Gu Flashcards
What’s normals output per day?
What amount do you usually void?
1500 ml/ say
Usually void when 200-600ml
5 function of kidney and wtd?
- Remove wast from blood in urine form
- Regulate electrolytes and acid base balance
- Control BP from agiotensin release
- Regular RBC production
- Synthesis of vitamin D to active form
What’s bowmans capsule
Glomerulus here and filter for urine
Proximal tubule wtd
Site of reabsorption
Loop of henle wtd
Site for further filter ruins through reabsoption . Where diuretics work ex: lasix and bumex
Collecting tubules wtd
release urine
What forms urine?
Glomerular filtration
Geriatric consideration 9
- Yearly decrease in glomerular p 35-45
- Decrease flow to kids
- acid base imbalance
- Poly pharmacy incr drug metabolites filt by kids
- Hypernatremia and fvd more common- thirst sensn
- Being prostate hyperplasia
7 Incomplete bladder empty and bladder wall contr 8 decrease
9 Urinary incontinence
Risk factors for GU disorders 8
strep disorder chronic renail failure 2-3wks later increase age- uti BPH invasive procedure- cysto, foley ut immobile- stones diabetes- renal F, neurogenic bladder hypertension- renal failure multiparous women- stress incont neurologic disorder- parkinson and mutliple scler
Signs and symptoms of urinary tract disease Pain where 5 places
- pain
- ureteral- cva flank radiates to abdomen thighs and gental area
- bladder- lower abd and suprapubic area
- urethra- male penis to meatus female urethra to meatus cariable severe w voiding
- prostatic- perineum and rectum
changes in voiding 11
frequency, urgency, dysuria, nocturia, retention, incontinence, hesitancy, enuresis, hematuria, proteinuria, bacteria
frequency- def and 3 diseases
urgency - def and 2 disease
dysuria
more often- infection. disease, diuretics
urgency- strong desire, prostate and infection
painful
incontinence
nocturia- important
involuntary loss of urine
more than 2x night
hesitancy
enuresis
delay in voidign
involuntary during sleep
output of urine hr
30ml/hr
anuria how much
less than 55ml in 24 hrs- hemodialysis
polyuria how much
2 diseas
more than 2500ml in 24 hrs
DKA CHF
UTD s/s overall
pain in 5 places
changes in voiding
GI symptoms- share autonomic innervation, N/V abd distention discomfort diarrhea
name 3 disease that urologic disorder may mimic that make diagn difficult.
3 s/s for each
appenditis- fever, chill, pain on right side
ulcer- open sore upper abd painn
cholecystitis- rigid abd, NV
health history important
onset, duratiob, hx of uti, fever, chillsm decr urine, discharge
physical exam
kidney- skin
- inspect edema, pallor, hydration
shouldnt be able to palpate on attempt
costovertebral angle tenderness
what is costvertebral angle tenderness CVA
patient behind, 12 rib, tenderness,
where intercoastal ribs meet
physical exam bladder 3
palpate for fullness location
height usually if distended
meatus exam3
edema redness and drainage
prostate exam
digital rectal exam- hyperplasia- enlargement of prostate in older men
urinalysis
what is ass
how to do
idenify abnmlty
clean catch or midstream is used
midsteam is better and clean before
urine C and S
cult and sens.
identify bacteria and totreat w appr antibiotic
normal UA result color opacity sp gvty osmot ph negative RBC, WBC Sediment and bacteria
- yellow to amber
clear- opacity ,
odor- faintly romatic
GLucose ketones protein negative- if present renal disease diabetes
RBC, sediment, bacteria and WBC negative
Spec gravity on UA
range
why decrease and increase 3 for each
normal 1.005 - 1.03
decrease- diab insipidus- glumernephritis, renal failure
incr- chf, hep disorders, dehydr.
normal osmolality on UA
250-900-
ability of kidneys to dilute and concentrate
ph on UA
ranges
5.8- 8
average is 6
more than 7- uto, alkaline diet, alkalosis (lighhead confused twitching) meds
less than 5- high protein fever and acidosis (SOB, sleepy tachycardia)
what is GFR ?
