urinary function Flashcards
(20 cards)
minimum urine output for
adult
child (>1 year old)
neonate/infant (<1yr old)
adult: 0.5 mL/kg/hr
child: 1.0 mL/kg/hr
neonate: 2.0 mL/kg/hr
differentiate:
urge incontinence
overflow incontinence
mixed incontinence
functional incontinence
gross total incontinence
transient incontinence
urge: sudden intense urge to urinate that occurs before or simultaneously with involuntary loss of urine. detrusor muscle contracts involuntarily while bladder is filling. aka overactive bladder
overflow: inability to empty bladder due to detrusor underactivity or bladder outlet obstruction. dribbling urine or a weak urine stream. detrusor issues can stem from age, neuropathy, spinal detrusor efferent nerve disorder, or low estrogen.
mixed: when symptoms of more than one type of incontinence occur.
functional : this is not a urinary system disorder but rather a mental or physical block. usually in older adults, especially those in nursing homes.
gross total: continuous leaking of urine, day and night or periodic large leaks. bladder has no storage capacity. spinal cord or urinary injury, fistula (abnormal opening) between bladder and adjacent structure like vagina.
transient: incontinence from temporary condition like lethargy, infection, alcohol, caffeine, fecal impaction.
risk factors of urinary incontinence
sex
advancing age
being overweight
smoking
renal disease or DM
Causes of neurogenic bladder based on where nervous system is affected:
* above the pontine micturition center (center of pons)
* below micturition center C2-T12
* below S1
above C2: detrusor hyperreflexia. (stroke, brain injury, Multiple sclerosis, cerebral palsy, alzheimer disease
C2-T12: detrusor hyperreflexia with vesicosphincter dyssynergia. (spinal cord injury C2-T12, multiple sclerosis, Guillain-Barre syndrome, disk problems)
Below S1: detruso areflexia with or w/o urethral sphincter incompetence. MS, spinal injury T12-S, causa equina syndrome, herpes simplex/zoster
What is bladder pain syndrome/interstitial cystitis?
key characteristics
risk factors
chronic bladder pain without apparent cause for the pain. bladder inflammation is usually absent despite the name.
5 times more prevalent in womean
key characteristics: visible ulcers aka Hunner lesions on the bladder wall. Suprapubic or urethral pain, can be on lower back and abdomen. Pain worsens with citrus and spicy food, caffeine, alcohol, or after exercise or sexual activities. Stress can be a trigger.
what is asymptomatic bacteriuria
urine contains bacteria without symptoms of a UTI. tx is not necessary, as it may increase antibiotic resistance.
what is hydronephrosis?
causes?
Normally, urine flows from the kidneys → through the ureters → into the bladder → then out of the body.
But if something blocks or slows down this flow, urine backs up into the kidney. causing it to swell
causes: nephrolithiasis, tumors, benign prostatic hyperplasia, stenosis, but can also occur without obstruction like diabetes (large diuresis). Pregnany women because of anatomic changes.
clinical manifestations of nephrolithiasis
colicky pain : periods of pain lastin 20min -60 min. calculi is scaping the wall. ureter spasms to move it along.
hematuria, almost always present
dysuria, frequency, and urgency with calculi in the distal ureter
fever and chills if infection is present
Wilms Tumor
rare kidney cancer that affects children. thought to arise in utero when kidney cells do not develop properly. Autosomal dominant. more higher in femals and Blacks.
CM: abdomninal mass or swelling with or without pain. humaturia, fever and HTN.
Classification of renal cysts and tx/malignancy potential
I
II
IIF
III
IV
type I : benign simple cyst - round, imperceptible cell wall. just evaluate, no tx. <1% malignancy
type II: minimally complex, benign cysts. defined margins, thin septa. just eval no tx <1% malignancy
type IIF: thicker calcification, multiple septa (walls), enhancement. CT and MRI with contrast. 5% malignancy potential
Type III: indeterminate cysts, thick and nodular septa. fine needle biopsy, partial nephrectomy, radiofrequency abalation. 55%
type IV: malignant cysts that are solid with necrosis. partial or total hysterectomy. 85%-100% malignancy.
clinical manifestations of renal cell carcinoma
asymptomatic in the early stages.
s/s hematuria, abdominal renal mass that is firm, abdominal flank pain thats dull and achy.
- if inferior vena cava is affected then edema, ascities, hepatic problems
most common bladder cancer type?
risk factors?
90% are urothelial (transitional) cell carcinomas. bladder, ureters, urethra, and renal pelvis. but mostly bladder
common in men and whites. 69-71 years. Smoking is most common risk facto, recurrent UTI, long term catheter placement.
clinical manifestation of bladder cancer
painless hematuria that is gross (visible) or microscopic. intermittent or can occur at anytime during urination.
what is benign prostatic hyperplasia
Clinical manifestations?
common porstate gland enlargement that presses against the urethra like a clamb. -> urine obstruction -> urinary stasis and UTIs. over time bladder wall becomes thick and irritated -> overactive bladder or destrusor instability. chronic issue is inability to empty completely.
CM: LUTS lower urinary tract symptoms- dribbling, spraying of stream, intermittende stream, straining to void. recurrent UTIs, retention, kidney failure.
prostate cancer risks
risk for men between 65-75 years increased. for black men at a younger age. family hx of other cancers, breast cancer varients will contribute.
high fat diet, androgen hormone replacement, STI
prostate cancer clinical manifestations
same as BPH + bloody semen, hematuria. Digital rectal exam will show prostate nodules, hardened tissue aka induration, asymmetry.
if metatisized to bone then bone pain, weigh tloss, spinal cord compression symptoms, pathologic fractures
what is glomerulonephritis?
inflammation of the glomeruli, which are tiny filters in the kidneys that remove waste and excess fluids from the blood. Usually autoimmune hummoral or cell mediated.
what is acute kidney injury defined by
3 categories of causes
sudden loss of renal function
- prerenal conditions: low BP or low blood volume (hemorrhage, sepsis, dehydration, shock). heart dysfunction. Liver disease with portal hypertension
- intrarenal conditions: reduced blood supply within kidnies like renal vein thrombosis, renal aneurysm, artherosclerosis.
- postrenal conditions: interfere with urine excretion. bilateral ureter obstruction.
Clinical manifestations of Acute Kidney Injury
initial
oliguric
diuretic
recovery
initial: marks the commencements of renal damage. usually asymptomatic
oliguric: impaired glomerular filtration leads to solute and water reabsorption which decreases daily urine output.
- electrolyte disturbances (increased levels), fluid volume excess, high creatinine, metabolic acidosis
diuretic phase: gradual return of renal functions. diuresis returnes due to tubular damage which means urine cannot be as concentrated -> dehydration, hypotension, lower electrolyte levels, increased urine output.
