HLTH 2501: renal failure and male reproduction Flashcards
reasons why the kidneys may fail to function
reduced blood flow to the kidneys, inflammation, necrosis, and obstruction
what is the result of kidney failure
oliguria or anuria
oliguria
reduced urine output
anuria
no urine output
what is the treatment for kidney failure?
dialysis
causes of acute renal failure
glomerulonephritis, shock, heart failure, nephrotoxins, and mechanical obstructions
how does glomerulonephritis cause acute renal failure?
it reduces GFR
shock and heart failure leading to acute kidney failure
this results in tubule necrosis; shock from burns or injuries can also cause this by causing damaged RBCs or myoblin that break down in the circulation and damage the tubules
nephrotoxins
are drugs, chemicals, or toxins that cause tubule necrosis and obstruction of blood flow
drugs that may cause tubule damage
sulfa drugs, phenacetin, NSAIDS, acetaminophen, aspirin, and penicillin
what may cause obstructions in the kidneys?
calculi, blood clots, or tumors
serum levels of acute renal failure
blood tests will show elevated serum urea nitrogen, creatinine, hyperkalemia, and metabolic acidosis
chronic renal failure
is the gradual, irreversible destruction of the kidneys over a long period
what may chronic renal failure result from?
chronic kidney disease like congenital polycystic kidney disease or systemic disorders like diabetes or hypertension; nephrotoxins may also have an effect
why is chronic renal failure irreversible?
because of scar tissue
stages of chronic renal failure
begins with decreased renal reserve and GFR and high serum creatinine levels; then the second stage is renal insufficiency and a continued retention of nitrogen wastes, which is marked by excretion of large volumes of dilute urine; the final stage if end-stage renal failure and GFR is negligible, causing fluid, electrolytes and wastes to be retained in the body
3 stages of chronic renal failure simple
decreased reserve, renal insufficiency, and end-stage renal failure (uremia)
decreased reserve signs
is pretty much asymptomatic but there is decreased GFR and higher than normal creatinine levels
renal insufficiency signs
continued decreasing GFR, retention of nitrogenous wastes (urea and creatinine), large amounts of dilute urine, and elevated BP
early signs of chronic renal failure
increased urinary output (polyuria) and nocturia, general signs of anorexia, nausea, anemia, fatigue, and weight loss, bone marrow depression, and high BP
end-stage chronic renal failure signs
oliguria, dry-pruritic-hyperpigmented skin that bruises easily, abnormal limb sensations, decreased libido in men and menstrual irregularities in women, encephalopathy, CHG, arrhythmias, bone impact, urine-like breath, and systemic infections like pneumonia
why are systemic infections common with chronic renal failure?
due to poor tissue resistance caused by anemia, fluid retention and low protein levels
encephalopathy signs
lethargy, memory lapses, seizures, tremors
how is bone impacted in end-stage renal failure?
the failure of the kidney to activate vitamin D impacts calcium absorption and metabolism, leading to hypocalcemia and hyperphostehtamia with osteodystrophy, osteoporosis and tetany
osteodystrophy
is a deficit of bone development due to impaired calcium and phosphate metabolism
3 key indicators of chronic renal failure
anemia, acidosis, and azoemia
serum levels for end-stage chronic renal failure
low pH due to metabolic acidosis, azotemia, low hemoglobin, and hyponatremia, hyperkalaemia, hypocalcemia, and hyperphosphatemia
azotemia
refers to the presence of urea or other excess nitrogen wastes in the blood
goal of treatment for chronic renal failure
all body systems are affected so maintaining homeostasis of fluids, electrolytes, and acid-base balance is important
treatment for chronic renal failure
drugs to stimulate erythropoiesis and reduce phosphate levels, as well as for other disorders like hypertension; reducing fluid intake and transplants
risk for children with chronic renal failure
retarded growth and renal rickets
scrotum
a sac outside the abdominal cavity that houses the testes; consists of a layer of skin that is continuous with the skin or the perineal area, plus an inner muscle layer and fascia
spermatic cord
refers to a collection of vessels, nerves, and the ducts (vas deferens) surrounded by a fascia
testes function
produce sperm and the sex hormone testosterone
tunica vaginalis
is a double-walled membrane with a small amount of fluid between the layers and this encloses the testis and attached epididymis
why are the testes located outside the abdominal cavity?
to maintain an optimal temperature for sperm production, 1-2 degrees below normal body temperature
what happens to the testes when the external temperature drops?
