Genitourinary System Flashcards
___ ___ ___ is the percentage of body weight that is made of up water
Total body water
Newborns have ___% total body water
75
Elderly people have a total body water of ___%
50
Adults have a total body water of ___%
55-60
____ fluid makes up 40% of our body weight which is 70% of total body water
Intracellular
____ fluid is a good indication of what is in the intracellular fluid
Extracellular
____ fluid is the fluid surrounding cells and makes up only 20% of total body weight
Interstitial
____ is the fluid in blood/vascular space
Plasma
___ ___ is the volume of all electrolytes and everything else in the blood, while plasma volume is just the fluid
Blood volume
We gain about 2500 cc per day from what three things?
-Ingested fluids
-Water in food
-Water from the oxidation of food
The GI tract absorbs up to ___ liters of fluid each day from salivary, gastric, biliary, pancreatic, and intestinal secretions
10
We usually ___ just as much water as we ___
Lose, gain
How do we lose water?
-Kidneys (lose 1400 cc per day)
-Skin and lungs (900-1000 cc per day)
-GI tract (200 cc/day)
___ ___ explains how the net effect for overall intracellular cations is greater than overall net effect for extracellular cations and anions
Electrolyte balance
There is a ____ concentration of potassium and magnesium in the cell (intracellular) than outside of the cell
Higher
There is a ____ concentration of sodium on the outside of the cell (extracellular)
Higher
___ is one regulator of fluid and electrolyte balance
Thirst
You have increased thirst in response to…
-Increased osmolality
-Decreased blood volume
What may impact an individual’s ability to respond to thirst?
-Decreased thirst as we age
-Medications may decrease thirst
-Neurologic impairment
-Childred
Antidiuretic hormone is also known as ____
Vasopressin
Antidiuretic hormone is released in response to…
-Increased osmolality
-Decreased blood volume
The ____ stimulates the anterior pituitary gland to release antidiuretic hormone
Hypothalamus
Antidiuretic hormone causes us to retain more ____
Water
When there is low blood flow or low oxygen, the kidneys release ____, which cuts a piece of angiotensin to make angiotensin I
Renin
Angiotensin I is not biologically active until ____ comes to activate it
ACE
When ACE (Angiotensin Converting Enzyme) comes across angiotensin I, it with cleave a piece to make ____ ____
Angiotensin II
___ ___ can inhibit the conversion from angiotensin I to angiotensin II
ACE inhibitors
Angiotensin II is biologically active and a potent ____
Vasoconstrictor
Angiotensin II stimulates the pituitary to release ___ ___ to increase water retention
Antidiuretic hormone
Angiotensin II also stimulates the adrenal gland to release _____ which also causes increased water and sodium retention in the body
Aldosterone
____ converts angiotensin II to angiotensin III
Angiotensinase
Angiotensin III is a biologically active molecule, but only has about ___% of the constriction power of angiotensin II (it still causes water and sodium retention by aldosterone production)
40
When the heart is stretched, it releases ___ ___ ___, which is a direct vasodilator, to decrease blood pressure and increase excretion of water and sodium
Atrial naturetic peptide
___ ___ ___ has the same vasodilator properties of atrial naturetic peptide but comes from the brain and not the heart
Brain naturetic peptide
Kidneys are located in the back, under the __ __
Rib cage
What are the three major functions of the kidneys?
-Filtration
-Reabsorption
-Secretion
The kidneys filter things from the blood into the ___ ___; this fluid will move through the tubules of the nephron where we will see reabsorption
Bowman’s capsule
Reabsorption refers to substances that are filtered but sent back to the body instead of the ____
Urine
___ refers to the movement of substances from the blood into the tubules
Secretion
The ___ is where the filtration occurs in the kidneys
Glomerulus
The ___ ___ brings oxygenated blood to the kidney to be filtered (juxtaglomerular cells that line the arteriole release renin)
Afferent arteriole
The ___ ___ is where filtered blood is returned to the circulation
Efferent arteriole
___ ___ ___ is determined by the balance between hydrostatic pressure and colloidal oncotic pressure
Glomerular filtration rate
What forces are involved in filtration?
