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Internal Med > Genitourinary 1 > Flashcards

Genitourinary 1 Flashcards

1
Q

Kidney function

A

filter waste products and remove excess fluid from blood
- high risk of cancer

mineral and water balance

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2
Q

Why do females have a higher risk of UTI?

A

shorter urethra - closer to bladder where bacteria can infect

closer to anus

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3
Q

Aging causes reduction of ___ to kidney and nephrons, which leads to inefficient _____

A

blood flow

removal of waste, volume of urine increases

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4
Q

with aging in the genitourinary, response to vasoconstriction ____ and response to vasodilation ____

(of blood vessels)

A

increases

decreases

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5
Q

T/F - With aging, we produce less urine at night and have pelvic floor dysfunction

A

F

more urine with pelvic floor dysfunction

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6
Q

What are the most common bacterial infections acquired in the community and in hospitals?

A

UTIs

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7
Q

Risk factors for UTI include impaired voiding or poor perineal hygiene in patients with ____ or _____

A

dementia or stroke

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8
Q

What is most often the cause of UTIs? (What bacteria)

A

fecal-associated gram-negative organisms, Ecoli accounts for 80%

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9
Q

Common clinical manifestations for a UTI (what regions are painful, what happens to the pee, how does it affect older adults?)

A

Fever nausea and vomiting, cloudy bloody or foul smelling urine

Pain with peeing, pain in suprapubic, lower abdominal, groin or flank areas

If kidney involved- diaphragm irritation = ipsilateral shoulder or lumbar back pain

*Malaise, anorexia, mental status change - confusion or delrium in older adults

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10
Q

Appropriate catheter care as a PT includes

A

no kinking or obstruction of urine flow, keep bad bellow bladder level, do not rest bad on floor

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11
Q

Acute pyelonephritis (cause)

who is more at risk?

A

ascending UTI from bladder into kidneys

most commonly by ECOLI

immunocompromised more at risk

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12
Q

Chronic pyelonephritis causes

A

most common - vesicoureteral reflux; urine is forced from the bladder into ureters and kidney

also obstruction, *analgesic neuropathy (from NSAID meds = kidney damage), bacterial infections that are superimposed because of a structural or functional abnormality (kidney stones or somethin)

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13
Q

Acute pyelonephritis symptoms

A

abrupt, fever, chills, malaise, murphy sign (tenderness on costovertebral angle) and bladder irritation (dysuria, frequency, urgency)

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14
Q

chronic pyelonephritis symptoms

A

vary depending on cause or may not be present

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15
Q

What is the most common form or renal neoplasm?

A

Renal cell carcinoma (90-95% of all renal tumors)

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16
Q

Pyelonephritis is more common in _____
whereas renal cell carcinomas have a __:___ ratio of men:women

A

women

2:1

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17
Q

Renal cell carcinoma treatment

A

often resistant to radiation and chemo so surgery is predominant

18
Q

What are the 5 major subtypes of renal cell carcinomas?

A

Conventional or clear cell (75%)
papillary RCCs
Chromophobe RCCs
Collecting duct RCCs
Unclassified

19
Q

Risk factors for renal cell carcinomas include

A

age, obesity, gender (male), African American, high BP, smoking,

overuse of diuretics and pain meds

work exposure to asbestos or cadmium

20
Q

What is the most common site of metastasis for renal cell carcinoma? Where should the PT watch?

A

sternal pain

also watch out for blood in urine, WL, fatigue, fever, back/flank/abdominal pain or cough

21
Q

What is renal calculi? What does it cause?

A

kidney stones - nephrolithiasis
causes urinary obstruction and severe pain

22
Q

Most common kidney stone

A

calcium stone

23
Q

In what areas of the world are renal calculi/kidneys stones most common?

A

industrialized countries, areas noted for high temps and humidity

24
Q

What disorders may cause kidney stones?

A

(Those that cause saturation of calcium and oxalate)

idiopathic hypercalciuria, renal tubular acidosis, primary hyperparathyroidism, hyperoxaluria

25
Q

What are other causes of kidney stones?

A

Acidic urine pH (= uric acid stones)

Gout (excess urate excreted = uric acid crystals/stones)

Chronic dehydration

Dietary - excess intake of calcium, sodium, sucrose and animal protein

26
Q

What is the process of kidney stone formation?

A
  1. Supersaturation - calcium, oxalate and water excretion determine saturation
  2. Nucleation
  3. Crystal growth
  4. Aggregation
    = Stone formation
27
Q

Healthy individuals have crystals < ___ in size while stone formers have crystals > __ in size

A

20 micrometers

28
Q

Symptoms of kidney stones

A

acute and severe “colicky” flank pain (cramping) radiating to the groin or perineal,

90% have hematuria

Similar to UTI symptoms

29
Q

Criteria for chronic kidney disease

A

decreased kidney function shown by glomerular filtration rate < 60 mL/min per 1.73m^2 OR markers of kidney damage or both for at least 3 months

30
Q

Main risk factors of chronic kidney disease

A

diabetes (30-50%)
hyper tension > 25%
analgesic drug use

31
Q

How does chronic kidney disease develop (pathogenesis)? (Who is the main player)

A

Diabetes/hyperglycemia releases angiotensin II (which causes vasoconstriction of arteries to keep pressure adequate for filtration)

Angiotensin II attracts inflammatory cells releasing cytokines and growth factors that change the structure of the glomerulus, causing enlargement of it and eventually fibrosis and sclerosis, reduccing GFR

unable to regulate fluid balance and remove waste from blood

I WOULD JUST REMEMBER ANGIOTENSIN II = STRUCTRUAL CHANGES = DECREASED GFR

32
Q

What is GFR and how is it measured?

A

asses how much blood passes through the filters each minute

can be measured directly or estimated with lots of info including creatine

33
Q

How is chronic kidney disease classfied?

A

Classified as G1-G5 stages using estimated GFR (eGFR), G1 = normal, G5 = kidney failure

34
Q

What abnormal lab values are looked for in staging chronic kidney disease?

A

elevated BUN (blood urea nitrogen), creatine or protein in the urine

35
Q

Kidney failure causes an increase in ___ retention and __ elimination

A

phosphate retention
calcium elimination

36
Q

What hormone responds to the effects of kidney failure? (inc. calcium excretion)

A

kidney failure = elimination of calcium so initial increase of PTH secretion

(eventually becomes unresponsive to normal feedback system)

37
Q

How does the gut respond to kidney failure?

A

decreased synthesis of vitamin D
decreases calcium absorption
increased phosphate retention

(affects of PTH secretion during kidney failure)

38
Q

What happens in the bones during kidney failure?

A

Bone resorption (demineralization) = release of calcium and phosphate into the blood

(bc kidney is eliminating calcium during failure, we need more calcium in blood)

39
Q

The overall systemic response to kidney failure causes _____ and ______ (result of PTH stimulation)

A

hyperphosphatemia and hypercalcemia

40
Q

Treatment of chronic kidney disease

A

Hemodialysis

Peritoneal dialysis (CAPD and CCPD)

kidney transplantation

Internal Med (25 decks)

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