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Pathophysiology > Quiz 2 - End of Renal & beginning of GI > Flashcards

Quiz 2 - End of Renal & beginning of GI Flashcards

1
Q

________ is a test used to look for problems with the filling and emptying of the bladder.

A

Cystometrogram

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2
Q

How bladder handles the pressure of the fluid

A

Cystometrogram

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3
Q

Insert scope and Graphic recording of pressures in bladder during bladder filling and emptying

A

Cystometrogram

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4
Q

Helps diagnose stress incontinence

A

Cystometrogram

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5
Q

Describes loss of urine from pressure (stress) exerted on the bladder by coughing, sneezing, laughing, exercising, or lifting something heavy

A

Stress Incontinence

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6
Q

A competent sphincter will not allow for any loss of urine, even with a full bladder and maneuvers such as cough, laugh, or position change

A

True

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7
Q

2 different types of disorders

A
  1. Neurogenic disorders

2. Non-neurogenic disorders

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8
Q

Bladder dysfunction caused by an interruption of normal bladder nerve innervation
–CVA, Dementia,
Diabetes, Multiple
Sclerosis, Parkinson’s

A

Neurogenic Disorders

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9
Q

What kind of disease is Spinal Cord Dysfunction: Acute injury or Degenerative disease?

A

Neurogenic Disorders

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10
Q

Overactive bladder, Post surgery, Stress incontinence

–Stroke problem,

A

Non-neurogenic Disorders

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11
Q

Caused by trauma or damage to nervous system/spinal cord (multiple sclerosis & diabetes) for both empty bladder by way of catheterization

A

Reflex incontinence

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12
Q

Result in a flaccid bladder that fills until it “leaks”

  • Nerve that goes from anterior horn of spinal cord to the muscle/bladder
  • Bladder/muscle is flaccid no more control of bladder, it fills and fills until leaks,
  • Need catheterization to drain the bladder
A

Lower Motor Neuron Injury

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13
Q
  • Spinal cord lesion above the voiding reflex arc; results in a spastic bladder
  • brain until anterior horn of spinal cord
  • CNS control
  • Spastic bladder so it is always contracting (not strong) constant contracting so often urine dribbling
  • Not good contraction of bladder so does not fully empty so need catheterization to empty it
A

Upper Motor Neuron Injury

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14
Q

In motor neuron injury patients, some need a bladder training program and have to sometimes catheterize themselves in order to adequately drain bladder and prevent UTI.

A

True

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15
Q 
Strong urge to void that cannot be suppressed followed by involuntary loss of urine; often individuals have only a few seconds warning.
--Occurs with urinary 
  tract infections, 
  neurologic dysfunction 
  (Parkinson’s disease, 
  Alzheimer’s, Stroke), 
  nervous system 
  damage (multiple 
  sclerosis)
A

Urge/Overflow Incontinence

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16
Q

Urge Incontinence with no known cause

A

Overactive bladder

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17
Q 
involuntary loss on urine due to over distention of bladder- may see dribbling because of a flaccid bladder, urethral damage, or diabetic neuropathy, tumors or obstructions, prostate conditions
--Inability to empty the 
  bladder/retention
--May also see weak urine 
  stream
A

Overflow Incontinence

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18
Q

urinary tract is intact but other factors involved – physical or mental impairment prevents toileting in time: Example- a person with severe arthritis may not be able to undress quickly enough to prevent incontinence.

A

Functional Incontinence

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19
Q

involuntary loss of urine due to extrinsic factors- medications like alpha adrenergic blockers that relax bladder neck to point where urine leaks with even minimal pressure

A

Iatrogenic:

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20
Q

What are the risk factors for developing urinary incontinence?

A
  1. Being female
  2. Advancing age
  3. Overweight
  4. Smoking
  5. Other diseases (renal disease, diabetes)
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21
Q

DRIPS = causes of acute urinary incontinence

A 
D = delirium, dehydration, diapers
R = retention, restricted mobility
I = impaction, infection, inflammation
P = Pharmaceuticals- opioids, calcium channel blockers, anticholinergics cause retention, alpha-adrenergic antagonists cause urethral relaxation, diuretics increase urine production, antidepressants have anticholinergic effects
S = Stool impaction (Constipation)
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22
Q

Treatments for incontinence

A
  1. Determine the cause: history taking, urodynamic testing (cystometrogram – looking at filling pressures of bladder)
  2. Biofeedback, behavioral therapy/bladder training
  3. Scheduled toileting (helpful in elederly)
  4. Anticholinergic agents: Ditropan, dicyclomine—blocks acetylcholine and an effect of this is urinary retention so these drugs are long acting are better with less cognitive decline in elderly. What would these do to bladder contraction?
  5. Tricyclic Antidepressants: May have a urinary functions ex are nortriptyline, doxepin
  6. Pseudoephedrine for Stress incontinence
  7. Estrogen- restores mucosal, vascular, and muscular integrity to urethra
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23
Q

