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Med Surg > 44 - Problems of Urinary System > Flashcards

44 - Problems of Urinary System Flashcards

1
Q

upper urinary system

A

2 kidney + 2 ureters

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2
Q

lower urinary system

A

bladder + urethra

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3
Q

(6) kidney functions

A 
1 reg volume + composition of ECF
2 excrete wastes
3 control BP
4 make erythropoietin
5 activate vit D
6 reg acid-base balance
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4
Q

kidney location

A
  • between T12-L3

- right is lower than left

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5
Q

__ protects the kidneys and acts as a shock absorber

A

capsule

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6
Q

parenchyma

A

tissue of the kidney

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7
Q

functional unit of the kidney

A

nephron

-each kidney has 1 mil nephrons

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8
Q

each nephron is composed of…

A
  • glomerulus
  • bowman’s capsule
  • tubular system
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9
Q

amount of blood flow to kidneys

A

1200 mL/min

-accounts for 20-25% of CO

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10
Q

glomerulus

A

collection of up to 50 capillaries

-where urine formation begins + where blood is filtered

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11
Q

filtration is more RAPID than ordinary tissue capillaries becasue ____

A

glomerular membrane is porous

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12
Q

formula to decide the average amount of urine output

A

0.5-1.5/mL/kg/hr

UOP

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13
Q

glomerular filtration rate [GFR]

A

amount of blood filtered each minute by the glomeruli

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14
Q

average GFR

A

125 mL/min

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15
Q

the peritubular capillary network ________ before it reaches the collecting duct

A

REABSORBS MOST of the glomerular filtrate

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16
Q

average rate of filtrate is excreted

A

1 mL/min

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17
Q

REABSORPTION is the passage of a substance from the ______ to the _____

A

fr the lumen of tubules

to the tubule cells + capillaries

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18
Q

SECRETION is the passage of a substance from the ______ to the _____

A

fr the capillaries

to the lumen of the tubules

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19
Q

proximal tubule

A

reabsorbs 80% of electrolytes

-inc glucose, amino acids, HCO3-, water

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20
Q

loop of henle

[ascending + descending]

A

concentration of filtrate
ASCENDING: reabsorbs Cl- > Na+
DESCENDING: reabsorption of water

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21
Q

distal tubule

A
  • reabsorption of water (reg by ADH)

- reabsorp HCO3-

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22
Q

collecting duct

A

reabsorption of water

-MUST HAVE ADH

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23
Q

distal tubule is regulated by

A

ADH

-makes the distal convoluted tubules + collecting ducts MORE PERMEABLE TO WATER

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24
Q

2 important functions of the distal convoluted tubules

A

1 final regulation of water balance

2 acid base balance

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25
Q

25% of Na+ is reabsorbed in the ____

A

ascending limb of loop of henle

-passive move, follows Cl-

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26
Q

how is ADH secretion inhibited?

A

osmoreceptors in hypothalamus direct DECR plasma osmolarity

  • supraoptic cells send messages to POST PITUITARY GLAND
  • inhibit ADH secretion

-tubules become impermeable to water

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27
Q

Aldosterone

A
  • released fr adrenal cortex
  • acts on distal tubule
  • reabsorbs Na+ + water
  • secretion of K+
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28
Q

HCO3-

A
  • reabsorbs + conserves HCO3

- secretes excess H+

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29
Q

Atrial Natriuretic Peptide

A
  • released by myocyte cells in rt atrium
  • triggered by atrial distention/incr plasma vol
  • incr Na sodium
  • inhibits renin, ADH, + ANG II
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30
Q

parathyroid hormone [PTH]

A
  • released in response to LOW Ca
  • incr in tubular reabsorp of Ca+
  • decr reabsorp of PO4 (phosphate)

major effect on bone metabolism

31
Q

vitamin D

A
  • obtained by diet or UV radiation
  • activated by liver then kidneys
  • essential for absorption of Ca in GI tract
32
Q

erythropoietin

A
  • secreted by kidneys in response to HYPOXIA + DECR RENAL BF

- stims RBC production in bone marrow

33
Q

renin

A
  • secreted by juxtaglomerular cells
  • activates ANGIOTENSINOGEN into ANGIOTENSIN I
  • INCREASES BP
34
Q

renin is released in response to ___

A
  • decr renal perfusion
  • decr arterial BP
  • decr ECF
  • decr serum Na
  • incr urinary Na
35
Q

angiotensinogen

A

plasma PROTEIN - not hormone

  • fr liver
  • activated into ANG I by renin
36
Q

ACE is found in _____

A

inner surface of all blood vessels

-esp high in vessels of lungs

37
Q

RAAS causes…

A

Na + water reabsorption>
incr in ECF>
incr in BP

38
Q

ANG II

A

causes vasoconstriction >

incr BP

39
Q

prostaglandin that are synth in the kidneys

A
  • occurs primarily in medulla
  • causes vasodilation > incr renal BF > promote Na excretion
  • vasodilation> decr BP
40
Q

