MT M 6.8 Common Urinary System Medical Conditions/Procedures Flashcards
Acute cystitis
Acute cystitis is an infection of the bladder commonly caused by E coli. The bacteria gain access to the urinary tract from the urethra. Patients will complain of voiding symptoms such as frequency, urgency, and dysuria.
Frequency
Frequency is the frequent need to urinate.
Urgency
Urgency is an urgent feeling of the need to void
dysuria
dysuria is painful or difficult urination.
Acute cystitis is diagnosed
Acute cystitis is diagnosed through a urinalysis and urine culture and sensitivity. A sample of urine is collected and evaluated in the lab. The urine sample is also cultured to see if any bacteria will grow and if it is sensitive to common antibiotics. Bacteria and white blood cells can be seen in Figure 6.25, which shows a microscopic evaluation of a urine sample. Patients are treated with a short course of antibiotics.
Hematuria
Hematuria is the presence of blood in the urine. Hematuria can be gross or microscopic. Gross hematuria is visible blood in the urine.
Acute pyelonephritis
Acute pyelonephritis is inflammation of the kidney and renal pelvis because of an infection of the kidney. This infection also ascends from the lower urinary tract.
Acute pyelonephritis diagnosis
The diagnosis is made through a urinalysis, urine culture, and imaging of the kidney with a renal ultrasound or CT scan. If left untreated, acute pyelonephritis can lead to sepsis and shock. Patients are typically hospitalized for IV antibiotics and IV fluids.
Acute pyelonephritis symptoms
Patients are more severely ill and may show fever, tachycardia, flank pain, shaking chills, and voiding symptoms. They also may have nausea, vomiting, and diarrhea.
Acute kidney injury (AKI)
Acute kidney injury (AKI) is worsening of kidney function over a short period of time, specifically hours to days. This results in an accumulation of waste products in the bloodstream called azotemia or uremia.
azotemia or uremia
Acute Kidney Injury
Uremia results in changes in mental status, nausea, vomiting, and malaise.
AKI can be classified as
Acute Kidney Injury
AKI can be classified as prerenal, intrinsic kidney disease, or postrenal.
Prerenal AKI
Prerenal AKI is caused by a decrease in perfusion of the kidney with blood. This can result from decreased cardiac output, decreased blood volume from bleeding or GI losses, or excessive diuretic use.
Intrinsic kidney diseases
Intrinsic kidney diseases that can lead to AKI include acute tubular necrosis,** acute glomerulonephritis**, or interstitial nephritis. Postrenal causes of AKI include obstruction of the urethra, bladder, or one or both ureters.
Acute Kidney Injury Treatment
Treatment involves treating the underlying cause of the AKI. AKI can lead to chronic kidney disease if left unaddressed.
Symptoms of CKD
Chronic kidney disease (CKD) or chronic renal failure
Symptoms of CKD do not develop until a patient is in the later stages of renal failure. As the kidneys fail, patients will develop uremic syndrome, which will cause nausea, vomiting, fatigue, anorexia, and a metal taste in the mouth. They can have puritis, restless legs, insomnia, and difficulty with memory. Complications of CKD include hypertension, anemia, hyperkalemia, heart failure, atrial fibrillation, and coronary artery disease.
Chronic kidney disease (CKD) or chronic renal failure
Chronic kidney disease (CKD) or chronic renal failure results in a decline in kidney function over months to years. Most cases of CKD occur in patients with hypertension and/or diabetes mellitus.
treatment for patients with CKD
The goals of treatment for patients with CKD include slowing the progression of the renal failure and treatment of diabetes mellitus and hypertension. Treatment options for patients with severe CKD include dialysis and renal transplant to prevent death.
Dialysis
Chronic kidney disease (CKD) or chronic renal failure
Dialysis is a medical procedure where the waste material in the blood is separated out and the normal fluid, electrolyte, and acid-base balance is maintained via a machine or chemical reaction. There are two types of dialysis: hemodialysis and peritoneal dialysis.
Hemodialysis
Dialysis
Hemodialysis is completed through an arteriovenous fistula. This is a surgically created connection of an artery and vein. The blood is removed from the body, processed through a dialyzer, and then returned to the body, as seen in Figure 6.26. Patients will need to go to a hemodialysis center several times per week to have this procedure completed.
Peritoneal dialysis
Dialysis
Peritoneal dialysis, seen in Figure 6.27, involves the introduction of dialysate into the peritoneal cavity, and the peritoneal membrane filters the blood. The dialysate is then removed from the peritoneal cavity and the dialysis fluid is replaced. Peritoneal dialysis has some advantages over hemodialysis in that the patient can complete this process within their own home. However, peritonitis, inflammation of the peritoneal membrane, is a common complication of peritoneal dialysis.
Renal transplantation
Chronic kidney disease (CKD) or chronic renal failure
Renal transplantation involves a kidney being taken from either a living or deceased donor and then surgically placed into the patient with CKD. Figure 6.28 shows a transplanted kidney in the abdominal cavity of a patient with CKD.
Nephrolithiasis
Nephrolithiasis is also called urinary stone disease and it is the development of stones within the urinary tract. It is a common disorder affecting 1 in 11 Americans each year. Stones develop due to the saturation of urine, and the most common type of stone is a calcium oxalate or phosphate stone.
Renal calculi
Nephrolithiasis is also called urinary stone disease
Renal calculi develop due to medications and inadequate hydration. Patients with a family history of urinary stone disease are more prone to developing renal stones, as well as patients who live in hot and humid environments
Renal calculi symptoms
Nephrolithiasis is also called urinary stone disease
Patients develop symptoms when the renal calculi obstruct the flow of urine from the kidney. They will complain of sudden, severe pain in the flank, nausea, and vomiting. They will have a hard time finding a comfortable position. The pain may move as the stone progresses through the urinary system and it likely will resolve if the stone passes into the bladder and out the urethra. Figure 6.30 shows multiple stones within the urinary tract including the kidney, ureter, bladder, and urethra.
procedures may need to be completed
Nephrolithiasis is also called urinary stone disease
If a urinary stone is unable to pass through the urinary tract, procedures may need to be completed to either remove the stone or to help it pass.
Stones that are within the ureter may require **extracorporeal shockwave lithotripsy **to break up the stone to allow it to pass (Figure 6.31).
Ureteroscopic stone extraction involves a scope that travels to the site of the stone for removal.
Percutaneous nephrolithotomy is a surgical procedure that removes the stone from the renal pelvis via a scope that is inserted through the back that breaks up the stone with ultrasound and then removes the stone fragments
