GU/ Renal Disorders Flashcards
What are the components of a nephron?
- Bowmans capsule/Glomerulus = Renal corpuscle
renal tubule:
3.Proximal Convoluted Tubule
4.Lope of Henle / nephron loop - Distal Convoluted Tubule
- Collecting duct
What are the functions of the Renal System
Filters wast products
Regulates ion levels in plasma
Regulates blood pH
Conserves valuable nutrients
Regulates blood volume
Regulates RBC production (erytripoietin)
Where is the nephron
Between the cortex and medulla
Filtration in the kidney
Blood from the renal a. is filtered in the glomerulus. Blood comes in to the afferent artery 1/5 of blood is filtered and exits the efferent arteriole to get move to the tubule
Tubular reabsorption
solutes taken out ( Glucose; Na +; K+; Cl-and H2O) and returned to circulation via capillaries surrounding Proximal tubule, loop of henle, and distal tubule
Tubular secretion
Capillaries surrounding the distal convoluted tubule move waste products into the DCT and then eventually transfered to bladder for storage and illemination
Urinary excretion
filtrate /urine is transported from the collecting duct to the bladder for elimination
Dark yellow urine, pale yellow urine, cloudy urine, Hematuria, redish brown urine , foamy urine
Normal pale yellow I/O of 2 L per day
dark yellow: dehydration
cloudy urine: white blood cells/infection UTI-AKI
Hematuria: blood RBC in urine / pink / red color- AKI
Redish brown: myoglobin happens in Rhabdo, AKI
Foamy urine: proteins stay in blood chronic renal failure
Polyuria
Abnormal amounts of diluted urine
ex: Diabetes
Urinary frequency
Need to urinate many times of day or night
ex: UTI
Nocturia
excessive urination at night
Acute kidney disfunction causes Oliguria and Anuria what does that mean
Oliguria: reduced volume of urine (<400 mL)
Anuria: no urine production
Causes of Acute Renal Failure and what is the most common??
pre-renal most common : 55%
Conditions that decrease renal blood flow
-HF,sepsis,hypovolemia
Intra-renal: 40%
injury or inflammation in the kidney
-nephritis, tubular necrosis
Post-renal: 40%
Conditions that obstruct blood flow
-kidney stones, blood clots
Pyelonephritis
When UTI progresses to involve the upper urinary system including the kidneys and ureters
Special test: Mental status change
How are kidney stones managed
Pain management
pain
Cystoscope: snare and sucking out (removal) of stone
Lithotripsy:ultrasound to breakdown stone
Rhabdomyolysis
Breakdown of skeletal muscle fibers resulting in release of myoglobin -can cause AKI /renal failure
Cause: traumatic /compression
Non-traumatic : exertion
Triad: muscle pain, weakness, dark urine
Creatine kinase 5x the ULN
Top 3 causes of Chronic Renal Failure
- Diabetic
- Hypertension
- Glomerulonephritis
Signs and symptoms of CKD
Wight loss , poor appetite , edema, SOB, DOE,Fatigue, Nocturia, Hematuria, Protenuria , insomnia , Pruritis, Muscle cramps, Headaches, Erectile dysfunction
Lab Values of Renal Function
- GFR Glomerular Fultration Rate
Great measure kidney function , but difficult to measure
As GFR goes down, kidney damage goes up -inverse relationship - Creatinine
Most common measure
as C goes up , kidney damage also goes up -direct relationship - Albumin
What is the role of Dialysis ?
Try’s to filter and clean blood and do the role of the kidney
Differences between Peritoneal Dialysis … Hemodialysis … CRRT?
Hemodialysis: placed in arm passes blood across a semi-permeable membrane (dialyzer) allowing the metabolic waste to diffuse into correction fluid (dialysate)
via AV fistula /AV graft or temporary access via catheter in IJV
Continuous Renal Replacement Therapy (RRT): continuous removal of solutes and fluid : used for patients that are critically ill
Peritoneal Dialysis: uses the peritoneum as semipermeable membrane, several hours of infusion prior to drainage
Lab values of CRD
High Creatinine
high potassium hyperkalemia
high calcium hypercalcemia
metabolic acidosis
Signs and symptoms of AKI:
Pain with urination
Nausea vomiting
Blood in urine: hematuria
Cloudy or foul smelling urine
Increasing frequency of urination
Confusion / Mental status change (in older adults esp.)
