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Pathophysiology > chapter 18 > Flashcards

chapter 18 Flashcards

1
Q

Anatomy of the urinary system

A

Kidneys, ureters, urinary bladder, urethra

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2
Q

nephrons

A

Functional units of the kidneys

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3
Q

each kindey has how many nephrons

A

over 1 mil

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4
Q

Where does filtration take place?

A

Renal corpuscles

- large volume of fluid passes from glomeruler capillaries into the tubule (bowmans capsule)

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5
Q

What is filtered in the kidneys

A

wasters, nutrients, electrolytes, other dissolved substances

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6
Q

Reabsorption (kidneys): explain

A

reabsorption of essential nutrients, water and electrolytes into the peritubular capillaries
- control of pH and electrolytes

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7
Q

What are the transport mechanisms of reabsorption

A

Active transport
Co-transport
Osmosis (water)

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8
Q

Proximal convoluted tubules

A

h2o and glucose reabsorption

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9
Q

Antidiuretic hormone (ADH): secreted from what

A

posterior pituitary

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10
Q

ADH function

A

Reabsorption of water in distal convoluted tubules and collecting ducts

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11
Q

Aldosterone: secreted from what

A

adrenal cortex

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12
Q

Aldosterone function

A

sodium reabsorption in exchange for potassium of hydrogen

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13
Q

Atrial natriuretic hormone comes from where

A

from the heart

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14
Q

Atrial natriuretic hormone function

A

Reduced sodium and fluid reabsorption

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15
Q

Specialized pattern of the blood flow through the kidneys

A
  1. renal artery
  2. interlobular artery
  3. arcuate artery
  4. interlobular artery
  5. afferent arteriole
  6. glomeruler capillaries
  7. efferent arteriole
  8. peritubular capillaries
  9. interlobular vein
    10 arcuate vein
  10. interlobar vein
  11. renal vein
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16
Q

GFR: auto-regulation and hormones control pressure in the glomerular capillaries by what

A
  1. Vasoconstriction of afferent arteriole
  2. Dilation of afferent arteriole
  3. vasoconstriction of efferent arteriole
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17
Q

Pressure control in the glomerular capillaries: vasoconstriction of afferent arteriole

A

decreases glomerular pressure – decreases filtrate

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18
Q

Pressure control in the glomerular capillaries: Dilation of afferent arteriole

A

increased pressure in glomerulus – increases filtration

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19
Q

Pressure control in the glomerular capillaries: vasoconstriction of efferent arteriole

A

increases pressure in glomerulus – increases filtration

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20
Q

Control of arteriolar constriction is done by what 3 factors?

A

Autoregulation, SNS, renin

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21
Q

Control of arteriolar constriction: auto-regulation

A

local adjustments in diameter of arterioles made in response to changes in blood flow in kidneys

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22
Q

Control of arteriolar constriction: SNS

A

increases vasoconstriction in both arterioles

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23
Q

Control of arteriolar constriction: Renin

A

Secreted by juxtaglomerular cells when blood flow to afferent arterioles is reduced

(renin-angiotensin mechanism)

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24
Q

Enuresis

A

involuntary unination by child (or under 4 years)

- often related to developmental delay, sleep pattern, or psychological aspect

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25
Q

Stress incontinence

A

increased intra-abdominal pressure forces urine through sphincter (coughing, lifting, laughing)

more common in women especially those who had babies

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26
Q

Overflow incontinence

A

Incompetent bladder sphincter; weakened detrusor muscle may prevent complete emptying of bladder - frequency and incontinence

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27
Q

what may cause overflow incontinence

A
  • age
  • spinal cord injuries / brain damage
  • neurological bladder
  • interference with CNS and ANS voluntary control of the bladder
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28
Q

neurological bladder may be what

A

spastic or flaccid

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29
Q

Retention

A

inability to empty bladder

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30
Q

retention may be accompanied by what

A

overflow incontinence

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31
Q

what cause retention

A

spinal cord injury at sacral level blocks micturition reflex

may follow anesthesia (general or spinal)

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32
Q

incontinence

A

loss of voluntary control of the bladder

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33
Q

Urinalysis:

