E4: urinary disorders Flashcards
Some causes of obstructions that occur inside the urinary tract
- stones
- tumors
- trauma
- infection
- congenital neurogenic bladder
- congenital reflux
Some causes of obstructions that occur outside the urinary tract (and cause pressure on the urinary
tract)
- benign prostatic hypertrophy
- pregnancy
- cancer with pressure
- inflammation of the gastrointestinal tract
what are the two main problems with urinary tract obstructions
- stasis of urine
2. increased hydrostatic pressure
patho chain for stasis of urine
stasis of fluid behind obstruction–> infection–>damage of the organs ivolved
patho chain for increased hydrostatic pressure
obstruction–> increased hydrostatic pressure behind obstruction–>dilation of the involved tissues–> organ damage–> renal failure
hydroureter
accumulation of urine in ureter
hydronephrosis
accumulation of urine in renal collecting system
nephrolithiasis
masses of crystals and protein which are one of the most common causes of obstruction
what are contributing factors to nephrolithiasis
- dehydration/inadequate fluid intake
- increases intake of substances that form stones
- urine pH
- various diseases, drugs
nidus
crystal caused by substances that come together and blocks ureters. it then attracts for crystals together and grown into stones
alkaline urine is prone to
calcium carbonate and phosphate stone formation
acidic urine is prone to
uric acid stone formation (esp below 5.5 and decreased volume)
either pH urine is prone to
calcium oxalate and cystine formation of stones
clinical mani of nephrolithiasis in ureters
causes distention
“colicky pain” as ureters try to advance stone
clinical mani of nephrolithasis above ureters
asymptomatic unless infection or obstruction is present
-dull, achy and constant pain
general clinical mani of nephrolithias
- flank or groin pain
- nausea/vomiting (stimulation of visceral receptors)
- hematuria related to trauma
neurogenic bladder
-interruption of nerve supply to bladder resulting in a functional obstruction to urine passage
cause of neurogenic bladder
- May have CNS or spinal cord origin
* May be result of trauma, diseases, tumors, congenital anomalies
two types of neurogenic bladder
- upper motor neuron damage (CNS)
2. lower motor neuron damage (spinal cord)
upper motor neuron damage neurogenic bladder
- at or below the cerebral cortex and above the sacral level (CNS)
- Reflex Arc intact-arc senses fullness but the sensation isn’t felt so can’t inhibit voiding
- “Reflex” Bladder
lower motor neuron damage in neurogenic bladder
- Disruption of the reflex arc at the Sacral level, with loss of sensation of bladder fullness
- “Atonic” Bladder
type of incontinence with lower motor
• Retention with overflow incontinence – loss of voluntary and involuntary control of voiding
what type of incontinence with upper motor
• Frequent incontinence with urinary retention – loss of voluntary control of voiding
who is upper motor usually seen in
• Many times seen in quadriplegics
who is lower motor usually seen in
• Many times seen in paraplegics
polycystic kidneys
kidneys with multiple fluid filled cysts
in infants with polycystic kidneys the kidneys can be….
be up to 10% of the child’s weight
• Infants born with autosomal polycystic kidney disease can die at birth or shortly after. - - - About
25% do survive to childhood.
cause of polycystic kidneys
- Usually genetic involvement–cysts begin forming in utero
- Adult onset is autosomal dominant
- Child onset is autosomal recessive
children who have polycystic kidneys frequently also have
hepatic abnormalities
clinical mani of polycystic kidneys
- Abdominal Mass
- Failure to Thrive
- UTI’s
- Hematuria
- Renal Insufficiency
causes of UTI
- Gram negative-E. Coli (80-90 percent of all initial UTI”S).
- More than 100,000 bacteria/ml. present
- Can happen anywhere along the urinary tract
- 20-50 percent of all women have lower urinary tract infections
Defenses against UTI:
- Frequent voiding – thus not allowing stasis, retention
- Acidic urine (a low pH has a bacteriocidal effect)
- Vesicoureteral junction (this normally closes during bladder contraction preventing reflux)
- Long urethra in males
- Prostatic secretions
- Good personal hygieneCystitis
cystitis
inflammation of bladder (most common UTI)
increased risk for cystitis with
- sexually active females
- pregnant females
- “honeymoon cystitis”
- indwelling catheters
- kidney stones
- tumors
- neurogenic bladder
- poor hygiene
- benign prostatic hypertrophy (BPH)
- diabetes mellitus
cystitis clinical mani
• Frequency, urgency, dysuria
• Pain – low-back, flank, or suprapubic
• Hematuria/cloudy urine
• 10% with bacteriuria are asymptomatic
• Children and the elderly may be asymptomatic. (If children have s/s – these would be bedwetting,
redness in females, scratching in the area)
acute pyelonephritis
- Infection of the renal pelvis – usually of bacterial origin (e.g. E.Coli).
-Pseudomonas or Proteus
may be cause after urinary tract surgery.
- More frequent in women.
-Involves one or both kidneys.
cause of acute pyelonephritis
• Obstruction (e.g. stones) with reflux of urine into the ureters
• Vesicoureteral reflux in children – (urine ascends into the ureters when the child voids because of
malplacement of ureters in the bladder)
increased risk of acute pyelonephritis with
- Neurogenic bladder
- Trauma
- Pregnancy
- Catheters, endoscopes
- Infection may be spread to kidneys through the blood stream
acute pyelonephritis usually affect what
the tubules but not the glomeruli
patho of acute pyelonephritis
• Focal inflammatory process with WBC infiltration, edema and purulent urine
• If infection continues, tubule destruction results in the formation of scar tissue and atrophy of
affected tubules which can lead to chronic pyelonephritis
clinical mani of acute pyelonephritis
- Usually acute
- Chills
- Fever
- Flank/groin pain
- Dysuria
- Older adults and children usually have non-specific s/s (malaise, fever, decreased appetite)
chronic pyelonephritis
A recurrent or persistent autoimmune infection of the kidney resulting in tubular destruction
and scarring. Results in decreased renal function and can cause renal failure.
cause of chronic pyelonephritis
- More likely to occur in renal infections associated with obstructive conditions (e.g. stones, reflux)
- May result from recurrent acute pyelonephritis, ischemia, irradiation
- Drug toxicity (phenacetin, ASA, acetaminophen)
- Progression may continue for years until renal failure occurs
clinical mani of Chronic Pyelonephritis
- Minimal and vague
- May have hypertension
- May mimic acute pyelonephritis – pain, dysuria, frequency
- Urine is dilute (unable to concentrate)
