chapter 33 (porth 2020)

Question 1

1.A 36-year-old man is admitted to the emergency department with a sudden onset of severe, intermittent, cramping pain that makes him feel nauseated. He describes the pain as originating in the left groin and radiating toward the flank. Microscopic examination of his urine reveals the presence of RBCs. His temperature is normal, and he does not exhibit signs of sepsis.
A.What is the probable cause of this man’s pain?
B.What diagnostic measure could be used to confirm the cause of his pain?
C.A plain film radiograph reveals a 4- to 5-mm kidney stone in the left ureter. What are the chances that this man will pass the stone spontaneously?
D.Once the stone has been passed, what type of measures can he use to prevent stone recurrence?

Answer 1

A. CLASSIC RENAL CALI

The pain may radiate to the lower abdominal quadrant, bladder area, perineum, or scrotum in the man. The skin may be cool and clammy; nausea and vomiting are common. – Noncolicky pain is caused by stones distorting the renal calyces or pelvis. It is usually a dull, deep ache in the flank or back that can vary in intensity from mild to severe. Drinking large amounts of fluid often exaggerates the pain.

B. DX: is based on symptomatology
DX tests: urinalysis, plain film radiography, intravenous pyelography (IVP), and abdominal ultrasonography. Provides information related to hematuria, infection, the presence of stone-forming crystals, and urine pH.

C. < 5MM USUALLY CAN PASS THE STONE, but A major goal of treatment for people who have passed kidney stones or have had them removed is to identify stone composition and prevent their recurrence

D. preventable measure: increase fluid and adequate diet

Question 2

A 6-year-old boy is diagnosed with acute glomerulonephritis that developed after a streptococcal throat infection. At this time, the following manifestations are noted: a decrease in urine output, increasing lethargy, hyperventilation, and generalized edema. Trace amounts of protein are detected in his urine. Blood analysis reveals the following: pH = 7.35, HCO3 = 18 mEq/L, hematocrit = 29%, Na = 132 mEq/L, K = 5.6 mEq/L, BUN = 62 mg/dL, creatinine = 4.1 mg/dL, and albumin = 2 g/dL.
A.What is the probable cause of this boy’s glomerular disease?
B.Use the laboratory values in the Appendix to interpret his laboratory test results. Which values are significant and why?
C.Is he progressing to uremia? How can you tell?

Answer 2

Poststreptococcal glomerulonephritis is caused by diffuse glomerular enlargement and hypercellularity. 7- 10 days after infection.

B.
Blood Chemistry Levels
Substance Normal Value*
pH 7.35 normal
HCO3 18 (22–26 mEq/L)
BUN 62 8.0–20.0 mg/dL (2.9–7.1 mmol/L)
Creatinine 4.1 0.6–1.2 mg/dL (50–
100 mmol/L)
Sodium 132 135–145 mmol/L)
albumin 2g/gL. 3.9–5.0 g/dL
HCT:29%

nephrotic syndrome (primary glomerulus) is seen in children
Bun: creatinine 62: 4.1
HCO3 18mEq/L (compensating breathing)
generalized edema
hypoalbuminemia
gram-positive infection

c. uremia, “urine in the blood”
clinical manifestation: altered fluid, electrolyte, and acid-base balance; alterations in regulatory functions (e.g., blood pressure control, production of red blood cells, and impaired vitamin D synthesis)
creatine is increased,
bun has increased
his current symptoms:
Decrease in urine output (kidney injury), increasing lethargy, hyperventilation (composition trying to get rid of the waste), and generalized edema (build-up)

Question 3

3.A 26-year-old woman makes an appointment with her health care provider, complaining of urinary frequency, urgency, and burning. She reports that her urine is cloudy and smells abnormal. Her urine is cultured, and she is given a prescription for antibiotics.
A.What is the most likely cause of the woman’s symptoms?
B.What microorganism is most likely responsible for the infection?
C.What factors may have predisposed her to this disorder?
D.What could this woman do to prevent future infection?

Answer 3

A. An acute episode of cystitis (bladder infection) is characterized by frequency of urination, lower abdominal or back discomfort, and burning and pain on urination (i.e., dysuria). Occasionally, the urine is cloudy and foul-smelling
B. UTIs are caused by bacteria that enter through the urethra. (E.Coli)
C. being a woman (urethra being close to anus), poor hygiene (not wiping front to back), sexually active
D. drink more water- flushing
go for an STD test (underlying cause),
wash hands, avoid bubble baths, and use proper wiping technique