A

Straw colored with mild odor

- normal urine

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34
Q

what is the specific gravity of normal urine

A

1.010 to 1.050

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35
Q

Urinalysis: cloudy

A

may indicate presence of large amounts of protein, blood, bacteria and pus

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36
Q

Urinalysis: dark color

A

may indicate hematuria, excessive bilirubin, or highly concentrated urine

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37
Q

Urinalysis: unpleasant or unusual odor

A

infection or result from certain dietary components or medication

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38
Q

Urinalysis: small amounts of blood

A

Infection, inflammation or tumors or urinary tract

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39
Q

Urinalysis: large amounts of blood

A

Increase glomerular permeability or hemorrhage

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40
Q

Urinalysis: elevated protein level (proteinuria, albuminuria)

A

Leakage of albumin or mixed plasma proteins into filtrate

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41
Q

Urinalysis: bacteria (bacteruria)

A

Infection of urinary tract (UTI)

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42
Q

Urinalysis: urinary casts

A

Indicate inflammation of kidney tubules

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43
Q

specific gravity

A

Indicated ability of tubules to concentrate urine

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44
Q

Urinalysis: low specific gravity

A

Dilute urine (with normal hydration)

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45
Q

Urinalysis: high specific gravity

A 
Concentrated urine (with normal hydration)
- related to renal failure
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46
Q

Urinalysis: glucose and ketones

A

Found when diabetes is not well controlled

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47
Q

Blood tests: electrolytes

A

Depend on related fluid balance

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48
Q

Blood tests: antibody level

A

Antistreptolysin O or antistreptokinase titters

Used for diagnosis of poststreptococcal glomerulonephritis

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49
Q

Blood tests: elevated renin levels

A

Indicated kidney as a cause of hypertension

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50
Q

Blood tests: elevated serum urea and serum creatinine levels indicate what

A

Indicate failure to excrete nitrogen wastes

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51
Q

Elevated serum urea and serum creatinine levels: cause

A

Decrease GFR

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52
Q

Blood tests: metabolic acidosis

A

Indicates decreased GFR

Failure of tubules to control acid-base balance

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53
Q

Blood tests: anemia

A

Indicated decreased erythropoietin secretion and/or bone marrow depression

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54
Q

Culture and sensitivity studies on urine specimens

A

ID of causative organism of infection

Help select appropriate drug treatment

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55
Q

Radiologic tests

A

Used to visualize structures and possible abnormalities, flow patterns and filtration rates

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56
Q

Clearance tests

A

Used to assess GFR

Ex. Creatinine or insulin clearance

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57
Q

Cystoscopy

A

Visualizes lower urinary tract; may be used to perform biopsy or remove kidney stones

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58
Q

Biopsy

A

Used to acquire tissue specimens

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59
Q

Dialysis

A

Provides filtration and reabsorption

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60
Q

Two forms of dialysis

A

Hemodialysis

Peritoneal dialysis

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61
Q

How often does one need to go to dialysis

A

Usually requires 3x a week - each lasts about 3 to 4 hours

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62
Q

Potential complications of dialysis

A
  1. Shunt may become infected
  2. Blood clot formation
  3. Blood vessels involved in shunt may become sclerosed
  4. Patient has increase risk of infection with HBV, HCV or HIV of standard precautions are not followed
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63
Q

Describe the process of hemodialysis

A

Patients blood moves from an implanted shunt/catheter in an artery to machine
º exchange of wastes, fluids, and electrolytes
º semipermeable membrane between blood and dialysis fluid (diastlsate)
— blood cells and proteins remain in blood
º after exchange is completed, blood retuned to patients vein

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64
Q

Peritoneal dialysis

A

Peritoneal membranes serve as the semipermeable membrane

Catheter with entry and exit points is implanted into the peritoneal cavity

Dialyzing fluid is instilled into a cavity

Dialysate is drained from cavity via gravity into container

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65
Q

Peritoneal dialysis requires what

A

More time
Loose clothing to fit the fluid bag
May be done at night (during sleep) or while patient is ambulatory
Usually done at outpatient basis

66
Q

Major complication of peritoneal dialysis

A

Infection resulting in peritonitis

67
Q

Why Is caution required with drugs when doing either type of dialysis

A

Toxic level buildup can occur

68
Q

Why are UTIs more common in women and older men

A

Women: short urethra, close to butthole

Older men: prostatic hypertrophy, urine retention

69
Q

Common predisposing factors of UTI

A

Incontinence, retention, direct contamination with fecal matter

70
Q

Is urine a good growth medium for bacteria?