-Glomerular capillary hydraulic pressure
-Oncotic pressure of fluid in Bowman’s capsule
-Hydraulic pressure in Bowman’s capsule
-Oncotic pressure of glomerular capillary plasma
-Filtration pressure
The tubules are responsible for ___ and ___
Resorption and secretion
The collecting duct collects, fluid that becomes ____
Urine
The majority of reabsorption of sodium occurs in the ___ ___ ___ (some also is reabsorbed in the loop of henle and the distal convoluted tubule)
Proximal convoluted tubule
___ ___ work to decrease water reabsorption in the loop of Henle
Loop diuretics
What helps regulate the pH of the blood?
HCO3
What are three blood tests of renal function?
-Creatinine
-Blood urea nitrogen (BUN)
-Urinalysis
Creatinine is a substance that is freely filtered from the blood into the glomerulus; it is an end product of ___ ___ (it is a very good indicator of glomerular function
Muscle metabolism
Normal creatinine level is ___-___ mg/dL
0.7-1.2
What is included in urinalysis?
-Sodium levels
-Specific gravity
-Potassium
-pH
-Osmolality
-RBC and WBC
-Casts
Normal BUN is from __-__ mg/dL
8-25
___ ____ measures the osmolality of urine
Specific gravity
There should not be many ___ or ___ in the urine
RBC or WBC (WBC may indicate UTI)
____ are mucoproteins that have come off the nephron and will stick to things and create a mold (we don’t want to see RBC casts, WBC casts, or bacteria casts because this would indicate that these were in the kidneys
Casts
We don’t want to see ___ in the urine
Glucose
____ in the urine would indicate pregnancy
HCG
Alterations in fluid volume may be…
-Isotonic
-Hypertonic imbalance
-Hypotonic imbalance
Hypertonic imbalance may be due to ____
Hypernatremia
Hypotonic imbalance may be due to ____
Hyponatremia
Hyponatremia is caused by serum sodium less than ____ mEq/L and causes blood to be less concentrated
136
Hyponatremia can be caused by…
-Excess sweating
-GI losses (long-term diarrhea)
-Diuretics
-Excess water retention (syndrome of inappropriate antidiuretic hormone)
-Decreased delivery of blood volume to the kidney
Hyponatremia may cause cells to be hypotonic and ____
Burst
Hyponatremia may cause what symptoms?
-High intracranial pressure (neurological issues)
-Muscle spasms and cramps
-Loss of appetite
-Weakness
-Fatigue
-Severe may cause coma and death
Hypernatremia may be caused by…
-Loss of body fluid
-Excess urinary output
-Diabetes insipidus
-Watery diarrhea
-Dehydration
-Excessive sodium intake
-Cardiac arrest treatment
-Hypertonic saline
Manifestations of hypernatremia:
-Decreased urine output
-Excessive thirst
-Dry mucous membranes
-Water pulled out of the cells of the CNS, causes lethargy, agitation, headache, restlessness
-Edema
-Severe could cause edema and death
____ is the abnormal development of fluid in the interstitial space
Edema
Possible etiologies of edema
-Increased hydrostatic pressure
-Decreased colloid osmotic pressure/oncotic pressure
-Increased capillary membrane permeability
-Lymph obstruction
What may cause increased hydrostatic pressure?
-Increased vascular volume (heart failure)
-Venous obstruction (thrombophlebitis, ascites)
-Gravity (swollen feet)
What may cause decreased colloidal osmotic pressure?
-Decreased production of plasma proteins
-Nephrotic syndrome
What may cause increased capillary permeability?
-Inflammation
-Sepsis
-Burns
What may cause lymph obstruction?
