patho exam 4 Flashcards
what is polycystic kidney disease and what is the etiology and RF
Genetic; Growth of multiple bilateral grapelike clusters of fluid-filled cysts in kidneys. cells within the tubule epithelium undergo repeated cell division, creating a cyst– enlarges the kidney and thickens basement membrane of tubule–compression and replacement of functioning renal tissue–deterioration–fatality
RF: family history, sickle cell disease, aortic/brain aneurysm, pancreatic/liver cysts, diverticula
polycystic kidney disease CM& complications
neuro/ MS: headache
Cardio: HTN
GI/GU: abdominal pain, flank pain, polyuria, UTI, gross hematuria, increased abdominal girth
Skin: pallor, dry skin, edema
complications: cyst rupture, liver failure, kidney cancer & failure, respiratory and heart failure
Urinary Tract Infection UTI? etiology and RF
bacterial infection of upper and lower urinary tract system: cystitis (bladder/lower), urethritis (urethra/lower), pyelonephritis (upper, renal parenchyma); caused by ascending infection by gram- bacterium like E. Coli, local defense mechanisms in bladder break down–bacteria invade mucosa & multiply
RF: more common in women bc anatomy, inadequate fluid consumption, catheter use, urinary stasis, benign hyperstatic hyperplasia, sexual activity, poor hygiene
UTI manifestations, complications, Dx
Neuro: malaise, fatigue, OLDER ADULTS: altered mental status and confusion
GI/GU: urgency, frequency, burning urination, bladder cramps or spasm, pain, nocturia, dysuria, discharge, flank pain, nausea, vomiting, foul smelling urine, hematuria
Compliations: dmg to uterine lining, pyelonephritis, sepsis, kidney abscess, acute urinary outlet obstruction, acute bacterial prostatitis (men)
Use clean catch urinalysis to show bacterial count
Pyelonephritis? etio & RF
bacterial infection of renal parenchyma affecting one or both kidneys w sudden onset, E.Coli most common, infection spreads from bladder to ureters then to kidney
etio: more common in ppl 50+ and women; occurs in approx 20-30% pregnancies
RF: female, lower UTI, nephrolithiasis, pregnancy, catheter, cystoscopy, sex, DM
pyelonephritis CM
Neuro/MS: fatigue, malaise, weakness, change in
mental status
GI/GU: CVA pain, nausea, vomiting, urgency, frequency,
burning urination, dysuria, nocturia, hematuria, anorexia,
cloudy urine, oliguria, foul smelling urine
Skin: chills, moist skin
Other: fever
complications: renal calculi, acuye kidney injury, renal abscess, multisystem infection, sepsis, HTN, kidney scarring
Dx: urinalysis and CT
glomerulonephritis? etio and RF
kidney disease of inflamed glomeruli–affect kidney function, associated with a postinfectious state,
commonly a streptococcal infection of the respiratory
tract, antigen-antobody complexes trapped in glomerular capillary membrane–inflammation–thickened glomerular membrane and dec. function
etio: Untreated group A beta-hemolytic streptococcus
infection, such as of the respiratory tract (strep
throat) or the skin (impetigo)
RF: strep throat, depressed immune state (AIDS, cancer), alocohol and IV drugs, children and elderly, males
glomerularnephritis CM, complications, Dx
Neuro/MS: back pain or joint stiffness, fatigue, malaise, headache,
confusion,
Respiratory: dyspnea, orthopnea, cough, crackles,
Cardio: hypertension, brady or tachycardia
GI/GU: hematuria, rust-color urine, abdominal pain, anorexia, anuria,
oliguria, CVA tenderness
Skin: pallor
Other: edema, weight gain, fever
complications: hypertensive retinopathy or encephalopathy, azotemia, anemia, HTN, heart failure, pulmonary edema, nephrotic syndrome, hyperkalemia, hypocalcemia, microhematuria
Dx: high serum potassium, low serum Ca, matabolic acidosis w/kidney impairment, BUN and creatinine elevated, GFR dec
acute kidney injury? etiology, classifications & phases
interruption of kidney function resulting in acute decline in GFR, retention of urea, interrupted regulation of ECF volume and electrolytes
