Chapter 21 Urinary System Disorders

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levzahav9
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182918
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Chapter 21 Urinary System Disorders
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2012-11-11 18:58:12
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Chapter 21 Urinary System Disorders Pathophysiology
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Chapter 21 Urinary System Disorders Pathophysiology
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  1. Composition of Blood, Filtrate, and Urine
    • Water (L): Blood 180; Filtrate 180; Urine 1.4
    • Cells: Blood Yes; Filtrate None; Urine None
    • glucose (mg/L): Blood 1000; Filtrate 1000; Urine 0
    • protein (mg/L): Blood 40,000; Filtrate 0-trace; Urine 0-trace
    • urea (mg/L): Blood 260; Filtrate 260; Urine 18,000
    • Na+ (mEq/L): Blood 142; Filtrate 142; Urine 128
    • K+ (mEq/L): Blood 5; Filtrate 5; Urine 60
    • HCO3- (mEq/L): Blood 28; Filtrate 28; Urine 14
  2. Urinalysis: Cloudy, Dark color, or unpleasant or unusual odor results
    • cloudy: may indicate the presence of large amounts of protein, blood cells, or bacteria and pus
    • dark color: may indicat hematuria, excessive bilirubin content, or highly concentrated urine
    • unpleasant or unusual odor: may indicate infection or result from certain dietery components (asparagus) or medications
  3. UTIs
    • very common
    • most infections are ascending from perineal area then to bladder, ureters, kidneys
    • common causative organism is Escherichia coli, a resident flora of intestine, that doesn't wash out when voiding
  4. Pathophysiology of cystitis
    • infection
    • the bladder wall and urethra are inflamed, red, swollen, and sometimes ulcerated
    • bladder wall is irritated, hyperactive, and bladder capacity reduced
  5. signs and symptoms of cystisis
    • pain in lower abdomen
    • dysuria
    • urgency
    • frequent voiding
    • nocturia
    • systemic signs: fever, malaise, nausea, leukocytosis
    • cloudy urine with unusual odor
    • urinalysis indicates bacteria >100,000 per mm of urine, pyuria, microscopic hematuria
  6. Pathophysiology of pyelonephritis
    • one or both kidneys may be involved
    • infection extends from the ureter into the kidney
    • purulent exudate fills the kidney pelvis and calces and the meddula is inflamed
    • abscesses and necrosis is visible
    • bilateral obstruction by inefection is likely to result in acute renal failure
    • recurrent or chronic infection--> loss of tubule function and hydronephrosis--> if severe or bilateral, chronic renal failure
  7. Signs and symptoms of Pyelonephritis
    • signs of cystisis
    • dull aching pain in the lower back or Flank area
    • systemic signs from cystitis
    • urinalysis results similar to those for cystitis plus urinary casts
  8. urinary casts
    • generated in the small distal convoluted tubules and collecting ducts of the kidney, and generally maintain their shape and composition as they pass the lower conveyances of the urinary system.
    • Although the most common forms are benign, other forms are indicative of a pathologic state.
    • Include: leukocytes or epithelial cells
  9. treatment of UTIs
    • antibacterial drugs
    • the tannin in cranberry juice seems to reduce capability of E. coli to adhere to bladder mucosa
  10. define Glomerulonephritis
    • also known as glomerular nephritis
    • abbreviated GN
    • is a renal disease (usually of both kidneys) characterized by inflammation of the glomeruli, or small blood vessels in the kidneys.
    • usually occurs as a secondary disease after an upper respiratory infection with Streptococcus
  11. Pathophysiology of glomerulonephritis
    • the antistreptococcoal antibodies formed from the previous infection create an antigen-antibody complex that lodges in the glomerular capillaries, activates the complement system + cause inflammatory response in both kidneys
    • Increased permiability--> leakage of proteins, RBCs into filtrate--> congestion
    • when severe, congestion interferes with filtration--> decreased GFR--> retention of fluid and wastes--> acute renal failure if blood flow impaired--> decreased blood flow triggers Renin--> widespread vasocontriction and edema
  12. Signs and symptoms of glomerulonephritis
    • dark and cloudy urine
    • facial and periorbitol edema followed by generalized edema
    • BP elevated
    • flank pain develops
    • general signs of inflammation including malaise, fatigue, headache, anorexia, nausea
    • decreased urine output
  13. Diagnostic tests for glomerulonephritis
    • blood tests show elevated serum urea and creatinine
    • blood levels of streptococcal antibodies elevated
    • metabolic acidosis
    • urinalysis confirms proteinura, gross hematuria, and RBC casts
  14. urolithiasis
    refers to the condition of having calculi or kidney stones
  15. pathophysiology of calculi
    • tend to form when there is an excessive amount of relatively insoluble salts in the filtrate, esp. in hypercalcemia, or insufficient fluid intake
    • also form from cell debris from infection
    • urine is highly alkaline
    • immobility may be possible because if stasis in urine
    • may lead to hydronephrosis
  16. uric acid stones
    • develop mostly with hyperuricemia esp. when urine is acidic
    • Saturation levels of uric acid in blood may result in one form of kidney stones when the urate crystallizes in the kidney.