Strategies for management (Incontinence)

A
  1. Be aware of fluid intake and times
  2. Take diuretics in AM
  3. No caffeine, alcohol, or aspartame (nutrasweet)
  4. Avoid constipation
  5. Void regularly
  6. Pelvic floor exercises
  7. Stop smoking- leads to coughing-leads to incontinence
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24
Q

Kidney stones aka ______/______:: You can have them in the ureter, pelvis of kidney, or calyces of the kidneys, can be anywhere a long the urinary tract

A

Urolithiasis/Nephrolithiasis

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25
Q

Stones or ____ in the urinary tract: Occur when substances like calcium oxalate, calcium phosphate, and uric acid increase

A

calculi

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26
Q
  • Theory: Can form when deficiency of substances such as citrate or magnesium exist (These prevent crystallization of urine)
  • Theory: Can form when patient in dehydrated state
A

Theories of

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27
Q

Causes of ______: infection, stasis of urine, immobility, increased calcium

A

Urolithiasis-Nephrolithiasis

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28
Q

Urolithiasis-Nephrolithiasis is more common in men and ________

A

Caucasians

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29
Q

-Hyperparathyroidism
-Cancers
-TB or sarcoidosis-these cause increased Vitamin D production by the granulomatous tissue
-Excessive dairy intake
Leukemias, multiple myeloma: increased bone marrow production of blood cells
-Gout-uric acid stones
-Proteus, Pseudomonas, Klebsiella-cause struvite stones produced in a ammonia-rich urine
-Inflammatory bowel disease, ileostomy patients- absorb more oxalate
-Medications: antacids, laxatives, Diamox, high doses of aspirin

A

Causes of stone development

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30
Q

Myth is that most stones are made form calcium so let’s not tell patients to avoid dairy or calcium products

A

True

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31
Q
  • INTENSE deep pain in the Costovertebral region (in the pic, if have kidney then will CVA tenderness)
  • Hematuria, foul-smelling
  • Nausea, vomiting

-Spasming; renal colic/colicky pain (pain
fluctuates in intensity lasting
20-60 minutes)

-Fever, chills

A

signs/symptoms of Urolithiasis/Nephrolithiasis

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32
Q
  • **Opioids and NSAID’s for pain
  • **Fluids, fluids, fluids
  • Dietary restriction of protein, sodium, perhaps calcium
  • Protein diet linked to increased urinary excretion of calcium and uric acid
A

Medical treatment for Urolithiasis/Nephrolithiasis

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33
Q

NSAID’s inhibit prostaglandin E which causes _______ of ureters and increases renal blood flow

A

contraction

34
Q 
Medical treatment for \_\_\_\_\_\_\_\_\_\_\_: low purine foods; avoid shellfish, anchovies, asparagus, organ meats, mushrooms- 
  -Treat Gout and for   
    Uric Acid stones: Take 
    allopurinol (Zyloprim) – 
    Decrease uric acid 
    production
A

Uric Acid Stones

35
Q

Avoid spinach, strawberries, rhubarb, chocolate, tea, peanuts, wheat bran

A

Oxalate Stones

36
Q

Calcibind, thiazide diuretics: Raise calcium levels so if we have calcium stones we will take patient off of these drugs

A

True

37
Q

Extracorporeal Shock Wave Lithotrypsy

A

Disintegrating calculi

38
Q

Delivering shock waves over the kidney area and that will cause busting up the major stones that could not otherwise be eliminated by voiding,
-Laser and forceps are used to grab the calculus and remove it through fiber optic scope

A

Extracorporeal Shock Wave Lithotripsy-

39
Q

Noninvasive procedure to break up stones

May or may not use anesthesia, depending on size of stone and number and intensity of shock waves

Strain urine after procedure; look for stone fragments

Observe s/s of infection

May also perform a
percutaneous nephrolithotomy

A

Extracorporeal Shock Wave Lithotripsy

40
Q

If stone cannot be broken down by ESWL, do Percutaneous nephrolithotomy to retract stones

A

True

41
Q

Males more than females: (3 to 1)
50-70 years of age

More common in Caucasians

4th leading cause of death in males

Main Cause: cigarette smoking (people who smoke get bladder cancer twice as much as those who do not)

Cancers arising from prostate, colon, and rectum may metastasize to bladder.

