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Med Surg > 44 - Problems of Urinary System > Flashcards

44 - Problems of Urinary System Flashcards

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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
25% of Na+ is reabsorbed in the ____
ascending limb of loop of henle | -passive move, follows Cl-
26
how is ADH secretion inhibited?
osmoreceptors in hypothalamus direct DECR plasma osmolarity - supraoptic cells send messages to POST PITUITARY GLAND - inhibit ADH secretion -tubules become impermeable to water
27
Aldosterone
- released fr adrenal cortex - acts on distal tubule - reabsorbs Na+ + water - secretion of K+
28
HCO3-
- reabsorbs + conserves HCO3 | - secretes excess H+
29
Atrial Natriuretic Peptide
- released by myocyte cells in rt atrium - triggered by atrial distention/incr plasma vol - incr Na sodium - inhibits renin, ADH, + ANG II
30
parathyroid hormone [PTH]
- released in response to LOW Ca - incr in tubular reabsorp of Ca+ - decr reabsorp of PO4 (phosphate) major effect on bone metabolism
31
vitamin D
- obtained by diet or UV radiation - activated by liver then kidneys - essential for absorption of Ca in GI tract
32
erythropoietin
- secreted by kidneys in response to HYPOXIA + DECR RENAL BF | - stims RBC production in bone marrow
33
renin
- secreted by juxtaglomerular cells - activates ANGIOTENSINOGEN into ANGIOTENSIN I - INCREASES BP
34
renin is released in response to ___
- decr renal perfusion - decr arterial BP - decr ECF - decr serum Na - incr urinary Na
35
angiotensinogen
plasma PROTEIN - not hormone - fr liver - activated into ANG I by renin
36
ACE is found in _____
inner surface of all blood vessels | -esp high in vessels of lungs
37
RAAS causes...
Na + water reabsorption> incr in ECF> incr in BP
38
ANG II
causes vasoconstriction > | incr BP
39
prostaglandin that are synth in the kidneys
- occurs primarily in medulla - causes vasodilation > incr renal BF > promote Na excretion - vasodilation> decr BP
40
____ + ____ are often sites of obstructions
ureteropelvvic junction [upj] + ureterovesical junctions [uvj] bc ureter lumens are the narrowest at these junctions
41
renal colic
acute, severe flank pain | -may be caused by passing stone
42
renal pelvis only holds _____ of urine
3-5 mL | -kidney damage can result fr backflow of more than that amount
43
what happens when bladder pressure rises i.e. during voiding or coughing
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
normal daily adult urine output
1500 mL/day -typically 5-6x during the day
45
vol of urine at night is less than half formed during the day bc of ___
ADH
46
on average, ____ mL of urine cause moderate distention + urge to urinate
200-250 mL -when it reaches 400-600 mL, it feels uncomfortable
47
urothelium
- transitional cell epithelium bladder - resistant to absorption of urine - ---once urine has left the kidney, they cannot be reabsorbed by the urinary sistem
48
continence
voluntary control
49
if you cannot void at a given time _____ are stimulated and transmitted back to cause _______
inhibitor impulses in brain detrusor muscles to accommodate pressure (do not contract), pshincter + pelvic floor tighten (contract)
50
changes in the aging kidney
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
anuria
<100 mL/daily
52
oliguria
100-400 mL daily
53
positions to help urinate
CREDES: pressing on lower ab VALSALVA: straining
54
how does sedentary lifestyle affect urinary
- more likely to have stasis of urine | - demineralization of bones> incr Ca> stones
55
can you palpate the urinary bladder?
normally no unless distended
56
should kidney punch (percussion) elicit pain?
not in normal kidneys
57
a bladder does not percuss until it contains ___
150mL
58
patients undergoing diagnostic studies should not receive _______________
magnesium citrate (anything w Mg), fleet enema, iodine based contrast
59
when a patient w kidney failure has multiple diagnostic studies, it is important to make the patient stays ____
HYDRATED
60
urinalysis is best obtained in the ___ and best examined within ____
morning | w/in 1 hr
61
creatinine
waste product made by muscle breakdown | -urinary excretion of creatinine is a measure of the amount of active muscle tissue in the body
62
normal creatinine ranges
MALE: 107-139 mL/min/1.73cm FEMALE: 87-107 mL/min/1.73cm
63
most accurate indicator of kidney function
creatinine clearance - almost all creatinine is excreted by the kidneys - reflection of GFR
64
anuria is a sign of
AKI, ESRD, bilateral ureteral obstructn
65
burning urine is a sign of
urethral irritation, UTI, calculus
66
dysuria is a sign of
UTI, interstl cystitis, calculus, + more
67
enuresis
involuntary nocturnal urination
68
enuresis is a sign of
lower urinary tract disorder
69
frequency is a sign of
acute inflamed bladder, retention w overflow, calculus
70
hematuria is a sign of
cancer, blood dyscrasias, kidney diseases, stones, UTI, anticoag
71
hesitancy is a sign of
partial obstruction, BPH
72
incontinence is a sign of
neurogenic bladder, bladder infection, injury to external sphincter
73
nocturia is a sign of
impaired concentrating ability, obstruction, HF, diabetes, post renal transplant, excess evening fluid intake
74
oliguria is a sign of
severe dehydration, shock, transfusion rxn, kidney disease, ESRD

Med Surg (18 decks)

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