A

Yes

71
Q

Lower urinary tract infections are called

A

Cystitis

Urethritis

72
Q

Upper UTI name

A

Pyelonephritis

73
Q

Common causative UTI organisms

A

E. Coli

74
Q

Cystitis and urethritis is inflammation of what

A 
Cystitis = bladder wall 
Urethritis = urethra
75
Q

Cystitis and Urethritis: cause

A

Hyperactive bladder and reduced capacity

76
Q

Cystitis and Urethritis: common local signs

A 
Pain in pelvic area
Dysuria
Urgency
Frequency
Nocturnal
77
Q

Cystitis and Urethritis: systemic signs

A

Fever, malaise, nausea, leukocytosis

78
Q

Cystitis and Urethritis: urine

A

Cloudy unusual odor

79
Q

Cystitis and Urethritis: urinalysis indicated what

A

Bacteriurea, pyuria, microscopic hematuria

80
Q

Pyelonephritis: what?

A

One or both kidneys involved - from ureter to kidney

Purple to exudate fills pelvis and calyces

81
Q

Pyelonephritis: recurrent / chronic infection can lead to scar tissue formation - what results from this?

A

Loss of tubule function
Obstruction and collection of filtrate —> hydronephrosis
Eventual chronic renal failure is untreated

82
Q

Pyelonephritis: signs of cystitis plus pain can be associated with renal disease - s/s of this

A

Dull, aching pain in lower back or flaunt area

83
Q

Pyelonephritis: systemic signs

A

High tempuruate

84
Q

Pyelonephritis: urinalysis indicates what

A

Similar to cystitis

Urinary casts are present - reflection of renal tubule involvement

85
Q

Treatment of UTIs

A

Antibacterial

? There is a long list on slide 26, not sure if I need to know all of these ?

86
Q

Inflammatory disorder (Glomerulonephritis): types

A

Many forms

87
Q

Inflammatory disorder (Glomerulonephritis): presence of antistreptococcal (ASO) antibodies —— what does this do?

A

Formation of antigen-antibody complex
Activates compliment system
Inflammatory response in glomeruli
Increased capillary permeability

88
Q

Inflammatory disorder (Glomerulonephritis): inflammatory response

A

Congestion and cell proliferation

Decreased GFR - retention of fluid and waste

89
Q

Inflammatory disorder (Glomerulonephritis): urine

A

Dark and cloudy

90
Q

Inflammatory disorder (Glomerulonephritis): edema

A

Starts with facial and periorbital edema - general edema follows

91
Q

Inflammatory disorder (Glomerulonephritis): elevated BP why

A

Increased renin secretion and decreased GFR

92
Q

Inflammatory disorder (Glomerulonephritis): flank or back pain, why

A

Edema and stretching of renal capsule

93
Q

Inflammatory disorder (Glomerulonephritis): signs / symptoms

A

General signs of inflammation and decreased UOP

94
Q

Inflammatory disorder (Glomerulonephritis): blood tests reveal what

A

Elevated serum urea and creatinine levels
Elevation of anti-DNase B, streptococcal antibodies, antistreptolysin, antistreptokinase

Complement levels decreased (use in renal inflammation)

95
Q

Inflammatory disorder (Glomerulonephritis): how does it effect pH

A

Metabolic acidosis

96
Q

Inflammatory disorder (Glomerulonephritis): urinalysis shows

A

Proteinuria, hematuria, erythrocyte casts

No evidence of infection

97
Q

Inflammatory disorder (Glomerulonephritis): treatment

A

Na+ restriction
Protein and fluid intake decreased (if severe)
Glucocorticoids (lower inflammation)
Antihypertensives

98
Q

Nephrotic syndrome

A

Abnormality in glomerular capillaries, increased permeability, large amounts of plasma proteins escape into filtrate

99
Q

Nephrotic Syndrome: cause

A

May be idiopathic in children 2-6 years
Secondary to SLE
Exposure to nephrotoxins or drugs

100
Q

Nephrotic Syndrome: patho

A

Hypoalbuminemia with decreased plasma osmotic pressure
º subsequent generalized edema
BP remains low or normal
ºmay be elevated depending on angiotensin II levels
Increased aldosterone secretion in response to reduced blood levels
º more edema
High blood cholesterol, lipoprotein in urine, lipiduria with milky appearance to urine

101
Q

Nephrotic Syndrome: s/s

A

Proteinuria, lipiduria, cast
Massive edema
Sudden increase in girth

102
Q

Nephrotic Syndrome: treatment

A

Glucocorticoids (lessen inflammation)
ACE inhibitors
Antihypertensives
Restrict Na+ intake

103
Q

What are examples of urinary tract obstructions

A

Urolithiasis
Hydronephrosis
Tumors

104
Q

Urolithiasis (Calculi)

A

Can develop anywhere in urinary tract

Kidney stones - small or large

105
Q

Urolithiasis (Calculi): tends to form with

A

Excessive amounts of solutes in filtrate
Insufficient fluid intake
UTI

106
Q

Urolithiasis (Calculi): manifestations only occur what?