norm range
rate which glumeruli filter blood
125 ml per minute
what can affect GFR
age
usually decreases with age
creatinine measure ?
how to
1 implemen
most accurate meas of glumer. filtration
do 24 hr urine collection to check level
also do serem creatinine halfway through 12 hrs
GFR equatn
volume of urine x urine creatinine divided by serum creatine
what urine creatine level vs serum
serum 0.7 to 1/4
urine - 125
BUn level and important
how effected, and 5
10-20- end product of protein met, kids excrete nitrogen waste
can affects by (meds, dehydr), prtn intake, tissue breakdown fluid volume changes
Glucose when show on UA 4
stress, pregnancy, high carb meal and BG 170
KUB image xray
why
asses 2
limited purpose
kids, ureter bladder size position
calculi or lesions
Ultrasonography
2 imple
use sounf depth of structure below skin
done on full bladder no special care p
Bladder US
2 consid
measures urine volume bladder
portable and handheld
CT or MRI
to see
consider
cross section view kid and GI tracr
can use oral or IV contrast
Nuclear scan what is
shows
implementation
injection radioisotope
shows kidney perfusion
increase fluids for excretion
Intrav Pyelogram IVP
can see 5
implementation5
visualize entire unrinary tract
show calculi, size and shape tumor, pyelonephritis
check alergies for contrast, laxitive night a, NPO 8hrs
or clear liquids, may feel flushed, warm salty taste when inj dye
how to check pedal oulses
at same time
voiding cystourthrograogy
how its done
1 thing checks
catheter contract into bladder for xrays taken while voiding
shows ureter reflex (pee coming back ureters-bad)
renal angio gram
how done to check what 2 things
implnt-5
catheter stick in femoral iliac art, dye inject to check tumors or cyst
imp- check bleeding, color, pulse and temp of extr,
VS
cystoscopy
whats done
implnt- 5
PC- 3
lens insertered in urethra up to bladder
imp- NPO p midnt, monitor UTI, may have sligh pink urinep, warm moist heat/sitz bath disccofort, monitor retention
PC- bleeding, infection, dysuria
Percut Renal bx
used for what 2
impt- 7
pt report 2 things why
needle to get tissue, not done as much
diagn or progression of disease
impltn- NPO p midnt, prone immediate after the BR x 8hrs, IVF p prevent clots, respon to anagesics, asses bleeding (ASA and anticoag), monitor urine,avoid stenuos actvty for 2 wks
Pt report backache, flank pain radiate to groin (clot in ureter)
when use renal or uretal brush bx
2
privide specific info p abnm crat finding of ureter or
pelvis detected
Chronic kidney disease GFR
GFR decrease more than 3 months
chronic kidney disease can result in
whhat ?
end stage renal disease ESRD
4 risk factors for chronic kidney disease
CAD DM HTN obesity
5 causes pf chronic kidney diseas
DM HTN, (glum.nephritis pye.nephritis), herdity or congenital disorders, and renal cancer
5 manifestation of chronic kidney disease
increase creatinine anemia- decr erythoprotein by kids metablic acidosis- lethargy and tachypnea calcium and phosphorus fluid retention
what 3 disease to treat to drecease pregression of CKd
HTN
hyperglycemia
proteinuria
Nephrosclerosis
def and 2 factors
tx-3
hard renal art d/t HTN DM
treatment control BP amd BG, renal replcmnt thpy
acute glum.nephritis def AGN
inflammation of kid affects capillary bundle of glum
onset of Acute Gum.nephritis usually follows what 6 disease
URI (strep) 2-3wks before AGN- cause injury impetigo mumps hep B HIV infections, varicella
S/s AGN 6
hematuria- may be cola color RBC edema azotemia- lot waste prodct in blood thats usually filtered out by kids mailase decrease out CVA and flank
Diagnt test for AGN 4
1 impl
UA, CBC, step titer, renal bx
may have low Hand H from blood loss
potential comps AGN 4
ESRD
Hypersensitivity encephalopathy
HF- bloated, SOB, chest pain
Pulmonary edema- wheezing distant h.s
Elderly pts AGN
PC 4
circulatory overload
dyspnea
cardiomegaly
atyp neuro change
Med managemnt to treat symp of AGN 5
antibiotic- strep PCN 1- emycin 2
diuretic- if HTN
bedside until protein and hemauria subside
sterioids-inflammaton
diet- low protein low sodium fluids restrictied , high cal and carb
CHO- energy and protein
what last resort for recovery AGN
dialysis
Notify s/s for of what 2 PC in AGN?