1. prerenal failure: crush injury, hemorrhagic blood loss, hypotension/ hypoperfusion, hypovolemia, loss of plasam vol, water and electrolyte loss, dec CO, ACE inhibitors
2. intrarenal dailure: acute tubular necrosis, coagulation defect, HTN, infection, cancer, artery or vein obstruction
3. postrenal failure: mechanical obstruction, siaruption of urinary flow: bladder neck obstruction, renal calculi, fibrosis, renal vein thrombosis or hematoma
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1. onset phase: cause: burn/ blood or fluid loss–kidney perfusion decreases& urine output <0.5 mL/kg/hr
2. oliguric-anuric phase: 1-2 weeks, urine output <400 mL/day, fluid volume excess, azotemia,hypoperfusion, necrosis
3. diuretic phase: 1-2 weeks, kidney function recoverd, cause is corrected, urine output graduallt increases & electrolyted return to normal range, GFR imporves
4. recovery phase: 3-12 months, gradual return of near normal kidney function, edema decreases, fluid and electrolyed return to normal balance
acute kidney injury patho, RF
RF: advanced age, ACE inhibitors, autoimmune disease, blood loss, exposure to toxic metal solvents, severe dehydration, heart failure, liver disease, HTN, DM,
Prerenal: caused by volume loss or impaired flow, decrease in GFR occurs due to decreased filtration pressure, failure to restore blood volume may result in tubular necrosis/ acute cortical necrosis
Intrarenal: structural injury, leads to intrarenal vasoconstriction, severe episode of hypotension, hypovolemnia; can also be caused by cytotoxic, ischemic, or inflammatory injury to kidney; reperfursion may lead to cell swelling and necrosis
Postrenal: mechanical urinary tract obstruction affecting kdineys unilaterally (obstruction of renal pelvis, ureter, bladder, urethra) or bilaterally (prostatic hyperplasia); tublar pressure increases, leading to a decrease in forces of filtration
acute kidney injury CM, complications, Dx
Neuro/MS: fatigue, weakness, back pain, confusion, muscle cramps,
irritable, drowsy, confusion, altered LOC, seizures, retinopathy,
Respiratory: dyspnea, shortness of breath, crackles,
Cardio: tachycardia, hypo or hypertension, atrial fibrillation, peaked T wave, edema
GI/GU: anorexia, nausea, vomiting, diarrhea, oliguria, anuria,
Skin: ecchymosis, purpura, pruritus, dry mucous membrane,
Other: fever, chills, thirst
complications: Electrolyte imbalance, Metabolic acidosis, Acute pulmonary edema, Heart failure, pericarditis, Arrhythmias, Fluid overload, Hypertensive crisis, infection, sepsis, Gastrointestinal bleeding, Cognitive or memory deficits, Uremia, Death
Dx: BUN and creatinine increased, BUN to creatinine ratio is greater than 20:1, crystals in urine as well as protien and blood, decreased hematocrit
R.I.F.L.E Acute Kidney Injury
Risk: GFR is greater than 25% or serum creatinine (SCr) is increased 1.5 to 2 times
baseline; UO is less than 0.5 mL/kg/hour for less than 6 hours
Injury: GFR is decreased by more than 50% or SCr is increased two to three times the
baseline; UO is less than 0.5 mL/kg/hour for more than 12 hours
Failure: GFR is decreased by 75% or SCr is increased by three times the baseline, is
greater than or equal to 4 mg/dL, or is increased acutely 0.5 mg/dL or more; UO is less
than 0.3 mL/kg/hour for 24 hours (oliguria) or is absent (anuria)
Loss of function: complete loss of kidney function for more than 4 weeks
End-stage renal disease: complete loss of kidney function for more than 3 months
Chronic Kidney Disease? etio and RF
progressive loss of kidney function, resulting in decline in GFR, retention of urea, interrupted ECF vol and electrolytes, signs minimal until 75% GFR lost, fatal if nor treated w/ dialysis or transplant. Nephron destruction eventually causes
irreversible kidney damage; Stage 1 GFR is greater than 90 mL/minute/1.73m2; stage 5, less than 15 mL/minute/1.73m2.