A

With obstructed urine flow

  • lead to infection
  • hydronephrosis with dilation of calyces
  • if located in kidney or ureter and atrophy of renal tissue
107
Q

Urolithiasis (Calculi): calculi composed of calcium salts, meaning what

A

High urine calcium levels

Form readily with highly alkaline urine

108
Q

Urolithiasis (Calculi): uric acid stones —> hyperuricemia

A

Gout, high-purine diets, cancer chemo

Especially with acidic urine

I think this is asking for what causes hyperuricemia

109
Q

What are the types of Urolithiasis (Calculi)

A

Uric acid stones
Struvite stones
Cystine stones

110
Q

Urolithiasis (Calculi): stone formation depends on what

A

Predisposing factor

111
Q

Urolithiasis (Calculi): s/s of stones in kidney or bladder

A

Often asymptomatic

  • frequent infection may lead to investigation
  • flank pain possible causde by distention of renal capsule
112
Q

Urolithiasis (Calculi): s/s —> renal colic

A

Caused by obstruction of ureter
- spasms and flank pain radiation into groin until the stone passes or is removed

N/v, cool moist skin, rapid pulse
Radiologic examination confirms location of calculi

113
Q

Urolithiasis (Calculi): treatment

A 
Small stones eventually pass
Extracorporeal shock wave lithotripsy (ESWL)
Laser lithotripsy 
Drugs to partial dissolve stones
Surgery
114
Q

Urolithiasis (Calculi): prevention

A

Treatment of underlying condition
Adjustment of urine pH through dietary modifications
Consistent increased fluid intake

115
Q

Hydronephrosis: what

A

Secondary condition caused by:

  • complication of calculi
  • tumors, scar tissue in kidney / ureter
  • untreated prostatic enlargement
116
Q

Hydronephrosis: s/s

A

Asymptomatic in early stages

117
Q

Hydronephrosis: diagnosis

A

Ultrasounds, radionucleotide imaging, ct or renal scan

118
Q

Hydronephrosis: what happens is cause not removed

A

Chronic renal failure

119
Q

Renal cell carcinoma: where

A

Tumor arising from tubule epithelium - more often in renal complex

120
Q

Renal cell carcinoma: s/s

A

Symptomatic in early stages

121
Q

Renal cell carcinoma: where does it metastasize

A

Liver, lung, bone or CNS at time of diagnosis

122
Q

Renal cell carcinoma: population

A

Men and smokers

123
Q

Renal cell carcinoma: treatment

A

Removal of kidney
Immunotherapy

Radioresistant and chemo is not used in most cases

124
Q

Renal cell carcinoma: manifestations

A

Painless hematuria (gross or microscopic)
Dull, aching flank pain
Palpable mass
Weight loss
Anemia or erythrocytosis
Paraneoplastic syndromes (hypercalcemia or Cushing’s syndrome)

125
Q

Bladder cancer: where

A

Most are malignant and commonly arise from transitional epithelium of bladder
- often develop as multiple tumors

126
Q

Bladder cancer: diagnosis

A

Urine cytology and biopsy

127
Q

Bladder cancer: early signs

A

Hematuria, dysuria

Infection

128
Q

Bladder cancer: explain how these tumors are invasive through wall to adjacent structures

A

Metastasize to pelvic lymph nodes, liver and bone

129
Q

Bladder cancer: predisposing factors

A

Working with chemicals (anilines, dyes, rubber, aluminum)
Cig smoking
Recurrent infections
Heavy intake of analgesics

130
Q

Bladder cancer: treatment

A

Surgery removal of tumor
Chemo and radiation
Photoradiation in early cases

131
Q

Vascular disorders (nephrosclerosis): involves what

A

Vascular changes in kidneys

- some occur normally with aging

132
Q

Vascular disorders (nephrosclerosis): patho

A

Thickening and hardening of walls of arterioles and small arteries in kidneys

133
Q

Vascular disorders (nephrosclerosis): narrowing of blood vessel lumen has what effects

A
  1. Loss of blood supply to kidneys
  2. Stimulation of renin
  3. Increased BP
  4. Ischemia
  5. Destruction of renal tissue
  6. Chronic renal failure
134
Q

Vascular disorders (nephrosclerosis): can be primary or secondary, how?