-Surgical removal of lymph nodes
Manifestations of edema:
-Pitting or non-pitting edema
-High risk for ischemia
-Edematous tissue is more likely to have injury
-Changes in blood pressure
___ disorders are caused by a blockage of urine flow at the renal pelvis, bladder, or urethra
Obstructive
Obstructive disorders may be caused by either an ___ or ____ blockage
Internal; external
With an internal blockage, urine can’t ____, so it builds up and causes increased pressure
Drain
Internal blockages increase the risk of ___ and can possibly damage kidneys
UTI
Most internal blockages are caused by ____, or kidney stones
Calculi
Other internal blockages can be caused by…
-Pregnancy
-Benign Prostate Hyperplasia
-Tumors
Manifestations of internal blockages:
-Back pressure/pain
-Urine output - unchanged or none
Renal calculi are caused by kidney stones that can be made of…
-Calcium
-Magnesium ammonium
-Uric acid
What factors are needed for stone formation?
-Saturated urine
-Organic material
-Deficiency of substances that hinder formation
Manifestations of renal calculi:
-Infections
-Hydronephrosis (too much water in the kidney)
Signs and symptoms of renal calculi:
-Pain
-Clammy skin due to pain
-Nausea and vomiting due to pain
____ is inflammation of the bladder
Cystitis
Cystitis is caused by a ___ ___, commonly E. coli
Bacterial infection
Risk factors for developing cystitis:
-Gender (women are more likely)
-Prostate hypertrophy
-Diabetes Mellitus
-Immunosuppression
-Pregnancy
-Foley catheter
-Post colonoscopy
Manifestations of cystitis:
-WBC in the urine
-Pus int he urine
Symptoms of cystitis:
-Possibly asymptomatic
-Young women typically have frequent urination, urgency of urination, dysuria (pain with urination), possible superpublic pain
-Severe cases may cause blood in the urine or cloudy urine
____ is infection of the kidneys and renal pelvis (a UTI/cystitis that has traveled up to the kidneys)
Pyelonephritis
____ pyelonephritis is more common and may lead to chronic
Acute
Pyelonephritis is caused by ___ of bacteria up the urethra to the kidney
Retrograde
Manifestations of pyelonephritis:
-Inflammation of the kidney, affecting the drainage system
Symptoms of pyelonephritis:
-Chills
-Fever
-Headache
-Back pain
-Purulent/thick urine
-Weird odor in the urine
-Casts in the urine
____ pyelonephritis is recurrent infections of acute pyelonephritis
Chronic
With chronic pyelonephritis, ____ causes shape changes and can even lead to kidney disease
Scarring
Manifestations of chronic pyelonephritis are similar to ____ pyelonephritis, but may lead to chronic kidney disease
Acute
_____ is inflammation of the glomerulus and causes it to lose its ability to properly filter blood
Glomerulonephritis
Glomerulonephritis is also known as __ __ __
Acute Nephritic Syndrome
Nephritic Syndrome is caused by leaky basement membranes that allow ____ to get into the urine
Protein
Possible causes of nephritic syndrome:
-Immune system overactivation (Lupus)
-Post streptococcal (10-14 days post-infection)
-Drug-induced
-Vascular disorders
-Hep B
Manifestations of nephritic syndrome:
-Hematuria with red blood cell casts
-Proteinuria up to 3.5 grams per day
-Oliguria
-Azotemia
-Hypertension
-Mild edema
About ___% of people with nephritic syndrome go on to develop nephrotic syndrome
10
Nephrotic syndrome causes more severe ____ than nephritic syndrome
Inflammation
What are possible manifestations of nephrotic syndrome?