Fever /chills
Feeling sick
Functions of the GI Tract
Digestion: physical/ chemical breakdown, GI motility /enzymes
Absorption: movement of nutrients
Excretion: food residue
Host defense: largest lymphoid organ in body , gut microbiome
Contributing factors of GERD
- Non functional lower esophageal sphincter
- Impaired gastric emptying
- Hiatal hernia
4.Alcohol abuse - developmental delays in kids
Functions of the stomach
Reservoir
-controlled release of chyme
Mechanical digestion
Motility: peristalsis
Chemical digestion
-pepsin , lipase enzymes
Hydrochloric acid
- chemical digestion, immune defense
Intrinsic factor
-binds Vit. b12 for absorption in small intestine
-deficiency leads to pernicious Anemia
Gastric defense
- Compact epithelial cell lining
- Mucus covering
- Bicarbonate ions
- Blood flow
Gastritis
inflammation of the inner lining of the stomach (the mucosa)
due to
1. excessive acid production > gastric defense
(NSAIDS , ASA, ETOH)
2. Stress induced
common in critically ill patients
Peptic Ulcer Disease (PUD)
increase acid secretions and digestive enzymes erode gastric mucosa
OR
helicobactor pylori infection
can lead to hemorrhage, perforation , peritonitis, scarring
defend by site of origin
NSAIDS Non steroidal anti inflammatory drugs
3 types:
Acetylsaclic acid (ASA) : ex asprin
Traditional: ex : ibprofen
Cox-2 inhibiters (off marked)
ASA and traditional NSAIDS
pain relief with increase in GI bleed risk
Cox 2 inhibiters
pain relief with decrease risk of GI bleed but increase risk of CVA /MI risk
50% of GI bleeding due to what?
NSAID use in elderly
Continued GI bleeding and re-bleeding are high predictors of what ?
mortality and morbidity in older adults
Syncope
Hypotension
Pallor
Diaphoresis
Tachycardia
all red flags and are suggestive of what?
Shock (GI bleed)
Hematemesis and coffee ground emesis usually originated from what?
an upper GI bleed
Melena is a result of what?
Lower OR upper GI bleed
In a GI bleed what do you need to be concerned about
Decrease in hematocrit , hemoglobin
Functions of small intestine
Segmentation
Peristalsis
Digests and absorbs nutrients
Secretes regulatory hormones
What type of hormones aide in chemical digestion in the small intestine
Endocrine cells, exocrine enzymes -regulate gastric pancreatic and gallbladder function
Cholecystokinin (CCK): increases pancreatic enzymes and bile release
Villi and microvelli in small intestine
Increase SA for absorption
Lacteals (lymphatic capillaries)
for fat absorption (chyle)
Main role of colon
re-absorption of water and ions , some vitamins
Crohns Disease
Crohn’s : Patchy inflammation that may occur anywhere in the Digestive Tract
-entire bowel wall
-pain in lower R abdomen
Ulcerative Colitis: continuous inflammation affected through the large intestine
-mucosa
-pain in lower L abdomen
Crohn’s Disease & Ulcerative Colitis medical management and presentation
presentation: joint pain , anemia
abdominal cramping, pain, diarrhea, malabsorption leading to weight loss & malnutrition
medications:
immunosuppressents
biologics
Anti-inflammatory agents
IBS: Irritable bowel syndrome
disturbed bowel without structural abnormalities
spastic motility pattern
malabsorption : nutrient deficiency + loose stools
related to colonic sensitivity
Types of hernia
Ventral : incision related where abdominal contents protude through the linea alba
Hiated hernia: gastroesophageal junction moves above the diaphragm with some of the stomach
Inguinal: abbdominal contents through induinal canal
Acute Abdomen
Medical emergency : palpation reveals rigidity, rebound tenderness , bowel sounds absent
Also known as peritonitis
sudden severe abdominal pain
Colorectal cancers
Progression starts with benign polyp
bleeding , pressure/pain with defecation
3rd most common Cancer , 3rd leading COD
Types of abdominal surgery
Ileectomy: resection of Small I.
Colectomy: resection of Large I
Ostomy: surgical opening for discharge of body wastes
Stoma : end of the intestine protruding through abdominal wall
Common post operative complications (POC) and PT role
pain
pulmonary issues
bleeding
infection
Ileus
Bowel leakage
Post surgical adhesions
PT role: bowel motility
Bariatric Surgery benefits
weight loss
remission of type 2 DM
improve CR risk factors and CV health
improve mental health
better sleep
decrease hip and knee pain
improve fertility
Meds for GI issues
Antibiotic therapy: pylori PUD
antiflammatory agents “ presone
anti-emetics : nausea and vomiting
laxatives: short term relief of constipation
antidirrheal