the scrotal muscle draws them closer to the body; vise versa for increased temperature
spermatogenesis
is the production of spermatozoa and is a continuous process that takes about 60-70 days
steps of spermatogenesis
sperm goes from the seminiferous tubules, to the epididymis, then peristaltic movements assist the sperm to move into the ductus deferens then to the ampulla, where the now-motile sperm may be stored for several weeks until ejaculation occurs
epididymis
is where the sperm mature
vasectomy
is a method of birth control that involves cutting or obstructing the vas deferens to block the passage of sperm
seminal vesicles
are located behind the bladder and provide a secretion that includes fructose to nourish the sperm
prostate gland
surrounds the urethra at the base on the bladder and adds an alkaline fluid to provide an optimum pH of around 6 for fertilization
other name for the bulbourethral glands
cowper gland
bulbourethral glands
are situated near the base on the penis and secrete an alkaline mucus, which probably neutralizes any residual urine in the urethra
what does FSH do?
initiates spermatogenesis
what do LH do?
stimulates testosterone production by interstitial cells (Leydig cells) in the testes
what hormone is essential for the maturation of sperm?
testesterone
negative feedback for sperm production
testosterone provides continuous control of gonadotropin secretions
functions of testerone
maturation of sperm, development of secondary sex characteristics such as hair, deeper voice, development of male external genitalia, and increases skeletal muscle mass
epispadias
refers to an urethral opening on the dorsal (upper) surface of the penis, proximal to the glans
exstrophy of the bladder
is a failure of the abdominal wall to form across the midline
hypospadias
is an urethral opening on the ventral (under) surface of the penis
chordee
ventral curvature of the penis
peyronie’s disease
is a condition resulting from the development of fibrous scar tissue on the penis that causes a significant bend and/or pain; can result in painful sex and erectile dysfunction
causes of peyronie’s disease
usually is due to injury but can also be CT disorders or hereditary
treatment for peyronie’s disease
can be penile traction therapy or penile injections (uses collagenase, interferon, and verapamil); sometimes surgery is used
cryptorchidism
aka maldescent of the testis and occurs when one or both of the testes fail to descend into the normal position in the scrotum during the latter part of pregnancy (they remain in the abdominal cavity or at some point in the inguinal canal)
ectopic testis
when the testis assume an abnormal position outside the scrotum
causes of cryptorchidism
hormonal abnormalities, a short spermatic cord, or a small inguinal ring
complications of cryptorchidism
the seminiferous tubules can degenerate and spermatogenesis is impaired; there is also an increased risk of testicular cancer
hydrocele
occurs when excessive fluid collects in the potential space between the layers of the tunica vaginalis
how does hydrocele develop?
as a congenital defect in a newborn when peritoneal fluid accumulates in the scrotum due to fluid escaping when the processus vaginalis does not close off
inguinal hernia
is common when the processus vaginalis remains open (hydrocele) and is a loop of intestine that passes through the abnormal opening
what does an inguinal hernia result in?
intestinal obstruction
acquired hydrocele
may result from scrotal injury, an infection, a tumor, or unknown causes; these are more common after middle age
spermatocele
is a cyst containing fluid and sperm that develops between the testis and the epididymis outside the tunica vaginalis
varicocele
is a dilated vein in the spermatic cord, usually on the left side; this frequently develops during puberty due to a lack on valves in the veins
results of a varicocele
usually are painless but if extensive, is can be painful and tender and leads to infertility due to impaired blood flow to the testis
torsion of the testis
occurs when the testis rotates on the spermatic cord, compressing the arteries and veins, causing ischemia to develop and for the scrotum to swell
causes of torsion of the testes
puberty or trauma
4 categories of prostatitis
1 is acute bacterial, 2 is chronic bacterial, 3 is nonbacterial, and 4 is asymptomatic inflammatory
prostatitis
is an ascending infection or inflammation closely associated with UTIs
acute bacterial prostatitis
causes a tender, swollen gland, typically soft and boggy on palpation
nonbacterial prostatitis
is indicated by large number of WBCs in the urine and prostatic secretions, although the prostate gland in not enlarged
chronic prostatitis
the prostate if slightly enlarged, irregular, and firm, because fibrosis is more extensive
causative organisms of acute bacterial prostatitis
mostly E coli
who does acute bacterial prostatitis occur in?
