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380: Patho/Physio > Ch. 30 Urinary/renal > Flashcards

Ch. 30 Urinary/renal Flashcards

1
Q

Abnormal bladder contraction and emptying due to neurologic conditions

A

Neurogenic bladder

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2
Q

Lack of coordinated neuromuscular contraction of bladder

A

Dyssynergia

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3
Q

With ______, as the bladder contracts, the sphincter closes

A

Dyssynergia

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4
Q

Associated with spinal cord injuries above T6

A

Dyssyngergia

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5
Q

A lesion above the micturition center in the pons caused from stroke or TBI causes what?

A

Dyssynergia; detrusor hyper-reflexia. Overactive reflex emptying when full

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6
Q

A lesion below micturition center in pons, but above sacral causes what?

A

(dyssynergia) detrusor hyper-reflexia, like when lesions are above, but with vesicosphincter.

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7
Q

OBS

A

Overactive bowel syndrome–hyperflexia but without VS dyssynergia. urgency with or without urge, incontinence, often frequency

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8
Q

What happens when lesions affect the sacral micturition center

A

Detrusor areflexia. Underactive, atonic bladder with retention, stress, and overflow incontinence

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9
Q

What are the common causes of bladder outlet obstruction, which blocks urine flow

A
  1. Urethral stricture- narrowing of urethral lumen (often due to scarring)
  2. Prostate enlargement- due to benign prostatic hyperplasia (BPH), acute prostatitis, or prostate cancer
  3. Pelvic organ prolapse–blockage to urine flow occurs when the bladder herniates into the lower vagina
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10
Q

Urethral stricture causes what

A

Bladder outlet obstruction

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11
Q

Prostate enlargement can cause what? (blocks urine flow)

A

Bladder outlet obstruction

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12
Q

Blockage to ___ flow occurs when the bladder herniates into the lower vagina.

A

urine

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13
Q

Treatment of Dyssynergia

A

Adrenergic blocking medications, urethral dilation, or surgical repair

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14
Q

What is the most common renal tumor

A

Renal cell carcinoma

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15
Q

Renal adenomas are benign or malignant?

A

Benign

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16
Q

renal cell carcinoma are ___________, usually arising from tubular epithelium (cortex of kidney)

A

Adenocarcinomas

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17
Q

Risk factors for renal tumors

A

Tobacco smoking, obesity, and HTN(uncontrolled)

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18
Q

Early stages of renal tumors are symptomatic or asymptomatic?

A

Asymptomatic

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19
Q

Dx of renal tumros?

A

Intravenous pyelogram (IVP), CT scans, etc. Nephrectomy with chemotherapy

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20
Q

WHat is the most common bladder tumor

A

Transitional cell carcinoma

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21
Q

What are the risk factors for transitional carcinoma and where are they found

A

Bladder; Males older than 60, smokers, chemical exposures

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22
Q

What is the pathogenesis of bladder tumors

A

Genetic alteration in normal bladder epithelium

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23
Q

Evaluation/Dx of bladder tumors

A

Cystoscopy, tissue biopsy

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24
Q

Tx of bladder tumors

A

Intravesical chemotherapy, bladder resection or removal, and adjuvant chemotherapy

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25
Q

Inflammation of the urinary epithelium caused by bacteria

A

UTI

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26
Q

Other names for UTI

A

Acute cystitis and pyelonephritis

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27
Q

Another word for kidney infection (considered a UTI)

A

Pyelonephritis

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28
Q

Name for infection of bladder

A

acute cystitis

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29
Q

Risk factors for UTI

A
  • Female (especially postmenopausal)
  • Indwelling catheters
  • Bladder disorders
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30
Q

what is urosepsis

A

Sepsis caused by prolonged, untreated bladder infection

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31
Q

Who is at risk for urosepsis

A

Elderly

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32
Q

Most common pathogen for UTI

A

Escherichia Coli

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33
Q

Inflammation of the bladder is called

A

Acute cystitis

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34
Q

Manifestations of acute cystitis

A
  • Frequency
  • Dysuria
  • Urgency
  • Lower abdominal and/or suprapubic pain
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35
Q

Dx of acute cystitis

A

Urinalysis or urine culture with sensitivity

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36
Q

Tx of acute cystitis

A
  • Antimicrobial therapy
  • Increase fluid intake
  • Urinary analgesics
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37
Q

Acute pyelonephritis occurs in the upper or lower urinary tract

A

Upper

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38
Q

Acute infection of the ureter, renal pelvis, and interstitium is called

A

Acute pyelonephritis

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39
Q

What causes Acute Pyelonephritis

A

Vesicoureteral reflex, E. Coli, proteus, and psuedomonas. Reflex and E. Coli are in red