____ + ____ are often sites of obstructions

A

ureteropelvvic junction [upj] + ureterovesical junctions [uvj]

bc ureter lumens are the narrowest at these junctions

41
Q

renal colic

A

acute, severe flank pain

-may be caused by passing stone

42
Q

renal pelvis only holds _____ of urine

A

3-5 mL

-kidney damage can result fr backflow of more than that amount

43
Q

what happens when bladder pressure rises i.e. during voiding or coughing

A

muscle fibers that the ureters shares w bladder base CONTRACT FIRST

  • promotes lumen closure
  • next BLADDER CONTRACTS against base
  • ensures UVJ closure + prevention of reflux
44
Q

normal daily adult urine output

A

1500 mL/day

-typically 5-6x during the day

45
Q

vol of urine at night is less than half formed during the day bc of ___

A

ADH

46
Q

on average, ____ mL of urine cause moderate distention + urge to urinate

A

200-250 mL

-when it reaches 400-600 mL, it feels uncomfortable

47
Q

urothelium

A
  • transitional cell epithelium bladder
  • resistant to absorption of urine
  • —once urine has left the kidney, they cannot be reabsorbed by the urinary sistem
48
Q

continence

A

voluntary control

49
Q

if you cannot void at a given time _____ are stimulated and transmitted back to cause _______

A

inhibitor impulses in brain

detrusor muscles to accommodate pressure (do not contract), pshincter + pelvic floor tighten (contract)

50
Q

changes in the aging kidney

A

30-90yr: 20-30% decr in size + weight
70’s: 50% of glomeruli have lost their function

  • decr renal BF > decr GFR
  • changes in hormone
    women: loss of elasticity + muscle strength
    men: prostate enlargement
51
Q

anuria

A

<100 mL/daily

52
Q

oliguria

A

100-400 mL daily

53
Q

positions to help urinate

A

CREDES: pressing on lower ab
VALSALVA: straining

54
Q

how does sedentary lifestyle affect urinary

A
  • more likely to have stasis of urine

- demineralization of bones> incr Ca> stones

55
Q

can you palpate the urinary bladder?

A

normally no unless distended

56
Q

should kidney punch (percussion) elicit pain?

A

not in normal kidneys

57
Q

a bladder does not percuss until it contains ___

A

150mL

58
Q

patients undergoing diagnostic studies should not receive _______________

A

magnesium citrate (anything w Mg),
fleet enema,
iodine based contrast

59
Q

when a patient w kidney failure has multiple diagnostic studies, it is important to make the patient stays ____

A

HYDRATED

60
Q

urinalysis is best obtained in the ___ and best examined within ____

A

morning

w/in 1 hr

61
Q

creatinine

A

waste product made by muscle breakdown

-urinary excretion of creatinine is a measure of the amount of active muscle tissue in the body

62
Q

normal creatinine ranges

A

MALE: 107-139 mL/min/1.73cm
FEMALE: 87-107 mL/min/1.73cm

63
Q

most accurate indicator of kidney function

A

creatinine clearance

  • almost all creatinine is excreted by the kidneys
  • reflection of GFR
64
Q

anuria is a sign of

A

AKI, ESRD, bilateral ureteral obstructn

65
Q

burning urine is a sign of

A

urethral irritation, UTI, calculus

66
Q

dysuria is a sign of

A

UTI, interstl cystitis, calculus, + more

67
Q

enuresis

A

involuntary nocturnal urination

68
Q

enuresis is a sign of

A

lower urinary tract disorder

69
Q

frequency is a sign of

A

acute inflamed bladder, retention w overflow, calculus

70
Q

hematuria is a sign of

A

cancer, blood dyscrasias, kidney diseases, stones, UTI, anticoag

71
Q

hesitancy is a sign of

A

partial obstruction, BPH

72
Q

incontinence is a sign of

A

neurogenic bladder, bladder infection, injury to external sphincter

73
Q

nocturia is a sign of

A

impaired concentrating ability, obstruction, HF, diabetes, post renal transplant, excess evening fluid intake

74
Q

oliguria is a sign of

A

severe dehydration, shock, transfusion rxn, kidney disease, ESRD

Med Surg (18 decks)

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