young men with UTIs caused by colon bacteria, in older men with benign prostatic hypertrophy, in STDs such as gonorrhea, through caterers, and from hematogenous spread
causative organism of chronic prostatitis
repeated infection by E coli
signs of acute and chronic prostatitis
dysuria, urinary frequency and urgency, fever and chills, low back pain or abdominal discomfort, prostate inflammation (may obstruct urinary flow), and systemic signs like fever, malaise, anorexia, and muscle aching
nonbacterial prostatitis signs
similar to bacterial but with less marked systemic signs
treatment for prostatitis
antibacterial drugs like ciprofloxacin and antiinflammatory drugs
balanitis
is a fungal infection of the glans penis that can be transmitted during sex
causative organism for balanitis
candida albicans
balanitis signs
appears as penile vesicles that later develop into patches that cause burning and itching
treatment for balanitis
topical antifungal agents like miconazole or tolnaftate
epididymitis
is an inflammation of the epididymis, the coiled tube at the back of the testicle
epididymo-orchitis
is an inflammation of both the epididymis and the testicle
causative agent of epididymitis and orchitis before puberty
often in E coli
causative agent of epididymitis and orchitis when sexuallary active
gonorrhea and/or chlamydia
who is at risk for epididymitis and orchitis?
men with a medical history of UTIs or prostatitis, as well as those who have had bladder surgery or used a catheter
benign prostatic hypertrophy
is common in older men and occurs when hyperplasia occurs of the prostatic tissue, with the formation of nodules surrounding the urethra, thus obstructing flow
why does hyperplasia of the prostate occur?
due to an imbalance between estrogen and testosterone that is associated with aging
diagnosis for benign prostatic hypertrophy
rectal examination
complications of benign prostatic hypertrophy
obstruction can cause incomplete emptying leading to frequent infections, as well as a distended bladder, dilated ureters, hydronephrosis, and possible renal damage
signs of benign prostatic hypertrophy
obstruction of urinary flow, hesitancy, dribbling, and decreased force of the urinary stream
treatment for benign prostatic hypertrophy
drugs to reduce the androgenic effects and slow nodular growth like dutasteride, alpha-adrenergic blockers that relax the smooth muscle, and a combination of finasteride and doxazosin
prostate cancer
is common in men over 50 and is the second leading cause of death from cancer in US men
what are most prostate tumors?
adenocarcinomas that arise from tissue near the surface of the gland
what prostate tumors are more aggressive?
those that are more undifferentiated or anaplastic tumors
what does prostate cancer effect?
the regional tissues such as lymph nodes or the urethra and is may metastasize to bone
causes of prostate cancer
many are inherited mutations in the HPC1 gene, but can also be high androgen levels, increased insulin-like growth factor, and recurrent prostatitis
signs of prostate cancer
is a hard nodule on the periphery of the gland (often in the posterior lobe); small tumors don’t cause urinary obstruction but if large is may cause these signs
two serum markers in prostate cancer
prostate-specific antigen and prostatic acid phosphate
prostate-specific antigen
provides a useful screening tool for early screenings of cancer
prostatic acid phosphatase
is elevated if the prostate tumor has metastasized
three criteria for prostate cancer diagnosis
an elevated prostate-specific antigen, abnormality on a digital rectal exam, and biopsy results
treatment for prostate cancer
surgery and radiation most often; if the tumor is androgen-sensitive, removal of the testes or anti testosterone drug therapy may be used
procedure for removal of the testes
orchiectomy
what are the majority of testes cancer
malignant and arise from germ cells
who is often affected by testicular cancer?
men from the 15-35 age group; it is the most common solid tumor in young men
teratoma
consists of a mixture of different germ cells combined with embryonal carcinoma (poorly differentiated cells) and may cause testicular cancer
serum levels for testicular cancer
elevated human chorionic gonadotropin or alpha-fetoprotein
what type of testicular cancer spreads early on?
choriocarcinoma
where does testicular cancer often metastasize to?
the common iliac, the para aortic lymph nodes, the mediastinal and supraclavicular lymph nodes; later on it may spread to the lungs, liver, bone, and brain
causes of testicular cancer
a change in chromosome 12, infection, trauma, or cryptorchidism
signs of testicular cancer
hard, painless, unilateral masses, dull aching pain in the lower abdomen, hydrocele or epididymitis, or gynecomastia
gynecomastia
enlarged breasts in testicular cancer due to hormones being secreted by the tumor
diagnostic tests for testicular cancer
ultrasound, CT, lymphangiography and the presence of tumor markers
treatment for testicular cancer
combination of surgery, radiation, and sometimes chemo