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40
Q

what is vesicoureteral reflex

A

when urine flows in wrong direction

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41
Q

Pathophysiology of pyelonephritis

A

Inflammation of urinary tract structures, renal edema, and possible abscess formation. Followed by tubular damage/fibrosis and necrosis of renal papillae

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42
Q

Clinical manifestations of pyelonephritis

A

Systemic signs of inflammation/infection including: fever, chills flank/groin pain, dysuria, and frequency (older adults have blunted symptoms. i.e confusion)

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43
Q

Chronic pyelonephritis leads to

A

scarring of tissue

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44
Q

Risk of chronic pyelonephritis increases in individuals with…

A

renal infections and some type of obstructive pathologic condition

45
Q

Interstitial cystitis is also known as

A

Painful bladder syndrome

46
Q

What are the two types of interstitial cystitis

A
  1. Nonbacterial infectious cystitis, and noninfectious
47
Q

List what causes nonbacterial infectious cystitis

A

Viruses, chlamydia, and fungi

48
Q

List what causes noninfectious cystitis

A

Chemical, autoimmune, radiation, hypersensitivity

49
Q

What is the pathogenesis of painful bladder syndrome (IC)

A

Uncertain…perhaps a defet in the bladder epithelium, autoimmune reaction triggering inflammation, or inflammation that caused fibrosis with hemorrhagic ulcers

50
Q

Manifestations of interstitial cystitis (painful bladder syndrome)

A
  • common in women 20-30 yrs

- Bladder fullness/pressure, frequency, small urine volume, chronic pelvic pain

51
Q

Tx of Painful bladder syndrome (IC)

A
  • no single treatment is effective. Strategies for symptom relief include:
  • oral medications such as nsaids, or bladder instillations of a variety of substances
52
Q

What is the glomerulus

A

bundle of capillaries that filters plasma; where urine is made

53
Q

What is glomerulonephritis

A

inflammation of the glomerulus

54
Q

What is the most common cause of glomerulonephritis

A

immunologic abnormalities such as acute post-streptococcal glomerulonephritis…damage caused by immune complexes…antibodies against . the group A beta hemolytic

55
Q

antibiotics, drugs, toxins, vasculitis, HIV, and diabetes mellitus can all be causes of _____nephritis

A

Glomerulonephritis

56
Q

Type III hypersensitivity along with deposition of circulating soluble antigen-antibody complexes (immune complexes) and nonimmunes such as drugs, toxins, and ischemia, are all mechanisms of what

A

Glomerular injury

57
Q

Manifestations of glomerulonephritis: the two major symptoms

A

Hematuria with red blood cell casts, and proteinuria exceeding 3-5 days with albumin as the major protein

58
Q

Other more minor manifestations of glomerulonephritis

A

Oliguria (not enough urine) hypertension, edema

59
Q

What are the two types of glomerulonephritis

A

Membranous and rapidly progressing. Membranous is an autoimmune response to renal antigen, idiopathic, or secondary to systemic diseases. Rapidly progressing: immune complexes leak into bowman space, form crescent shaped lesions

60
Q

Chronic glomerulonephritis is an umbrella for several glomerular diseases, it is progressive, and leads to what?

A

Chronic renal failure ):

61
Q

Which type of glomerulonephritis is associated with crescent shaped lesions

A

Rapidly progressing

62
Q

Antiglomerular basement membrane disease (goodpasture syndrome) is associated with which type of glomerulonephritis

A

Rapidly progressing

63
Q

Which type of glomerulonephritis is associated with an autoimmune response to a renal antigen, is idiopathic, or secondary to a systemic disease

A

Membranous nephropathy

64
Q

Nephrotic syndrome: _______: degenerative disease of the tubules (non-inflammatory)

A

Nephrosis

65
Q

Nephrotic goes with ______ and Nephritic goes with ______

A

Nephrotic=nephrosis

Nephritic=nephritis

66
Q

Nephrosis is the degenerative disease of tubules and is caused by ____ ____

A

glomerular injury

67
Q

Is nephrosis non-inflammatory?

A

Yes

68
Q

Inflammation of the kidneys: _______

A

nephritis

69
Q

Nephritis is the inflammation of the kidneys. It is caused by increased permeability of the _____ ____

A

glomerular membrane

70
Q

Nephrotic is an ______ to the glomerular basement membrane and podocytes, whereas nephritic is an ______ injury to the glomerulus

A

Nephrotic is an injury, and nephritic is an immune injury

71
Q

Clinical manifestations of nephrotic syndrome?

A

Massive proteinuria: excretion of 3.5g or more of protein in urine per day. And edema

72
Q

Clinical manifestations of nephritic syndrome?