3 s/s for one
renal failure- fatigue nasea vomitting decr urine
infecton
AGN- what to give for emergy and reduce protein
CHO liberally
Chronic glom. nephritis
what happens
who may present to first 3
HTN, hyperlipidemia, dm nephrosclerosis may present in first
KIdney shrisk 1/5 normal size and arteries thicken
acute may go to chronic
Sympt CGN
general
ss that specfc- 5
HTN edema, incr BUN and CRTN
weight loss, nocturia, headache, dizziness retinal changes
What complication occur late in CGN
peripheral neuropathy and confusion
lab abdn CGN 6 all
2 spec
hyperkal, acidosis, anemia hypoalbumin
increase phosph decrease calcium
Intervention CGN 3
HBV- dairy products, eggs, meats- good
calories to spare protein
detection of UTI
Discharge Teaching 4-
long term
BP control,
dialysis, assess site, fluid rest
diet
Rept- NV decrease urin output hematuria edema
Nephrotic syndr
5 causes and dx
ss
intervention
CGN, DM, lupus MYELOMA, renal vein thrombosis
dx- needle bx of kidney
ss- PROTEINURIA- color 3.5g/d. PITTING EDEMA- periobital- hypoalb,hyplip
same as AGN- antibiotic , bedrest, steriods diet,
diuretic
Renal trauma- cause ,
how pt feel/ happens 5
ss-5
mngt- 6
cause by injry to flank, back, upper abd pain- bruising or lacercn, rupture kidney- decr HR
ss pain hematuria (mo com)swelling in flank ECCHYMOSIS wounds, SHOCK with hemmorage
contol hemorhage ,pain,infection, H/H freq , tx quick if surg,
br-hematuria minot lacn- until hem clear
bladder injury - def, 3PC, mngt
pelvic trauma with multiple trauma to low abd when when
PC-hemorrhage, shock, SEPSIS- treat quickly
mangt- surgery repair of laceration
UTI
common sites
causes 2
pathogen in bladder, urthrea prostate kidney (pye.nephritis) sterile above ureter- upper or lower
GI contamination commn cause- pressure on female urethr sex icr risk
urethrovesical refux
AKA
how happens
can be from reflex urine
coughing sneezing incr force urine to urethra, press back normal urine flows back into bladder BACTERIA
Risk factor UTI 6
retention urine stasis and residual 100ml and less bladder destn and obstr met diseas DM and gout Nueroloic disorders and cogn impairment decrease host defnese pregnancy
Prevention of UTI 5
void q 2-3 hrs front to back, shower instead bath cotton under[aons pericare p and a intercouse- void imm drink fluids-
UT drinks iriitants 4 and 2 drink to have
coffee tea cola alohol
acidity urine with abs of Vit C and Cranberry - bring down ph
cystitis (lowe UTI)
3 causes
ss-6
mngt 2 meds
bladder inf from ureter- urine backflow, fecal contm, cath
ss/ freq and urgency, burn urine (hesitancy) noctiria
suprapubic pain, hematuria, NV PYURIA (pus)
sulfa and macrodantin 3-4 day or 7-10 days longer if complct/ reoccurant fluid intake
Urethritis
important
ss/ males 3 females-4
mngt-3
males usually caused by gono (us caused by chymd)
ss- m- inflam, purulent drainage burnign urine
f- may have none /may discharge/can result in steriltiy and usually not dign
mng- antibiotic F/u, secual part tested, hydrated
Acute Plyenephritis
causes- 7
ss- 5 halmark
tx 4
infec renal pelvis, tube kidney tiss, freq sec to urine back up and obstr
causes- bact infect- E coli most commen, from
proteus, psuedomonas, staph, strep
CVA Flan, Fever childs dysuria, freq and urg MAIlaise. PUS, BCTRA and white cells in urine
tx antibiotic, fluid, rest, drink acidity
Chronic Pyelonephritis
1 imp
ss4
tx7
persistant kid infla can lead to chr renal fail
