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Clinical Pathology II > Urinary System Pathologies > Flashcards

Urinary System Pathologies Flashcards

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1
Q

What is the role of PT’s in urinary system disorders?

A
  • treating incontinence

- screening out potential renal and urinary tract disorders from musculoskeletal disorders

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2
Q

What are the kidney functions?

A
  • maintain vol of body fluids, electrolyte balance, and osmolarity with changes in food intake and metabolism
  • regulates electrolytes (Na, K, Cl, Ca, Mg, and phosphate)
  • secretes renin and erythropoietin
  • involved with vit D formation
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3
Q

what happens to most of the water and solutes that enters the proximal tubule?

A

It is reabsorbed

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4
Q

Blood flows through what for filtration?

A

glomerulus

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5
Q

What blood contents are too large to pass through the glomerulus, so stay in the blood?

A

plasma proteins, cells and platelets

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6
Q

99% of the blood filtrate is reabsorbed where?

A

in the tubules

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7
Q

What is the excreted byproduct of muscle metabolism?

A

creatine

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8
Q

What is the excreted byproduct of protein metabolism?

A

urea

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9
Q

What percent of urea is reabsorbed?

A

53%

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10
Q

What percent of creatine is reabsorbed?

A

0%

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11
Q

What does renal failure cause with creatine and urea?

A

build up in blood

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12
Q

Steps of blood pressure regulation (Renin-angiotensin sysytem)

A

BP Drops –> Kidney secretes Renin–> Renin converts angiotensinogen to angiotensin I–> angiotensin converting enzyme (ACE) converts A I to angiotensin II (A II) –>A II stimulates release of Aldesterone from adrenal glands (increases Na+ and H20 reabsorption) –> A II causes peripheral vasoconstriction

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13
Q

H20 and Na+ reabsorption and vasoconstriciton causes what?

A

increase BP

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14
Q

What type of drugs are used to decrease arterial pressure?

A

ACE inhibitors and A II receptors

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15
Q

High BP has a direct relationship with what disease?

A

kidney disease

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16
Q

What hormone is secreted by the posterior pituitary in response to increased plasma osmolarity and decreases in BP?

A

Antidiuretic hormone

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17
Q

ADH causes water reabsorption by the kidney, which, in turn does what?

A

decreases urine ouput and increases blood pressure

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18
Q

What drugs cause a loss of water and are sometimes used to treat hypertension or edema caused by CHF?

A

diuretics

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19
Q

A decrease in plasma levels of calcium causes secretion of what hormone?

A

parathyroid hormone

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20
Q

What does the parathyroid hormone do to regulate Ca?

A

increased Ca++ reabsorption in kidney –> then activates vitamin D (increases absorption of Ca++ from small intestine–> releases Ca++ from bones (can cause osteoporosis)

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21
Q

what is secreted by the kidney and stimulates the bone marrow to produce red blood cells in response to tissue hypoxia?

A

Erythropoieten (EPO)

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22
Q

What does blood doping cause?

A

artificially increasing the number of red blood cells in order to increase oxygen carrying capacity

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23
Q

What is the role of Vitamin D?

A

increases the absorption of calcium from intestinal tract and reabsorption of calcium in the kidney (similar to PTH)

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24
Q

Why are UTI’s more common in females and elderly?

