A&P Test 5 Flashcards
Urine flows from
the kidney pelvis and is propelled through the ureters by perstalic action
The urge to void
Parasympathetic nerve response to stimulation by bladder wall stretch
-usually occurs after about 200-300 ml of urine has collected in the bladder
Motor nerves to external urinary sphincter
When activated, the sphincter remains contracted, allowing voluntary control over urination
Urinary retention
- an inability to void due to blockage of the urethra
- sufficient urine is being produced by kidneys but patient is unable to expel urine from the bladder
- Causes can be mechanical, congenital or functional
Retention with overflow
- Pt will complain of full bladder with frequent small amounts of urine
- As the bladder overfills, the restraining capability of the sphincter is taxed
- Small amount of urine will be released to reduce pressure to the level where the sphincter can control the flow of urine again
Normal Kidney Function
- Electrolyte balance
- Acid-base balance
- Metabolic regulation
- Body water regulation
- Excretory regulation
Body water regulation:
Functional unit of the kidney is the nephron
- normal GFR is 125 ml/min (180 L/day)
- blood filtered across semipermeable membrane into Bowman’s capsule
- 99% of water is reabsorbed
- ADH and aldosterone help reabsorption in distal tubule-blood pressure regulation
Acid base balance-
- Bicarb retention
* Eliminates excess H+ (acids)
Excretory regulation-
- phosphates
- uric acid
- drug metabolites
- nitrogenous waste products
- urea
- creatinine
Normal Renal BUN:
3-29
Normal Creatinine
0.5-1.4
Sodium:
135-148- more than 99% is reabsorbed
Potassium
3.4-5.3 Excrete >90% of total daily K intake
Cl
96-110
Calcium
8.5-10.4 activate vitamin D and assist with calcium absorption
Magnesium
1.4-2.5 excrete excess magnesium
Phosphorus
2.5- 4.5 excrete phosphorus
Kidneys produce and release:
erythropoietin
Erythropoietin stimulates
bone marrow to make RBC
- vit D activation
- RAA
Chronic renal failure def:
Progressive, irreversible destruction of the nephrons of the kidneys
- up to 80% of the GFR may be lost with few changes in the functioning of the body
- remaining nephrons hypertrophy to compensate
- gradual onset-months to years
Stage 1
Signs of mild kidney disease with normal or better GFR- 90%
Stage 2
mild kidney disease, decreased GFR 60-89%
Stage 3
moderate chronic renal insufficiency- 30-59%
Stage 4
severe chronic renal insufficiency 15-29%
Stage 5
ESRD- less than 15%
Gerontologic Considerations:
- Physiological changes in vascular bed affect renal function
- Arteriosclerotic changes in the renal arteries cause renovascular pathology
- Blood pressure changes in the elderly effect renal function
- Prostatic hypertrophy common in older males
- Muscle tone decreases and the pelvic organs put increasing pressure on the bladder-stress incontinence
- 20-30% decrease in size and weight between ages of 30-90 years
- by 70 yrs, 30-50% of glomeruli have lost their function
- Blood flow to/within kidneys decreases
- Periurethral muscle fibers become less elastic, more prone to urethral irritation, urethral/bladder infections, urinary incontinence
Common nephrotoxins
- Anitbiotics- gentamycin, tobramycin, amphotericin, cephalosporins, vancomycin
- Chemicals- methanol/gasoline, carbon tetrachloride, ethylene glycol, lead, lithium, mercury
- Radiographic dye
- Anesthetics
- Drugs- NSAIDS, thiazides, dilantin, amphetamines, cisplatin
- Other- transfusion reactions, crush injuries, heroin
Urine studies-
- I&O and daily weight- best information r/t fluid balance
- Urinalysis-visual, chemo, micro
- Creatinine clearance (urine and blood) calculation corrected for body size, appears to decrease with age
- Bladder scan
- Urine culture- clean catch, midstream
- 24 urine (on ice or with preservative)
Diagnostics:
- KUB
- Biospy (bladder or kidney)
- Abdominal x-ray
- Ultrasound (site)
- CT/MRI (site)
- Introvenous pyelogram
- Cystoscopy
- Urodynamics
- IVP
- Retrograde pyelogram
- Cystogram/urethrogram
Cystoscopy:
- Interior inspect with a tubular lighted scope
- general anesthesia
- monitor bleeding post scope
Male external genitalia
penis, scrotum
Testes:
male reproductive organs
Glands:
produce and secrete seminal fluid, seminal vesticles, prostate gland, cowper’s glands
Ducts:
- Epididmysis
- Ductus deferens (vas deferens)
- Ejaculatory duct
The testes in conjunction with
the hypothalamus and pituitary secrete hormones which stimulate production and maturation of sperm- Follicle stimulating hormone (FSH)- interstitial cell stimulating hormone (ICSH or LH)- Testosterone- the major gonadal male hormone
Spermatogenesis continues
throughout life
Gerontologic Considerations:
- Increase in prostate size
- Decreased testosterone level and sperm production
- Decreased scrotum muscle tone
- decreased size and firmness of the testicles
- erectile dysfunction and sexual dysfunction can occur as result of these changes
Testes should feel
smooth and firm, oval and freely movable
Seminiferous tubules
produce spermatozoa
Epididymis
transport of mature sperm
Vas deferens:
- sperm are stored
* joins the ducts of the seminal vesicles at the base of the prostate gland to form the ejaculatory duct
