GU Flashcards
How much blood do the kidneys cycle through per minute?
1200 ml/min (20-25% of CO)
What is the glomerular function (GFR)?
Amount of blood filtered by the glomeruli in a given time (125 mL/min)
Define what the proximal convoluted tubule does and what is reabsorbed here
80% of electrolytes reabsorbed, all glucose, amino acids, small proteins, using active transport
What does the Loop of Henle do? What is absorbed here?
Conserves water, concentrates filtrate, and resorption continues
What part of the kidney do Lasix target?
Loop of Henle
What does the distal tubule do?
Final regulation of water balance and acid-base balance
What test will recognize the acid-base balance in the distal tubules?
ABGs - they detect acid-base
What does the collecting duct do?
Any more water to reabsorb/final reabsorption
What is erythropoietin? Where is it produced? What triggers its release?
Stimulates the production of RBCs in the bone marrow
Produced in the kidney in response to hypoxia in the body and decreased renal flow
Where does the second step of Vitamin D activation occur?
Kidney
How much urine in the bladder would cause distention and urge to urinate?
200-250 mL
How much urine causes an individual to become uncomfortable?
400-600 mL
How much urine does the average individual excrete per day?
1500 mL/day
How long are male and female urethras?
Male - 20 to 25 cm long
Female - 3 to 5 cm long
Does GFR increase or decrease with age?
Decreases
Define BUN, creatinine, and GFR blood tests
- BUN - Measures the amount of urea nitrogen in blood
- Creatinine - Measures amount of protein digestion and normal muscle breakdown
- GFR - Checks how well kidneys are functioning
Define urinalysis, C&S, cytology, and uric acid studies
- Urinalysis - Detect a wide range of disorders
- Urine C&S - Checks for bacteria that could be causing an infection
- Urine cytology - Screens for cells
- Uric acid - Occurs during the breakdown of purines
Why should we know if a client has had a hysterectomy prior to a bladder scan?
Use the male key for gender on the scanner because the bladder will sit lower
What is a cystoscopy?
Scope up the urethra to the bladder
What is radiography-KUB?
Evaluates the urinary system and its surrounding structures
What is renal pyelography? What do we need to be cognizant of?
Uses contrast material to evaluate kidneys, ureters, and bladder
Dye allergies
What is acute pyelonephritis?
Inflammation of the renal pelvis and kidney - swelling and increased blood flow
How does acute pyelonephritis begin?
Begins with colonization and infection of the lower urine tract, ascends upward
Usually starts in the renal medulla and spreads to the cortex
What is colonization and when does it become problematic?
organisms are present and they are staying where they are, which causes no issues or problems, but when they begin to move is when a problem occurs
What is a pre-existing factor for acute pyelonephritis?
vesicoureteral reflux or dysfunction of lower urinary tract function
if the sphincter is not tight enough, organisms and urine can back flow which can cause an infection
What is the most common cause of acute pyelonephritis?
E. coli that comes from stool due to improper wiping
What is urosepsis resulting from acute pyelonephritis?
The infection has gone from the kidneys into the entire body
What conditions are the two many causes of sepsis in elderly patients?
acute pyelonephritis and pneumonia
Define vesicoureteral reflux
backflow from an incomplete sphincter of the ureter
What are the clinical manifestations of acute pyelonephritis?
Symptoms will vary across individuals
Mild fatigue to sudden onset of chills, fever, vomiting, malaise, flank pain, emptying and storage symptoms, costovertebral tenderness (pain on the back with light tapping)
What is costovertebral tenderness?
Pain on the back with light tapping
What would a urinalysis show in someone with acute pyelonephritis?
It will show pyuria (pus in the urine), bacteriuria, hematuria, and WBCs
Urine may be so infected you won’t be able to see through it
What is pyuria?
Pus in the urine
Why would we not use a pyelography or CT in the early stages of pyelonephritis?
These tests are too invasive/hard on the kidneys because they would need to work to breakdown the contrast
What 4 things would the team do to manage mild symptoms of acute pyelonephritis?
- Outpatient treatment - antibiotics and hydration via IV
- Maintain hydration
- Antibiotics for 14-21 days, initially IV route
- Follow-up culture and imaging
How long would someone with mild symptoms of acute pyelonephritis be on antibiotics? How long after treatment would they require a follow-up culture?
14-21 days
can be 6 weeks to 6 months to look for any residual damage
How would a team manage severe symptoms of acute pyelonephritis?
NSAIDs and antipyretics, parenteral antibiotics then switch to oral, and follow-up culture/imaging
What do we need to ensure prior to administering NSAIDs/antipyretics to someone with acute pyelonephritis?
These meds can be damaging to the kidneys and create issues with excretion - we need to know kidney function prior to admin
What is chronic pyelonephritis?
The kidney has shrunk, resulting in lost function due to scarring/fibrosis
It is the outcome of recurring infections - need to determine the route of recurring infections
What condition often leads to end-stage renal disease?
Chronic pyelonephritis
Where in Canada has higher rates of urinary tract calculi?