Study These Flashcards
A

females–> close proximity of urethra, vagina, and rectum

elderly–>side effects of immobility or inactivity

25
What factors increase risk of UTI?
- increased age - gender-female - incontinence leading to catherization - increased sexual activity - diabetes - pregnancy
26
What are significant signs and symptoms of UTI's?
- dysuria (painful or difficult urination) - increased frequency and urgency - hematuria (blood in urine)
27
What kind of pain can UTI' mimic?
musculoskelatal--> back pain near costovertebral angle (flank or side) tenderness
28
What is the infection of the renal pelvis and interstitum?
Pyelonephritis (kidney infection)
29
What are risk factors for pyelonephritis?
- result of ascending UTI or reflux of urine from bladder ( neurogenic bladder) - kidney stones that cause blockage
30
what is a neurogenic bladder?
the lower sphincter closes as the bladder contracts dispelling which causes urine to be dispelled up into the kidney rather than out of the urethra. (paraplegia, stroke)
31
What are some clinical manifestations of pyelonephritis?
- UTI symptoms (fever,chills, hematuria)-back pain, shoulder pain - urinalysis shows increased WBC
32
What is the most common adult neoplasm?
renal cell carcinoma
33
What are the signs and symptoms of renal cell carcinoma?
- hematuria (most common) - silent symptoms, initially - abdominal/flank pain later on - palpable abdominal mass
34
What is the most common inherited cause of kidney disease?
Polycystic disease
35
What is polycystic disease?
accumulation of fluid in kidney causing a cyst or cysts, caused by obstruction or weak basement membrane
36
What are symptoms of polycystic disease?
- flank pain (most common) - palpable, enlarged kidneys - hematuria - hypertension
37
What should you be aware of as a PT with a pt with polycystic disease?
- aware of signs of symptoms worsening - increased risk of UTI's - increased risk of hypertension
38
What is the third most common urinary tract disorder? below UTI's and prostate disease
Kidney stones (nephrolithasis, renal calculi)
39
What are some risk factors of kidney stones?
- 4 times greater in males - increased grapefruit juice - obesity and weight gain - warmer climates - 50% reoccurance
40
How do you differentiate renal/urethral pain from LBP?
renal/urethral pain is usually not altered by position, whereas musculoskeletal pain often is
41
What is the role of the PT with a patient suspection of nephrolithiasis?
- have a positive history and exam requires immediate referral to physician - differentiate from signs and symptoms due to musculoskeletal origin
42
What occurs when someone has chronic renal disease (CKD)?
- gradual loss of nephrons - decreased glomerular filtration and reabsorption - decreased endocrine function of kidneys * *up to 50% of nephrons can be lost before functional impairment shows up
43
Why is Chronic renal disease (CKD) referred to as a silent disease?
often has no symptoms in its early stages and can go undetected until very advanced.
44
What are CKD risk factors?
- hypertension - diabetes - use of NSAIDs - increased age - smoking - hereditary
45
Why is hypertension a risk factor of CKD?
by damaging the glomerulus arterioles, decreasing GFR and increasing protein filtration. Excretion of albumin is a sensitive marker for kidney disease.
46
What happens to the hematocrit system and cardovacular system in renal disease?
hematologic- anemia due to decreased RBC production resulting in fatigue cardio- hypertension caused by increased renin production, increased Na+ retention and increased fluid volume, leading cause of death
47
What does renal disease do to the neuromuscular and skeletal system?
neuromuscular- muscle cramping, weakness, myopathy, sensory loss, tremors skeletal- demineralization of bone due to loss of calcium in urine and drop in serum calcium triggers release of PTH-->osteoporosis
48
What does renal disease do to the neurologic and gastrointesitinal system?
neurologic- increased uremia alters nervous system function, memory loss, irritability, impaired judgement, seizures, coma gastro- anorexia, nausea vomiting
49
What does renal disease do to ones physical performance and integumentary system?
performance- becomes impaired early in course of disease, not always related to anemia integumentary- pallor, bruising, skin pigmentation
50
What are some PT concerns when treating a patient with renal disease?
- decreased RBC--> anemia, fatigue, weakness - osteoporosis - renal osteodystrophy--> Ca++ loss, bone pain in LE and spine - memory loss, coma, decreased alterness
51
What are the 2 types of dialysis treatment a patient with renal disease can undergo?
hemodialysis- filtering blood (most common) | peritoneal- catheter
52
What can exercise do with someone with renal disease)
- increase aerobic capacity - increase walking capacity - reduce BP and HR - increase strength
53
what bladder muscle is affected in an UMNL? What occurs?
Detrusor muscle - decreased urine volume - increased frequency and urgency - involuntary voiding - incoordination of detrusor and sphincter muscle leding to decreased flow and reflux
54
What happens to the detrusor muscle in a LMNL below sacral level?
- flaccid bladder (spina bifida, diabetes) | - detrusor muscle inactivity and loss of sensation of bladder fullness causes overflow incontinence
55
What are some treatments of a neurogenic bladder?
- catherization (intermittent or permanent) - bladder retraining, EMG biofeedback - control of fluid intake - surgery
56
What is functional urinary incontinence?
normal urine control but have difficulty reaching a toilet in time because of muscle or joint dysfunction
57
What is stress urinary incontinence?
loss of urine during activities that increases intra-abdominal pressure such as coughing or laughing -->pelvic floor weakness
58
What is urge urinary incontinence?
sudden, unexpected urge to urinate and the uncontrolled loss of urine (overactive or spastic) UMNL
59
What is Overflow incontinence?
frequent dribbling or leaking of urine form a bladder that is full but unable to empty (blocked or flaccid bladder) LMNL

Clinical Pathology II (1 decks)

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