A

Microscopic hematuria, and mild, mild, mild proteinuria

73
Q

Tx of nephrotic syndrome?

A

Restrictions on protein

74
Q

Tx of nephritic syndrome?

A

High-dose corticosteroids

75
Q

Pathophysiology of acute kidney injury

A

Ischemic injury due to decreased renal blood flow. Hypovolemia. Sepsis induced injury

76
Q

Most common cause of acute KI?

A

Prerenal. Due to decreased RBF, and glomerular filtration rate decreases as well

77
Q

What is the most common cause of intrarenal AKI?

A

Acute tubular necrosis (ATN). Post-ischemic–inflammatory response with necrosis along any part of nephron

78
Q

_______ AKI occurs with urinary tract obstructions that affect the kidneys bilaterally

A

Postrenal

79
Q

What are the three phases of AKI

A

Initiation, maintenance(oliguric), and recovery (polyuric)

80
Q

Which AKI phase is this:

-Kidney injury is evolving, and prevention of injury is possible

A

Initiation phase

81
Q

Which AKI phase is this:
-Established kidney injury and dysfunction. Urine output is lowest during this phase (hence oliguric),and serum, creatine, and blood urea nitrogen both increase

A

Maintenance (oliguric)

82
Q

Which AKI phase is this:

-Injury repaired and normal renal function reestablished. Diuresis common. Decline in serum creatine and urea.

A

Recovery (polyuric)

83
Q

Prevention of AKI is kinda important, not a big deal, or paramount

A

paramount

84
Q

Tx of AKI

A

Correct fluid and electrolyte disturbances

85
Q

Progressive loss of renal function that affects nearly all organ systems is

A

Chronic Kidney Disease

86
Q

What is CKD associated with

A

HTN, diabetes, intrinsic kidney disease

87
Q

What is the initial adaptation to the loss of nephron mass

A

Hypertrophy and hyperfunction.

88
Q

Is the initial adaptation of CKD enough to compensate the loss of nephron mass?

A

No. Compensatory capacity fails.

89
Q

Clinical manifestations of CKD if damage is primarily vascular or glomerular

A

Proteinuria, hematuria, nephrotic syndrome, and uremia

90
Q

Clinical manifestations of CKD if damage is primarily to tubules

A

-Renal tubular acidosis, salt wasting, and difficulty regulating urine concentration

91
Q

What happens as glomerular filtration rate declines?

A

Plasma creatine level increases. Plasma urea level also increases. However, the level of urea in the plasma is a less sensitive indicator of GFR

92
Q

Is an increased level of urea in the plasma a strong enough indicator of GFR?

A

No.

93
Q

Explain the sodium and water balance due to CKD

A

Sodium excretion increases, with obligatory (bc water follows salt) water excretion leading to sodium deficit and volume loss

94
Q

Explain the potassium balance due to CKD

A

Tubular secretion increases early (hypokalemia, so the potassium in blood decreases) However, once oliguria sets in, potassium is retained

95
Q

Explain the acid-base balance due to CKD

A

Metabolic acidosis occurs when glomerular filtration rate declines to 30-40%

96
Q

Explain the calcium and phosphate balance due to CKD

A

Decreased renal synthesis of 1,25-(OH)v2, Vitamin D3, and hypocalcemia (due to decrease calcium in gut). The parathyroid released pthormone to compensate

97
Q

CKD causes an increased risk of _____

A

Fractures

98
Q

Altered protein is another metabolic disruption due to CKD. Dyslipidemia. T or F

A

True (dyslipidemia: increased amount of carbs and fat in blood)

99
Q

Risk factors of the CV system when pt is diagnosed with CKD

A

HTN, dyslipidemia, risk for heart failure, and pericarditis

100
Q

Pulmonary risk for patients with CKD

A

Pulmonary edema, compensation for metabolic acidosis (kussmauls respirations=deep in an attempt to release excess CO2)

101
Q

Hematologic issues with CKD?

A

Anemia (decreased EPO)

102
Q

Immune issues with CKD?

A

Suppression of phagocytosis, decreased antibody production, decreased T-cell function

103
Q

Neuro issues with CKD?

A

Elevated nitrogenous wastes

104
Q

GI issues with CKD

A

Uremic gastroenteritis, anorexia

105
Q

Endocrine and reproductive issues with CKD

A

Insulin resistance: big one. others: decreased sex hormone, hypothyroidism

106
Q

Skin issues with CKD

A

Uremic frost. d/t deposition of nitrogenous wastes = itching

107
Q

Dx of CKD

A

Serum creatinine, BUN, GFR. CT scan

108
Q

Tx of CKD

A

Dialysis :( which is renal replacement therapy. Treatment is supportive, and prevention is important.

380: Patho/Physio (8 decks)

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