria. molecules with inc sizes percipitate out

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38
Q

how man chronic glomerulonephritis present

A

with mfnts of either/including nephrotic s, nephritic s, sediment disordres

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39
Q

what type of reaction is rapidly progressive glom neph (RPGN)

A

type 3 H rxn

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40
Q

2 main problems with rpgn

A

impede filtration

abn deposits and attempted removal by macrophage -> endothelial destr -> inc perm dt “holes” and inflm

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41
Q

what must be present for ic to form (rpgn

A

infection

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42
Q

how many weeks does infc usually proceed rpgn

A

1 - 1.5

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43
Q

which pts have inc risk for rpgn

A

peds pts who had strep throat or dermal infc dt beta hemolytic stretococcus bact

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44
Q

what percent of adult cases of rpgn lt rf

A

1/3

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45
Q

2 histologic components of rpgn

A

hypercellularity

glomerular enlargment

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46
Q

hypercellularity

A

inc number of cells, pathologic hyperplasia, unexplained

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47
Q

what 3 cells does hypercellularity normally affect

A

wbc
mesangial (between caps)
endothelial cells

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48
Q

why does glomerular enlargement occur in rpgn

A

inflm and swelling

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49
Q

mnfts of rpgn

A

impeded filt and perm
olgiuria followed by proteinuria and hematouria
inc bun, creatinin
fluid retention

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50
Q

what is olgiuria in rpgn rt

A

dec urine vol rt dec perm in glomerulsu

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51
Q

what is proteinuria in rpgn rt

A

rt tears in endothelial lining allowing large molecules to escape

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52
Q

what hematuria in rpgn rt

A

cap damage

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53
Q

why is there an inc in bun, creatinin in rpgn

A

azotemia

54
Q

what are the 2 serious comps rt fluid retention in rpgn

A

sev htn rt inc vascular volume

systemic edema rt inc hsp dt fluid rtention and l/o protein lt dec OP

55
Q

how do we tx rpgn

A

self limiting with monitors by inc renal fx and symptomatic tx

56
Q

how long is recovery of rpgn

A

several weeks post onset

57
Q

renal calculi

A

kindey stones that form in kidney and move out to any part of ut

58
Q

who has an inc in renal calculi

A

men, 2-3x inc incidence

59
Q

what plays a large role in the et of renal calculi

A

diet and metb

60
Q

et of renal calculi

A

complex interaction rt diet and str changes of ut

61
Q

why does diet play a role in the et of renal calculi

A

inc [blood] -> inc [filtrate]

62
Q

what does the kidney normally sec to prevent crystallization of urine

A

3 different proteins present only in kidney

63
Q

what do the proteins sec by kidney not prevent

A

urine stasis

64
Q

what factors outweigh the benefit of proteins in the kidney (RC)

A

inc solute concentration and or urine stasis

65
Q

what happens in the kidney when benefits of proteins are outweighed

A

percipitate in urine forms nucleus -> stone formation

66
Q

what must be present for a kidney stone to form

A

nucleus

67
Q

4 types of kidney stones

A

calcium
mangesium ammonium phosphate
ureic acid
cystien

68
Q

contb factors to calcium RC

A

inc ca, immbolization, vit d intoxification, bone disease

69
Q

tx for calcium rc

A

underlying cause, inc fluid intake, thiazide diuertics

70
Q

cont fact to mangnesium ammonium phosphate rc

A

urea splitting uti’s

71
Q

tx for mg nh3 ph rc

A

tx uti, acidify urine, inc fluids

72
Q

cont factors for uric acid rc

A

formed in acid urine with ph about 5.5
gout
high protein diet

73
Q

tx for uric acid rc

A

inc fluid

alkalize urine

74
Q

cont factors for cystine rc

A

cystinuria rt inhereted aa metb disorder

75
Q

tx for cystine rc

A

inc fluid, alkalize urine

76
Q

what is beneficial about knowing the type of rc that has formed

A

prevents it from happening aagain

77
Q

staghorn rc

A

stone with a head and horn

78
Q

mnfts of rc

A 
sev pain with acute onset
renal colic
non colicky sev pain
n and v
diaphoresis
79
Q

how long may renal colic last (RC)

A

mins - days

80
Q

what is renal colic associated with

A

stone migration

81
Q

why may uretur be distended in RC

A

stone migration causing obstr

82
Q

what is non colicky sev pain in rc rt

A

distention of renal pelvis

83
Q

why is somebody with rc have n and v

A

sev pain

84
Q

dx for rc

A

cant use pain alone
US/CT (Fast)
labs - urinalysis
IVP

85
Q

IVP

A

intravenous polygram

86
Q

how does IVP work

A

inject dye via IV and watch it move thru circulation and into filtrate and urine. visualize blockage. not routine.