s/s usually asympt-vague flank pain, fatuwye occasional
fever bacturia
tx antibiotic 2-6mo, antiemtic, fluids, pain meds, urin sesptics- discomfort, br
UTI all diet
acid food -6
fluid 3000 day
acid- canberry, prune vit c bread meats eggs
Urinary antiinfective med name do s.e-3 imp3
nitrofurantoin
disinfect urn tract
s.e- nv, gi upsey, DiaRrhea
impl - give c food may discolor urine i and o
sulfonamide med do se3 implnt4
co-trimozalone
bacteriostatic
s.e- gi upset headache HYPOGLYCEMIA
imp-c lots fluids, fullcorsem monitor BG I and o
Flouroniqinolen
med
do 5
se
implication
levofloxacin
bacterstaic, coli, monas enter coccas URETHRITS
s.e- tendonitis/rupture, gi headache HYPER OR HYPERGLYCEMIA
imp- sensty reatn, muscloskelt compkant monitor BG
Anagecis UTI
med
1 per action se impl
phenazopyridine
action mucosa
s.e - will discolor urine
impl- not anti biotic
UrOlithiasis
important 5
what ist cause 3
stones inn bladder calculi, more commen in men, uncommon in blaks and kids
cause ischemia, elim prob, an UTI
ss- usual sever pain,
most common caise of urin obstn
Factors favor stone8
meds diet, disease, body func
lower fluid- change in ph diet- hi calcium, vit D oxalates (spinach beets fied potatoe nut butters) immobility obstrn- also infection foreign body met fact- hyperthyr. hi uric acid genetic systiine met, Inflamm bowel disease fam history meds- laxatice anatacis ASA DIAmox
calcium stone 3
most comm
small to big
staghorns
oxalate stoen
oxalate diet
second most commin
struviate stone 2
bacteria alkaline in urine
uric acid 3
increase u.a dehrdtion low urine ph
cystine 1
rare inherited decfect of cystine an amino acid
Stone manifestation renal pelvis 3
deep ache in CVA down to bladder nv renal colic
stone manif ureter
obctrn
UTI hematuria retention id obstr
General stone s/s 3
diaphoresis restless pain in GI (nv diarrh)
PC of stones 4
obstn- renal impairment
pylen- infection
tissue irrtn- renal abcess contr to cancer
urosepsis
s.s obst 1
small but freq voiding
UTI ss5
chills fevr dysuria freq and hesist
Relieve pain stones 3
narcotic heat pad/ bath
position of comfort
PC of stones
UTI, VS for infection, all urine strain in guage for pa
PT teachign stonnes 7
diet, do at home call md
restrict ptn- 60g day na 3-4 g avoide oxalate dont want to limit calcium- ostepars. high fluid 1-2hrs more than 2l day water, awakenin straining urine home MD UTI sign or increase pain
Stones managmet surgical 4
ESWL- shock- icr fld, pass in few days
ureteroscopy- lazer destroy- basket
Perct nephrostomy/ nephrolith.- utrasound waves to
pulverize stone
What surgery to do for stones if pt have kid measure
Nerphectomy-
Diet and meds per stone
1.calcium intake 3 meds 3
- no restrict CA unless high, rest protein, acid diet avoid cal/alumn hydroxide anatacid, amphogel
Med- Cellulose sodium phosphate- redc absn,
hydracholorothiazide- thiazide diutcs,
lithostat,
uric acid stone mngt
dos donts 2 meds
avoid- hi in purine , limit ptn- no alch, fasting crash diet
do- alkaline diet
med allopurinol- rdc kevel
sodium bicard-icr ph
purine foods 5
shellshish anchovies, asparegus, mushroom, organ meats
oxalate foods 7
spinish strabrry rhubarb chocalte tea penut wheat brain
cystine2 and struvite 1t mngt
cystine low proetin alkalin diet
struviate- antibiotc for bact
Alkaline diet4
Acid diet5
milk vegt rhurab most fruits
cranberry, prunes/plum eggs bread meat
Urethra stricture 2 import 3 causes ss3 1 pc mgntt 2