Etio: HTN, DM, glomerular disease, congenital abnormality (polycystic kidney disease), kidney dmg, vascular disease, cystic kidney disease
RF: >65, genetics, chronic infection, collagen diseases, nephrotoxic agents, calculi, vascular disease, high cholesterol
CKD stages
⦿ Stage 1: GFR normal or increased (greater than 90 mL/minute/1.73 m2) but at
an increased risk of kidney disease
⦿ Stage 2: GFR mildly reduced (60 to 89 mL/minute/1.73 m2) and signs of mild
kidney disease
⦿ Stage 3a: GFR moderately reduced (45 to 59 mL/minute/1.73 m2) and signs of
moderate chronic renal insufficiency
⦿ Stage 3b: GFR moderately reduced (30 to 44 mL/minute/1.73 m2) and signs of
moderate chronic renal insufficiency
⦿ Stage 4: GFR severely reduced (15 to 29 mL/minute/1.73 m2) and signs of
severe chronic renal insufficiency
⦿ Stage 5: GFR indicates kidney failure (less than 15 mL/minute/1.73 m2) and
signs of end-stage kidney disease
CKD is defined as either the presence of kidney damage or a sustained glomerular filtration rate (GFR) of lower than 60 mL/minute/1.73m2 for 3 months.
CKD CM, complications, Dx
Neuro/MS:fatigue, muscle cramps, weakness, twitching, altered LOC,
Respiratory: shortness of breath, chest pain, crackles, pleural rub,
Cardio: peripheral edema, hypo or hypertension, arrhythmias,
GI/GU: nausea, vomiting, anorexia, infertility, decreased libido, amenorrhea,
erectile dysfunction, change in urine output, malnutrition, abdominal pain on
palpation,
Skin: ecchymosis, poor skin turgor, pale or bronze skin, thin brittle nails and
hair
Other:dry mouth, hiccups, sleep problems, gum ulceration and bleeding
complications: anemia, HTN, CV disease, hyperparathyroidism, lipid disorder, malnutrition, decreased immune response, death
Dx: BUN, creatinine, Na, K, PO4, ammonia elevated; hematocrit low
GERD? etio and RF
gastroesophageal reflux disease; backflow of gastric or duodenal contents (acid) into esophagus past the lower esophageal sphincter w/o vomiting, usually is after a meal; AKA heartburn; esophageal motility is slowed leading to decerased clearance of acidic material, lower esophageal sphincter is dysfunctional, casued decreased gastric emptying and consequent increase in volume and pressure of stomach
Etio: condition/ position increasing intra-abdominal pressure, hiatal hernia w/in ompetent sphincter, pyloric surgey, >40 y/o; asthma can cause lower esophageal sphincter to relax allowing stomach contents to flow back
RF: any agent that lowers lower esophageal sphincter pressure (acidic/fatty food, cigarettes, anticholinergenics), NG Tube for more than 4 days, obesity, smoking
GERD CM, Complications, Dx
Respiratory: chronic cough, morning hoarseness,
wheezing, laryngitis
GI/GU: pyrosis (heartburn), retrosternal burning, pain
(relieved with antacids), sour or bitter taste in mouth,
radiating pain to neck/arm/jaw that may imitate angina
pectoris,
CM:peptic stricture, reflux esopagitis, esophageal stricture, esophageal ulcer, barreyy esophagus, reflux aspiration leads to COPD, GERD-induced asthma
Dx: Barium swallow showing evidence of recurrent reflux; pH monitoring
peptic ulcer disease? etio and RF
development of circumscribed lesion (ulder) in mucosal membrame of lower esophagus, stomach, duodenum, jejeunum; 2 forms: duodenal(80%) or gastric; h. pylori releases toxin promoting mucosal inflammation and ulceration,