Higher on the east coast than west, likely due to diet
Is urinary calculi more common in men or women?
Men
What type of urinary calculi is higher in women than men?
Struvite - a renal calculi that has calcium, magnesium, phosphate, and ammonia
What is the age range for urinary calculi?
20-55 years
What seven factors are related to urinary calculi?
Genetics, seasonal variation/climate (more common in summer due to dehydration), metabolic, dietary, lifestyle, and occupation
Why do urinary calculi lead to obstructions?
The GU cannot reverse peristalsis, so the individual will end up with back flow and distention/expansion
What is the differences between a calculus and lithiasis?
Calculus - abnormal stone formed in body tissues by an accumulation of mineral salts
Lithiasis - stone formation
What are the 5 types of calculi that need to be sent to pathology?
Calcium phosphate, calcium oxalate, uric acid, cystine, and struvite
When do symptoms present in urinary calculi?
Occur when the urine flow is obstructed - will not see symptoms or signs until obstruction occurs
What are the six signs/symptoms of urinary calculi?
Severe abdominal/flank pain, hematuria, renal colic, nausea/vomiting, cool/moist skin, and urinary infection
Define colic pain
Pain that comes and goes; pain can be intense and then mild, and intense again
Why would you use a retrograde pyelogram for urinary calculi?
Detects any reflux occurring that can lead to pyelonephritis
What 3 blood studies would you want to take for an individual admitted with urinary calculi?
BUN, GFR, and serum creatinine
How do we treat an acute urinary calculi episode?
treat pain, infection, and obstruction through morphine (iv) and tracking I/O
What is the primary question to ask as a HCP when the urinary calculi has settled?
Why did the stones form? Composition of the stone and goal of preventing it again
Would we put an individual with urinary calculi on a sodium restriction? Why or why not?
Yes, we want to flush out as much water as possible
What three dietary changes do we want to make to someone with urinary calculi? Provide examples of each
Purine - organ meat, anchovies, gravy
Calcium - dairy, cheese, yogurt salmon, almonds
Oxalate - green leafy vegetables, soy, almonds, tea, rhubarb
What four generic things do medication to prevent stone formation aim to do?
Alter pH, prevent excessive urinary excretion of particular substances, correct primary disease, control infection
What is an endourological scope?
Scope fragments the stone and scoops it up
What is a lithotripsy?
Sound waves break stones apart - used for larger stones that cannot be acquired through the scope
What six things are surgical scopes (i.e., endourological scope) indicated for in urinary calculi?
- Stones are too large to pass
- Associated with bacteria/symptomatic infection
- Causes impaired renal function
- Causes persistent pain, nausea, or ileus (peristalsis stops in an area of the GI, which often leads to an obstruction)
- Pt can’t be treated medically
- Pt only has one kidney
What would the fluid intake be of someone after an episode of urinary calculi?
High fluid intake 3000 mL/day to ensure urine output of at least 2000 mL/day
What are the dietary restrictions for someone with urinary calculi?
Diet restrictions as indicated, must wait for stone pathology to come back
What four things do sex hormones regulate?
Ovulation, spermatogenesis, fertilization, formation/function of secondary sex characteristics
What age does menarche begin?
12.4 years of age
What does a testosterone blood study detect?
Reveals tumours and developmental anomalies
What is a PSA?
screens for prostate cancer
What is a mammography? At what age should they begin and how often?
X-ray image of breast tissue
Done from 50-74 years, every 2 years - after 75 develop/discuss a screening program
What is mastalgia?
A benign breast disorder that results in breast pain
What is cyclic mastalgia?
Diffuse breast tenderness/heaviness, lasts 2-3 days or most of the month
What is cyclic mastalgia related to?
Hormonal sensitivity and a woman’s menstrual cycle
What is noncyclic mastalgia?
Benign breast disorder, breast pain not related to the menstrual cycle
Usually only one breast affected, constant or intermittent pain that lasts months to years
What are the signs and symptoms of noncyclic mastalgia?
Burning sensation, aching, or soreness
What is fibrocystic change of the breast?
A benign condition, where there are changes to breast tissue - can be one or both
Excess fibrous tissue, hyperplasia of epithelial lining of mammary ducts, and cyst formation
What physiologically causes pain in fibrocystic changes of the breast?
Caused by irritation of nerve endings (edema and fibrosis)
Are fibrocystic breast changes associated with breast cancer?
They are NOT associated with increased risk for breast cancer
What age range are fibrocystic breast changes most common in?
30-50 years
With age, how does fibrocystic breast changes alter?
Pain and nodules increase over time but tend to decrease after menopause due to decreased estrogen
What are the signs/symptoms of fibrocystic breast changes?
Pain, palpable lumps that are round, well delineated, and freely movable
What differs malignant and benign breast lumps?
Malignant - often not round and typically have irregular borders. In addition, they do not move
Benign - Palpable lumps, often round, well delineated, and freely movable
What are the three stages of menopause?