-Edema
-Hypocalcemia
-Proteinuria > 3.5 grams per day (more than nephritic syndrome)
-High serum and urine LDL
-Hypoalbuminemia (albumin gets dumped in the urine)
-High lipidemia
___ ___ ___ is an acute reduction of renal function; seen in up to 5% of hospitalized patients
Acute Kidney Injury
____ acute kidney injury is caused a problem before the kidney
Prerenal
Causes of prerenal acute kidney injury:
-Dehydration
-Volume depletion
-Diuretics
-Shock
-Edema
-Heart failure
-Hypovolemia
-ACE inhibitors
-NSAIDs
Mechanism of prerenal acute kidney injury:
-Vasoconstriction of glomerular arterioles to decrease perfusion of the kidney
-Renal function remains normal (just slightly slower)
Manifestations of prerenal acute kidney injury:
-BUN and creatinine levels will decrease
-Slight decrease in urine output
____ acute kidney injury is caused by a problem with the actual tissue of the nephron
Intrarenal
Intrarenal, or ____ kidney failure, is due to primary damage of the nephrons or destruction of the tubular epithelial cells
Intrinsic
Possible causes of intrarenal acute kidney injury:
-Prolonged renal ischemia
-Toxicity (chemo, drugs, NSAIDs)
-Tubular obstruction (by hemoglobin, myoglobin, etc)
-Postrenal acute kidney injury
What are the three phases of intrarenal acute kidney injury:
-Onset/initiating phase
-Oliguric/anuric phase
-Diuretic phase
In the oliguric phase, someone has little to no ___ ___, as well as increased serum potassium and decreased serum sodium
Urine output
In the oliguric phase, the body has increased water retention, causing _____ that can look like heart failure
Hypertension
In the diuretic phase, nephrons recover enough to where they are functional; serum potassium ____ and serum sodium ____
Decreases; increases
Mechanism of intrarenal acute kidney injury:
Ischemia and toxins lead to damage to the renal tubular cells
What are some possible manifestations of intrarenal acute kidney injury?
-Edema
-Acute tubular necrosis
-Neuropathy
-Muscle pain
-Confusion
-Rash
____ acute kidney injury causes a backup of fluid so the capsule has higher pressure which means less blood can move across
Postrenal
Postrenal acute kidney injury causes damage to the ____
Tubules
Possible causes of postrenal acute kidnye injury:
-Obstruction (prostatic disease, tumor, calculi, congenital abnormality)
-If there is a stone in the urethra, there would be increased pressure in both kidneys but sometimes there might only be damage to one kidney
Manifestations of postrenal acute kidney injury:
-Increased BUN and creatinine
-Elevated serum potassium
-Low serum sodium
___ ___ ____ is progressive and irreversible destruction of kidney structures
Chronic kidney disease
Stages of CKD:
-Stage 1: GFR >90%
-Stage 2: GFR 60-90%
-Stage 3: GFR 30-59%
-Stage 4: GFR 15-29%
-Stage 5: GFR <15% (end-stage renal disease)
Causes of CKD:
-Diabetic nephropathy
-Chronic glomerular disease
-Hypertension: leads to bumpy surface of the kidney that damages it
-Polycystic disease
What are fluid, electrolyte, and acid-base balance manifestations of CKD?
-Hyperkalemia
-Metabolic acidosis
-Edema
What are some calcium, phosphate, and bone metabolism manifestations of CKD?
-Too much parathyroid hormone is released and is toxic
-Hyperphosphatemia
-Hypocalcemia
What are some hematologic and immune manifestations of CKD?
-Anemia
-Poor coagulation and GI bleeding
-Bruising
-Impaired immune system function
What are some cardiovascular manifestations of CKD?
-Hypertension (90%)
-Congestive heart failure
-Pericarditis
What are some GI manifestations of CKD?
-Anorexia
-Nausea
-Vomiting
What are some neurological manifestations of CKD?
-Peripheral neuropathies
-Uremic encephalopathies (excess toxins in the blood cause brain problems)
What are some skin manifestations of CKD?
-Yellow-brown tinge
-Diminished activity of the oil glands
-Pruritis
-Uremic frost
CKD may also cause ___ dysfunction in men and women
Sexual