etio: H. pylori infection, NSAIDS use
RF: Type A in gastric Type O in duodenal, mucosal defects, exposure to irritants, tobacco use, stress, genetics
Peptic ulcer CM, complications, Dx
GI/GU: left epigastric pain described as heartburn and feeling of
fullness shortly after meals, weight and appetite loss, nausea, vomiting, pain thats worse at night and morning, relieved by antaids or vomitng (gastric) or between meals
(duodenal); epigastric pain that awakens patient at night;
heartburn, pain relieved by antacids, pain after 1.5-3 hours after eating; belching; bloating; dark stools; hematemesis;
difficulty swallowing; vomiting; early satiety, epigastric
tenderness; anorexia; hyperactive bowel sounds
Skin: pallor
Other: weight loss
70% asymptomatic!
Complications: Bleeding (hemorrhage)from granulation tissue from erosion of an ulcer into a blood vessel, perforation of ulcer eroding through layers of stomach, bowel, or duodenum wall (peritonitis), outlet obstruction: edema, spasm, or contraction of
inflammation or scar tissue and interference with the free passage of gastric contents through the pylorus or
adjacent areas.
Dx: CBC showing anemia, fecal occult blood test positive, H.pylori antibody test positive, barium swallow, x ray showing mucosal abnormalities in upper GI
Inflammatory bowel disease
chrons and ulcerative colitis
produce inflammation of bowel, pattern of familial occurence.
Crohn’s? etio and RF
chronic inflammatory bowel disease affecting GI tract from mouth to anus, extends through all layers of intestinal wall, may involve regional lymph nodes and mesentery, slow preogressive inflammation of bowel or GI tract, granulomas through all layers of intestinal wall
etio: idiopathic, altered immune response to intestinal bacteria, lymph obstruction and infection, genetics
RF: history of allergies, immune disorders, high protien lvls of tumor necrosis factor, smoking, NSAIDs
Crohns CM complications and Dx
Neuro/MS: fatigue, weakness, arthritis
GI/GU: flatulence, nausea, cramping pain in right lower
quadrant, diarrhea (especially after emotional upset or ingestion
of poorly tolerated foods), abdominal mass, anorexia,
hyperactive bowel sounds, bloody diarrhea, perianal abscess
Other: intermittent fever, weight loss, uveitis, iritis, episcleritis
complications: fistulae, colon perforation, toxic megacolon, gallstones, osteoporosis, malabsorption, abscess, colon cancer, hemorrhage
Dx: fecal occult blood test positive, hemoglobin and hemotocrit decreased or reflect anemia
ulcerative colitis? etio and RF
Episodic chronic inflammatory bowel disease that
causes ulcerations of the mucosa in the colon, Initially affects the lower colon (rectum and sigmoid
colon) and may extend upward into the entire colon
etio: idopathic, immune disorder in GI tract
RF: stress, genetics, jewish ancestry, NSAIDs, dairy consumption
ulcerative colitis, CM, Dx
Neuro/MS: fatigue, weakness, arthralgia, joint pain
Cardio: tachycardia
GI/GU: cramping and lower abdominal pain, mucosal discharge,
bloody diarrhea, tenesmus, anorexia, nausea, vomiting,
urgency, incontinence, distended abdomen, hemorrhoids
Skin: jaundice
Other: weight loss, fever
complications: nutritional deficiency, sepsis, anal fissure/ fistula, abscess, hemorrhage, anemia
Dx: stool specimen analysis revealing blood, pus, mucus, no pathogenic organisms
