M10: Renal/GI Flashcards
Pyelonephritis
A type of UTI that has reached the pyelum (pelvis) of kidney.
ascending infection: some type of vesicoreflux dysfxn. or instrumentation
MC female
CM: fever, sudden onset, flank Pain, uti s/s (dysuria, freq, urgency)
DX: cbc (leukocytosis), BUN/CR, **UA w/ micro and C&S; white cell casts (renal cause for pyuria & has reached renal tubules)
imaging: CT ABD w/ or w/o
TX: abt-adjusted for bacteria, most will improve on their own
renal fxn not @risk d/t only 1 kidney affected.
Obstructive renal disease- what does it cause?
Obstructive renal disease causes a blockage in the urinary tract that impedes the flow of urine, leading to urine accumulation and kidney damage.
anatomic or functional
severity based on:
Location, completeness, involvement of one or both upper urinary tracts, duration, and nature/cause
Upper Urinary obstruction complications
Hydroureter: dilation of ureter
Hydronephrosis: dilation of renal pelvis & Calyces (swelling of kid.
Ureterohydroneph: dilation of both ureters, renal pelvis and calyces
Tubulointerstitial fibrosis: depsoition of excessive amoutns of extracelluar matrix
Leads to excess cellular destructions and death of nephrons
Renal calculi (AKA nephrolithiasis) causes
crystals, protein and mineral salts from uro tract form masses/stones
calcium oxilate and ca phosp=70-80%
Struvite (infectious) from UTI-stone from MG, Ammonium, and PHos
Uric acid/cystine 5-10% (pink stone)
Staghorn calculi: large and fill the minor and maj calyx’s
RF: male (doubled), most before age 50, inadeq po fluid intake, geo location, familial hx
diet heavy in: rhubarb, spinach, chocolate, nuts and beer.
<5mm will resolve on own
DX: U/S, CT, UA w/ micro
s/s: renal colic (d/t dilation), dull/local flank pain; n/v/d, pale, cold sweats
*huge sympathetic response
Tx: hydration to reverse precipitation, potass. citrate, ca channel blockers, and alpha adrenergic blockers, lithotripsy, surg w/ stents
Urinary Tract Obstruction - most common cause
MC cause of a urinary tract obstruction is renal calculi.
tumors
enlarged prostate
neurogenic bladder
urethral stricture
pelvic organ prolapse
UTI:
**Bacturia
Pyuria (WBC in UO)
can be complicated vs non-comp.
comp: asso w/ structural d/o
MC Pathogen: E coli and staph saprophyticus (found in fecal flora)
Virulence: evade host defense, adherence to uroepithlium (have pili or fimbraie or both), biofilms to resist host mechanisms.
DX: midstream UA w/ micro
Urinalysis: application scenario
Urinalysis is crucial in diagnosing UTIs, including pyelonephritis, by detecting the presence of bacteria, white blood cells, or pus in the urine.
UTI-UA micro
10 leukocytes/microliter
>5 RBC’s
gram stain
>1, 000 colony forming unit (CFU) if <1K=contamination
Mechanisms that protect the
urinary tract from infection
include
1. monocytes in the urine.
2. acidic urine.
3. decreased urine osmolarity.
4. type-I pili.
- acidic urine pH=1.0
low pH reduces likelihood of infection
Innate defenses against UTI (think urine composition)
Urine composition plays a vital role in preventing UTIs.
urine’s acidity,
the presence of urea,
various immune proteins help deter bacterial growth.
NephrOtic
proteinuria >3.5gm (from glom injury)
decr albumin= decr plasma oncotic pressure=severe edema
causes: damage to basement membrane and podocytes of glom.
C/B: systemic ds (lupus, dm, amyloidosis)
Tx: low protein diet (incr will do more harm), low fat diet, NA restrict , diurectics, glucocorticoids, ARBS
Nephrotic syndrome produces
1. sodium loss.
2. protein retention.
3. susceptibility to infection.
4. IgA nephropathy
- susceptibility to infection:
loss of proteins via the basement membrane, includes loss of immunoglobins
Nephritic
Gross hematuria w/ sudden onset
RBC casts in urine
s/s: small azotemia, edema, htn, oliguria
C/B: incr permeability of Glom filtration membrane
50% of adults will progress to ESRD in 10-20 years after onset
linked to strep infections
Causes of acute renal injury and nephritis
Acute renal injury can be caused by severe or sudden kidney damage. w/ decr in GFR & accum of nitrogenous waste.
incr CR/BUN
Pre-renal: hypoperfusion MC
Intrarenal: d/o involving parenchymal or interstitial tissue OR actue tubular necrosis (ischemia) (ATN)
Postrenal: rare; d/o asso w/ acute obstruction.
Nephritis is often caused by infections, toxins, or autoimmune diseases affecting the kidneys.
Individuals with chronic renal failure often develop
1. hypocalcemia.
2. macrocytic anemia.
3. increased
erythropoietin
secretion.
4. metabolic alkalosis.
- hypocalcemia
Stomach anatomy and production of what substances
4 areas of stomach
- Cardia: lined by mucin secreting Foveolar cells
- Fundus: houses glands that contain chief cells which use & produce digestive enzyme: Pepcin
- Body: has similar glands, also produce pepcin
- Antrum: similar to foveolar cells, but contain endocrine cells (G cells) that secrete Gastrin which stims gastric secretion.
