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Patho II > E4: urinary disorders > Flashcards

E4: urinary disorders Flashcards

1
Q

Some causes of obstructions that occur inside the urinary tract

A
  • stones
  • tumors
  • trauma
  • infection
  • congenital neurogenic bladder
  • congenital reflux
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2
Q

Some causes of obstructions that occur outside the urinary tract (and cause pressure on the urinary
tract)

A
  • benign prostatic hypertrophy
  • pregnancy
  • cancer with pressure
  • inflammation of the gastrointestinal tract
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3
Q

what are the two main problems with urinary tract obstructions

A
  1. stasis of urine

2. increased hydrostatic pressure

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4
Q

patho chain for stasis of urine

A

stasis of fluid behind obstruction–> infection–>damage of the organs ivolved

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5
Q

patho chain for increased hydrostatic pressure

A

obstruction–> increased hydrostatic pressure behind obstruction–>dilation of the involved tissues–> organ damage–> renal failure

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6
Q

hydroureter

A

accumulation of urine in ureter

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7
Q

hydronephrosis

A

accumulation of urine in renal collecting system

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8
Q

nephrolithiasis

A

masses of crystals and protein which are one of the most common causes of obstruction

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9
Q

what are contributing factors to nephrolithiasis

A
  • dehydration/inadequate fluid intake
  • increases intake of substances that form stones
  • urine pH
  • various diseases, drugs
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10
Q

nidus

A

crystal caused by substances that come together and blocks ureters. it then attracts for crystals together and grown into stones

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11
Q

alkaline urine is prone to

A

calcium carbonate and phosphate stone formation

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12
Q

acidic urine is prone to

A

uric acid stone formation (esp below 5.5 and decreased volume)

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13
Q

either pH urine is prone to

A

calcium oxalate and cystine formation of stones

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14
Q

clinical mani of nephrolithiasis in ureters

A

causes distention

“colicky pain” as ureters try to advance stone

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15
Q

clinical mani of nephrolithasis above ureters

A

asymptomatic unless infection or obstruction is present

-dull, achy and constant pain

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16
Q

general clinical mani of nephrolithias

A
  • flank or groin pain
  • nausea/vomiting (stimulation of visceral receptors)
  • hematuria related to trauma
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17
Q

neurogenic bladder

A

-interruption of nerve supply to bladder resulting in a functional obstruction to urine passage

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18
Q

cause of neurogenic bladder

A
  • May have CNS or spinal cord origin

* May be result of trauma, diseases, tumors, congenital anomalies

19
Q

two types of neurogenic bladder

A
  1. upper motor neuron damage (CNS)

2. lower motor neuron damage (spinal cord)

20
Q

upper motor neuron damage neurogenic bladder

A
  • 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
21
Q

lower motor neuron damage in neurogenic bladder

A
  • Disruption of the reflex arc at the Sacral level, with loss of sensation of bladder fullness
  • “Atonic” Bladder
22
Q

type of incontinence with lower motor

A

• Retention with overflow incontinence – loss of voluntary and involuntary control of voiding

23
Q

what type of incontinence with upper motor

A

• Frequent incontinence with urinary retention – loss of voluntary control of voiding

24
Q

who is upper motor usually seen in

A

• Many times seen in quadriplegics

25
Q

who is lower motor usually seen in

A

• Many times seen in paraplegics

26
Q

polycystic kidneys

A

kidneys with multiple fluid filled cysts

27
Q

in infants with polycystic kidneys the kidneys can be….

A

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.

28
Q

cause of polycystic kidneys

A
  • Usually genetic involvement–cysts begin forming in utero
  • Adult onset is autosomal dominant
  • Child onset is autosomal recessive
29
Q

children who have polycystic kidneys frequently also have

A

hepatic abnormalities

30
Q

clinical mani of polycystic kidneys

A
  • Abdominal Mass
  • Failure to Thrive
  • UTI’s
  • Hematuria
  • Renal Insufficiency
31
Q

causes of UTI

A
  • 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
32
Q

Defenses against UTI:

A
  • 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
33
Q

cystitis

A

inflammation of bladder (most common UTI)

34
Q

increased risk for cystitis with

A
  • sexually active females
  • pregnant females
  • “honeymoon cystitis”
  • indwelling catheters
  • kidney stones
  • tumors
  • neurogenic bladder
  • poor hygiene
  • benign prostatic hypertrophy (BPH)
  • diabetes mellitus
35
Q

cystitis clinical mani

A

• 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)

36
Q

acute pyelonephritis

A
  1. 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.
37
Q

cause of acute pyelonephritis

A

• 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)

38
Q

increased risk of acute pyelonephritis with

A
  • Neurogenic bladder
  • Trauma
  • Pregnancy
  • Catheters, endoscopes
  • Infection may be spread to kidneys through the blood stream
39
Q

acute pyelonephritis usually affect what

A

the tubules but not the glomeruli

40
Q

patho of acute pyelonephritis

A

• 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

41
Q

clinical mani of acute pyelonephritis

A
  • Usually acute
  • Chills
  • Fever
  • Flank/groin pain
  • Dysuria
  • Older adults and children usually have non-specific s/s (malaise, fever, decreased appetite)
42
Q

chronic pyelonephritis

A

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.

43
Q

cause of chronic pyelonephritis

A
  • 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
44
Q

clinical mani of Chronic Pyelonephritis

A
  • Minimal and vague
  • May have hypertension
  • May mimic acute pyelonephritis – pain, dysuria, frequency
  • Urine is dilute (unable to concentrate)

Patho II (23 decks)

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