87
Q

tx for rc

A

pain relief
nv releif
tx cause
sx

88
Q

what sx may be used to treat rc

A

lithopsy - break down of stone using sound waves. fractures of large stones may cause problems distally

89
Q

what do we do to stones passed spontaneosly? which stones do we pass like this

A

collect them

90
Q

urinary incontinence

A

voiding incontinently
occurs inc with >60yo
mnft of a problem

91
Q

et/patho of urinary incontinence (3)

A

stress incontinence
overflow incontience
overactive bladder

92
Q

why is stress incontinence occur in UI

A

p application onto bladder + weakness/incompetence of bladder sphincter rt age.
- urethral vesicular angle change in women

93
Q

how does P application of bladder cause stress incontinence

A

inc intra abdm p can inc p on weak bladder sphincter

94
Q

why does change in urethral vesicular angle cause stress incont.

A

change in angle rt child birth is more susceptible to changes in P

95
Q

overflow incontinencec

A

intravesicular P > urethral P or retention and bladder distention

96
Q

overactive bladder

A

inc activity of bladder rt hyperactivite detuosur m. excessive contr/relax -> inc P -> incont

97
Q

what type of problem may an overactive bladder be

A

n or m

98
Q

tx for UI

A

drug (alpha adrenergic agonist)

sx (artificial sphincter)

99
Q

ARF

A

acute onset/recovery, l/o renal fx w/o warning with dec renal fx

100
Q

2 pressing problems with ARF

A

fluid/lyte imbal

azotemia

101
Q

what is kidney fx determined by

A

egfr

output (not always reliable)

102
Q

olguirua

A

100-400cc output a day

103
Q

what amount of output is barely enough to prevent azotemia

A

400cc/day

104
Q

anuria

A

no urine or

105
Q

why does kidney receive blood

A

filter it

perfusion

106
Q

when cant the kidney perfuse blood

A

dec blood vol or obstr

107
Q

what perecent of CO assists with kidney perfusion

A

20-25

108
Q

what happens when less then 20% of co goes to kidneys

A

problem

109
Q

primary et of arf

A

def renal perf rt hypovoluima/perf

110
Q

3 groups of et of arf

A

pre, intra, post

111
Q

what group of et of arf is most common

A

pre renal

112
Q

what et makes up 80-90 percent of arf

A

pre/intra

113
Q

pre renal arf

A

dec renal perf dt dehydration? lt olguiria/ischemia

114
Q

2 consequences of pre renal arf

A

inadeq perf -> ischema

dec filtration

115
Q

eg of intra renal arf

A

glomerular nephritis

116
Q

3 phases of intra renal arf

A

initiating
maintencance
recovery

117
Q

initiating phase of intra renal arf

A

problem is just starting from percipitating events

118
Q

maintenance phase of intra renal arf

A

dec egfr

olgiuria/azotemia

119
Q

recovery phase of intra renal arf

A

inc time dt tissue repair. grad inc in egfr. address cause

120
Q

post renal arf

A

eg bph

obstr to urine flow

121
Q

mfnts of arf

A

olguria/anuria
lyte imbal
azotemia
proteinuria, hemouria

122
Q

complications of arf

A

htn

edema

123
Q

tx for arf

A

stat intervention
replace fluid and lytes with monitoring
dialysis
diet

124
Q

why do we monitor when giving fluids to pts with arf

A

can they handle the inc fluid?

125
Q

types of dialysis

A

hemodialyis

peritoneal dialysis

126
Q

what diet changes do we make in pts with arf

A

well balanced, inc calories/carbs

dec protein to dec N waste

127
Q

crf

A

prog perm damage that occurs in stages

128
Q

stages of crf

A

diminshed renal reserve
renal insufficenty
rf

129
Q

diminshed renal reserve

A

dec kidney fx.
dec egfr by > or equal to 50% of normal
no mfnts of dec renal fx yet

130
Q

renal insufficency

A

gfr 20-50% of normal

131
Q

renal failure

A

gfr

132
Q

what is the gfr of total end stage failure

A

PAtho (31 decks)

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