  17. signs and symptoms of kidney stones
    • frequently asymptomatic unless found by looking for a source of frequent infection
    • obstruction of the ureter causes renal colic
  18. renal colic
    • due to obstruction of the ureter
    • intense spasms of pain in the flank area radiating into the groin that last until the stone passes or is removed
    • caused by vigorous contractions of the ureter in an effort to force the stone out
    • may be accompanied by nausea and vomiting, cool moist skin, and rapid pulse
  19. hydronephrosis
    • cystic distension of the kidney caused by the
    • accumulation of urine in the renal pelvis as a result of obstruction to outflow and accompanied by atrophy of the kidney structure and cyst formation
  20. renal cell carcinoma
    • adenocarcinoma of the kidney
    • a primary tumor arising from the tubule of epithelium, more often in renal cortex
    • often has metastasized to liver, lung, bone, or CNS at time of diagnosis
    • more frequent in men and smokers
  21. signs and symptoms of renal cell carcinoma
    • usually painless hematuria that might appear then disappear after 1-2 days
    • dull, aching flank pain
    • palpable mass
    • unexplained weight loss
    • anemia or erythrocytosis (depending on the tumors effect on erythropoietin)
    • Paraneoplastic syndroms ie hypercalcemia (increased parathyroid hormone)or Cushing's syndrome (increased adrenocoirticotropic hormone)
  22. treatment for Renal Cell Carcinoma
    nephrectomy
  23. Bladder Cancer
    • often develops as multiple tumors and tends to recur
    • diagnosed by urine cytology and biopsy
    • tumor is invasive to adjacent sructions and metastasized through the blood to pelvic lymph nodes, liver, and bone
    • Early Sign: painless hematuria, gross or microscopic. Dysuria or frequency; infection common.
  24. Wilms' Tumor
    • nephroblastoma
    • most common tumor occuring in children
    • associated with defects on chromosome 11 + other congenital disorders
    • presents as large encapsulated mass
    • diagnosed at ages 2-5 when mass is obvious
    • pulmonary metastases possible
  25. acute renal failure
    • both kidneys must be involved
    • often reversible if the primary problem is treated successfully
    • kidneys may sustain permanent damage
    • causes: severe and prolonged circ. shock or heart failure; shock associated with burns or crush injuries; nephrotoxins including NSAIDS, when exposure is intense; mechanical obstructions--calculi
  26. chronic renal failure
    • the gradual irreversible destruction of the kidnesy over a long period of time.
    • may result from chronic kidney disease, systemic disorders such as hypertension or diabetes, nephrotoxinscannot be stopped once it has begun
  27. pathophysiology of chronic renal failure
    • Three stages: Decreased renal reserve, insufficiency, end-stage renal failure
    • Decreased Renal Reserve: 60% nephrons lost but remaining nephrons adapt and increase capacity for filtration. No clinical signs.
    • Insufficiency: 75% nephrons lost.indicated by a change in blood chemistry and manifestations. GFR decreased to 20% less,significant retention of nitrogenous wastes in blood. Marked by excretion of large volumes of dilute urine.
    • End-stage renal failure: More than 90% nephrons lost. Uremia. Fluid, electrolytes, and wastes are retained in the body and all body systems affected. Marked oliguria/ anuria.
  28. Signs and symptoms of chronic renal failure
    • Early signs: polyuria manifested as frequency and nocturia
    • anorexia, nausea, anemia, fatigue, unintended weight loss, exercise intolerance
    • bone marrow depression and impaired cell function caused by increased wastes
    • high BP
    • End-Stage: uremic signs are oliguria, dry pruritic and hyperpigmented skin, easy bruising
    • peripheral neuropatyy--abnormal sensatiosn in the lower limbs
    • impotence and decreased libido in men, menstrual irregularities in women
    • encephalopathy
    • CHF, arrhythmias
    • failure of kidney to activate vit. D for Ca absorption and metabolisms, urinary retnetion of phosphate ion--> hypocalcemia and hyperphosphatemia with osteodytrophy, osteoporosis, and tetany
    • possibly uremic frost on the skin and urinelike breath (terminal)
    • systemic infections such as pneomonia
  29. azotemia
    • a medical condition characterized by abnormally high levels of nitrogen-containing compounds, such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds in the blood.
    • largely related to insufficient filtering of blood by the kidneys-->indicative of renal failure

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