narrowing urethra;- congtnt or accrq
cause - injury, gon. urethretis, born w it
ss- overflow incontin strainin, decreased force urine
PC- hydronephrosis
mgnt - dilation, surgical removal
hydronephritis
causes 5
ss4
mngt 3
urine traps in pxml to bladder
casuse- stone tumor, scar tiss,urteral str BPH
ss- may none, flank pain, infected UTI ss, may have hematuria
mngt- antibc remove obtr, may urinary diversion
Bladder cancer risk factor 3 main 6 others
(Caucasian, men, over 55,)
smoke chemical like ink leather paint, chronic UTI, high PH, high CHO intake, Pelvic radiation therapy, mestasis from prosate, colon, rectum
Bladder cancer
ss
3 test
painless hematuria
diagn test UA IVP Cysto
Management of bladder cancer
5
radiation BGC med- inject chemo-retain gluid 2 hrs then void
local resection or tatal cystectomoy c diversion
urinary diversion types
cutaneous and continent
urinary diversion pre op 5 intvnt
clean bowel, low res diet, antibiotic fluid
may neeed hyperlimentation TPN mark stoma location
ileal conduct
3 impot
PC 5
ureters attact to intestin- pouch for urine- watertight if leaks mucous encourage fluid
PC-infection dishenc, urin leakage small bowel obst,
stoma gangrene- not ntomal see stool in drainage
Assess diversion mangtnt
6
check appliance early am avoid moist soap avd food strn odor- apra eggs cheese liquid odorizer- white vineger ascorbic acid PO change when 1/3 full
uretersigmostomy
3 pts for
4 impltn
implant ureters in sigm colon- pelvic rdts small bowel disease or resection
some bowel inc may occur q 2 hr- likelu watery and some degree noctia
anal pictr- contol of void defect
may have cather in rectum- irrigate but dont force
Continent Ileal urinary resev (Indiana pouch ) 5
kock pouch 2
most common content diversion ileam and cecum form reser. Ureters anastomased- narrow part of the ileam and ter terniem ileum to sq tissure
cath inserted to drain
kock pouch-nipple on valve prevnt leakage, in males opuch connect to end urethra for more normal voiding
post op Indiana puch
5 -how look, teaching
stoma- beefy red moist UOP- less than 30cc hr watch for dehydration obstruction body image teach pt how to drain c cath
Indiana pouch 5 PC
1 intvnt
Atelectasis
skin irrit- bleed, infect,
Perotonitis
Stoma ischema pink- dark color- vascular compr
Stoma restraction and separtion
Ascorbic acid to keep urine ph below 6.5- alkaline inscr around stoma
Benign Prostate hyperplasia
6 risk factors
7 ss
most men over 50 some enlrg
90% men 85yrs old
risk- smoking etoh HTN CV disease DM, incr age
ss- urinary elimination problem, straining dribbling, UTI , nocturia decre force urine chronic retn (azotemia and renal fail)
diagn test BPH 6 ,2 spec
dital exam UA CBC- clotting facr
Urodynamics
PSA- antigen normal 4 can be slight elec BPH abd prostatis
Compication of BHP 4
hydroureter, hydroneph, pylephrutis renal failure
Medical treatment BHP 7 surgical
waiting- no obstn or comps ok
balloon dialation- sht term
suprapubic cath
transurethra; needle abliation- destroy tiss
microwat therapy
TRansurethr lase resect- less bleeed TUIP
TUIP- electric laser incisn to decrease rest to urine flow
Meds for BHP 3
Aplha block- terazosin, doxazosin, tamsulosin -obstn
antiandrogen- dustasteride, finasteride- block DHT -
erectile dysfunct gynecomasty and flushing
Saw palmetto herb
Turps trans. resect, proatste preop-2 post-3 meds2 and se teach 5
take inner part or entire gland
preop- 3 way foley and pain from bladder spasm