Perimenopause, menopause, and post-menopause
Define perimenopause
Starts when first changes in menstrual cycle are noticed and ends after cessation of menses
Define menopause - how long does menses have to be gone for someone to be considered menopausal?
cessation of menstrual cycle and ovulation, no menses after 12 months
Define post-menopause
Life after menopause
What is the average age and age range of menopause?
Avg - 52
Range is anywhere from 40-58
What will be the physical presentation of the vagina in perimenopause?
Labia majora will be smaller and the vaginal canal will be wider/looser
What are the 6 symptoms of perimenopause?
Atrophy of genitourinary tissue, irregular menses, mood changes, occasional vasomotor symptoms, osteoporosis, and stress/urge continence
What are the 5 symptoms of post menopause?
Atrophy of genitourinary, breast tenderness, cessation of menses, stress/urge continence, vasomotor instability (hot flashes/night sweats)
What four primary things should be assessed in menopausal individuals?
Depression, thyroid dysfunction, anemia, and anxiety
In someone with a uterus, what are some increased and decreased risks and of estrogen and progesterone hormone therapy for menopause?
Increased risk for breast cancer, stroke, heart disease, and emboli
Decreased risk for hip fractures and colorectal cancer
Is hormone therapy for menopause short or long-term?
Short-term
What kind of dose should you start with for estrogen/progesterone therapy
Use lowest dose possible
What are three non-hormone therapies for menopause?
SSRIs, gabapentin, and mood stabilizers
What is the best exercise prescription for menopause?
Moderate aerobic exercise 3-4x per week and weight bearing to avoid/offset osteoporosis
What are some complementary therapies for menopause?
Cool environment, bed linens, limit caffeine/alcohol, relaxation techniques, cool cloths, vitamin E
What dietary/nutritional therapy is best for menopausal women?
Calories, calcium, and vitamin D, complex carbohydrates, vitamin B complex
What foods to avoid in menopausal women because they provide more vasomotor symptoms
Alcohol, chocolate, and caffeine
Define benign ovarian tumors
Multiple benign tumors or cysts on the ovaries
What are the clinical manifestations of benign ovarian tumors
Masses are often asymptomatic until they are large enough to apply pressure
What are the symptoms of a malignant ovarian cyst or tumour?
Constipation, menstrual irregularities, urinary frequency, full feeling, anorexia, peripheral edema, increase in abdominal girth, pelvic pain
What is the interprofessional care for an ovarian cyst that is less than 8cm in size?
Return for re-examination in 6-8 weeks, the aim is that the body will reabsorb the cyst
What is the interprofessional care for an ovarian cyst that is greater than 8cm in size?
Solid laparoscopic surgery is performed
Define benign prostate hyperplasia
Increase in size of the prostate gland, disruption of urinary flow
What seven factors may lead to an enlarged prostate?
hormonal changes, aging, obesity, lack of PA, smoking, diabetes, family hx
What are the clinical manifestations of prostate enlargement/the largest concern?
Symptoms are gradual - can be either obstructive or irritative
We are most concerned with urethra obstruction
What are the four symptoms of urinary obstruction from prostate enlargement?
decrease in flow and force of urinary stream, difficulty initiating stream, intermittent urination, and dribbling following urination
What are the five irritative symptoms from prostate enlargement?
frequency, urgency, dysuria, bladder pain, nocturia (how many times and has it increased from your normal?), incontinence
If the prostate is enlarged upon the digital rectal exam, how will it feel? What would it normally feel like?
Firm and smooth
It should be smooth, symmetrical, and round
What five things should the team with an enlarged prostate implement into the care?
- Decrease caffeine
- Avoid artificial sweeteners
- Avoid medications like decongestants and anticholinergics (decrease the drive to urinate)
- Limit evening fluids
- Timed voiding schedules (i.e., only voiding every 2 hours and not any sooner)
Why should someone with enlarged prostate avoid artificial sweeteners?
They irritate the bladder
How many hours before bed should someone with an enlarged prostate stop drinking fluids?
Three hours before bed and no sipping at night
What is a cootie catheter and when is it indicated?
An angled/curved catheter that accommodates for enlarged prostates
What are the four non-invasive therapies for enlarged prostate?
Transurethral microwave thermotherapy (TUMT)
Transurethral needle ablation (TUNA)
Laser prostatectomy
Intraprostatic urethral stents
What is a transurethral resection of prostate (TURP)?
Portions of the prostate are removed through the urethra
What type of catheter would be inserted after a TURP?
A 20-26G catheter and the patient may have bleeding
This catheter irrigates to allow for drainage of blood clots
What are the three invasive therapies for enlarged prostate?
TURP, transurethral incision of the prostate (TUIP), and prostatectomy
What is dutasteride? What are its contraindications? What are the side effects/cautions?
Treats enlarged prostate
Allergy
Severe skin reaction along with fever and sore throat
If a woman is exposed to medication it can cause birth defects
What is tamsulosin? What are the contraindications? Side effects?
Treats enlarged prostate and results in the relaxation of smooth muscle fibres and improved urinary flow
Allergy, concurrent use of ED medications
Dizziness and fainting, severe skin reaction along with fever and sore throat