A

Can be primary lesion developed in kidney

May be secondary to essential hypertension

135
Q

Vascular disorders (nephrosclerosis): treatment

A

Antihypertensives agents
Diuretics
Beta blockers
Sodium intake should be reduced

136
Q

Congenital kidney disorders: vesicoureteral reflux

A

Not in slides, look it up

137
Q

Congenital kidney disorders: agenesis

A

Failure of one kidney to develop

138
Q

Congenital kidney disorders: ectopic kidney

A

Kidney and ureter not in normal position

139
Q

Congenital kidney disorders: “horseshoe” kidney

A

Fusion of 2 kidneys

140
Q

Congenital kidney disorders: hypoplasia

A

Failure to develop to normal size

141
Q

Adult polycystic kidney: what

A

Autosomal dominant gene on chromosome 16

- no indications in child and young adults

142
Q

Adult polycystic kidney: when do manifestations begin

A

Around 40 years

143
Q

Adult polycystic kidney: multiple cysts develop in both kidneys leading to what

A

Enlarged kidneys
Compression and destruction of kidney tissue
Chronic renal failure

144
Q

Adult polycystic kidney: diagnosis

A

Abdominal CT or MRI

145
Q

Wilms’ Tumor: what

A

Most common tumor in children
Defects in tumor suppressor genes on chromosome 11
- may occur WITH other congenital disorders

146
Q

Wilms’ Tumor: usually what

A

Unilateral

- large encapsulated mass

147
Q

Wilms’ Tumor: what may be present at diagnosis

A

Pulmonary metastasese

148
Q

Acute renal failure: causes

A
  1. Acute bilateral kidney diseases
  2. circulatory shock or heart failure
  3. Nephrotoxins
  4. Mechanical obstruction
149
Q

Acute renal failure: onset

A

Sudden

Hence “acute”

150
Q

Acute renal failure: blood tests show what

A

Elevated serum urea nitrogen and creatinine levels
Metabolic acidosis
Hyperkalemia

151
Q

Acute renal failure: treatment

A

Fix primary problem to minimize risk of necrosis and permanent damage

Dialysis to normalize body fluids and maintain homeostasis

152
Q

Chronic renal failure: what

A

Gradual irreversible destruction of the kidneys over a long period of time

153
Q

Chronic renal failure: s/s

A

Asymptomatic in early stages

154
Q

Chronic renal failure: may result from

A

Chronic kidney disease
Congenital polycystic kidney disease
Systemic disorders
Low-level exposure to nephrotoxins over sustained period of time

155
Q

Chronic renal failure: stages

A

Decreased renal reserve
Renal insufficiency
End-stage renal failure

156
Q

Chronic renal failure: decreased renal reserve

A
  1. Decrease in GRF
  2. Higher than normal serum creatinine levels
  3. No apparent clinical symptoms
157
Q

Chronic renal failure: Renal insufficiency

A
  1. Decreased GFR to about 20% of normal
  2. Significant retention of nitrogen wastes
  3. Excretion of large volumes of dilute urine
  4. Decreased erythropoiesis
  5. Elevated BP
158
Q

Chronic renal failure: end-stage renal failure

A
  1. Negligible GFR
  2. Fluid, electrolytes and wastes retained in body
  3. Anemia’s
  4. All body effected
  5. Oliguria or Anuria
  6. Dialysis or kidney transplantation
159
Q

Chronic renal failure early signs and complete failure

A

Slide 51

160
Q

Chronic renal failure: diagnostic tests

A

Metabolic acidosis becomes decompensated
Azotemia
Anemia becomes severe

Serum electrolytes may vary depending on the amount of water retained in the body. Usually hyponatremia and hyperkalemia occur, as well as hypocalcemia and hyperphosphatemia

161
Q

Chronic renal failure: treatment

A 
Drugs to stimulate erythropoeisis 
Drugs to treat CV issues
Fluid restriction
Dialysis 
Transplant

Pathophysiology (11 decks)

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