post- irigattion 36-48hrs decr bleeding clots- rate for pink urine NS 50cc for clots assess for clots,
meds probanthine-antichol- se palptn blurred vision no glucoma, antispamotics for bladder. Bella and opium cause tachy, confus, consti,
teach-bladder exercise, stool softner, fluid clear, only mD for cath, mintor bleding 2 weeks
Prostate Cancer
risk factors 4
clinical mainfest
most prevelent in AA males men p 40 ecam yearly
familu, diet hi fat, chemical exhst fumes, fertilizer chems increase with age
usually none early then obstruct later, painfull eject blood in urine if bladder, may mestasis to boone or lymph nods
diagnt test 4 prostate cancer
tissue prostectomy
PSa- norm less 4
PAP PAA notmal 2.5-3.7 mestaistx effetv
DRE- advnced lesion stony-hard and fox
prostate cancer
medical managemt 5
- surgery standard- laparoscomy radical prost
- radiation- found early- ext(teletherapy 6-7 wks daily) interna(brachyther)-seed implant- avoid pregn and 2 mo old- strain urine for seed use condom 2wks implant
- Hormone tx- control not cure mnthy inj LEUPROLIDE prevent progge-
- orchiectomy-testes
- take estrogen
epidymitis 3 impt things pc-3 manifest-5 mangment 6 , no to 2 meds-3
infection from protate or UTI usually unilateral, may take 4 weeks normal, remove if reoccurance or no resp treatemt
PC- orchitis, abcess, sterility
manifest severe pain and tenderness dysur, freq, fevr, WBC 20-30k
mang- 24hrs onset spermatic cord anethsia, BR 3-5 ,days elevate scrotum (ice), later heat sitz bath. no straining or sex, lifting until undercontrol
MEds- analgesics, antipyretic antibiotic
prostatis
4 manifest
can be acute chronic viral or bactr
manifest buring, nocturia pain in peri and rectal pain ejaculation and fever
acute chronic s/s prostatitis
acute- sudden fever low back urinary symp
chronic major cause reoccurant UTI, fever and temp uncommon
managemtn protatitis
3 meds
3 home
antibiotic- sufla drugs 30 days - months vira- NSAIDs analgesics do not force fluids-med avd- codee chocolate alcohol spices f/u 6mo -12
erectile dysfunct
9 causes
test- 1
age 40=70 causes- anxty fatique
diseases- occlusive vasc disease, endocrine dis, chronic renail failure GU condit hematol, neuro, trauma etoh meds drug abuse
test- noctural penile tumescence- organic or psycologcal isssue - healthy men paralled Rapid eye move
Pharmalogical erectile dysfunction
(PDE-5) time
se-3
contrainct7
phosphodiesterase (PDE-5)- sildenafil,vardenafil, tadafil- take one hour beforelast 60=120 min
se- headache flushing dyspepsia
contr- nitration uncontroled BP CAD MI (6mo)cardiac dysm kid or liver dysfn
Erectile dysfn
VAsoactives
time
meds PC
alprostadi papaverine phentolamin
inj directlu into penic
PC- priapism- persist erectn abnm
inhect 20 min before last 20 minutes
Erectile dyfn
urethra; suppositiry
used 2 day
COntra- pregnt women
inset 10 minute sbefore inte last 1 hr
SUrgical erectile dyfn
3 PC
penile implants- inflama rod prosethesis
PC infection erosion persistant painn
Phimosis
what is it
tx
foreskin cannot be restacted from poor hygience
use steriod cream
Paraphimosis
what is it
PC 2
Tx
foreskin not reurned over glas once restracted
causes venous conge edema enlargemtn of glan
PC arterial occlusion necrosis
tx pressing firmly 5 mins to reduce edema and size then move skin
Nephrotic syndrome management 4 food meds3
Diuretic(sometme) ace inhibitors steroid
Tx hyperlipidemia mod- protein and CHO