A

Bladder Cancer

42
Q

Visible, painless hematuria

A

Bladder Cancer

43
Q

Sometimes UTI, frequency, urgency and dysuria

Alteration in voiding pattern

A

Bladder Cancer

44
Q
  • environmental carcinogens
  • High cholesterol
  • pelvic radiation – for treatment of prostate cancer
A

Risk factors for Bladder Cancer

45
Q

Cystoscopy

CT scan

Biopsy

Examination

Bladder tumor antigens, other markers

A

Diagnostic evaluation of bladder cancer

46
Q

Cauterization of simple benign epithelial tumors

Cystectomy or removal of the bladder

Radical cystectomy in male: removal of bladder, prostate, and seminal vesicles

Also consider transurethral resection of bladder tumor, radiation, and chemotherapy

A

Management of Bladder Cancer

47
Q

Combination of methotrexate, 5-fluorouracil, vinblastine, doxorubicin (Adriamycin), cisplatin

A

Chemotherapy for bladder cancer

48
Q

instillation of antineoplastic agent directly into bladder-BCG-Bacillus Calmette Guerin- most effective intravesical agent for recurrent bladder cancer because it enhances body’s immune response to cancer.

A

Topical chemotherapy

49
Q

6 week course of weekly instillations

Followed by a 3 week course at 3 months in tumors that do not respond

BCG has 43% advantage in preventing tumor recurrence, compared to 16-21%
advantage with other intravesical agents

Patient retains intravesical solution for 2 hours before voiding

At end of procedure, patient must drink fluids liberally to flush medication from bladder

A

BCG-Bacillus Calmette Guerin

50
Q

Immediately post-op: monitor urine hourly

Need to see more than 30 mls/hr

Catheter may be inserted through conduit if prescribed by MD

Stents may be placed in ureters to ensure urine flow

A

Bladder removal post op

51
Q

When bladder has been removed, what do you do to help them eliminate urine?

A

Formation of ileal conduit (Illeostomy), this includes taking 2 ureters stitching them to a part of the bowel, a segment of ileum is removed and we stitch the 2 ureters to that segment of ileum, we bring ileum to the front of abdominal cavity which is formed into a stoma. Kidneys make urine, drains into ureters, illeal conduit, outside of body via stoma, bag sealed over stoma, collected in the bag is the urine.

we may have to place stents in the ureters to keep them open to ensure good urine flow

52
Q

____ should be beefy red;

If dark, purple indicates decreased blood supply

A

Stoma

53
Q

Inspect skin for irritation, bleeding, encrustation

Keep urine acidic (pH below 6.5)

May prescribe vitamin C
Patient may be prescribed ascorbic acid po

Will see large amounts of mucus mixed with urine so it will look like urine – tell patient to be well hydrated so stoma will not be clogged

Avoid foods that have an odor like asparagus, fish

A

Stoma care

54
Q

Consumes, digests, and eliminates food

A

Gastrointestinal System

55
Q

2 divisions of G.I tract

A
  1. Upper division

2. Lower division

56
Q

oral cavity, pharynx, esophagus, and stomach

A

Upper division of G.I tract

57
Q

small intestine, large intestine, and anus

A

Lower division of GI tract

58
Q

liver, gallbladder, and pancreas

A

Hepatobiliary system

59
Q

Mucosa, submucosa, muscle, and serosa (connective tissue)

A

Four layers of G.I tract

60
Q

Large serous membrane that lines the abdominal cavity, semi permeable, made of layers

A

Peritoneum:

61
Q

Parietal peritoneum:

A

Outer layer

62
Q

Visceral peritoneum:

A

Inner layer

63
Q

space between the two layers

A

Peritoneal cavity

64
Q

What happens if there is decreased blood supply to the G. I tract?

A

GI tract goes without good blood supply, no good intervention –> parelytic illeus: Intervention of blood supply to the gut is lacking so now food particles movement through gut is limited which can lead to sepsis and sever infection, obstruction

65
Q

Double-layer peritoneum containing blood vessels and nerves that supplies oxygen and nutrients to the intestinal wall

A

Mesentery

66
Q

Food enters through the mouth to begin chemical and mechanical digestion.

A

Upper GI Tract

67
Q

opening from stomach to the duodenum

A

pyloric sphincter

68
Q

______ is coordinated by the swallowing center in the medulla and cranial nerves 5 (trigeminial), 9 (glossopharyngeal), 10 (vagus), and 12 (hypoglossal nerve).

A

Swallowing

69
Q
  • expansion of the stomach as food enters;
  • contractions of the stomach to break food into smaller particles
  • release of gastric acid required for food processing;
A

Vagus nerve (X)

70
Q

emptying of the stomach contents into the small intestine;

secretion of digestive pancreatic enzymes (amalayze, lipase, protease) that enable absorption of calories; and

controlling sensations of hunger, satisfaction and fullness.

A

Vagus Nerve (X)

71
Q

______ Duct: synthesizes bile, needs this to digest and absorb fat, travel to L/R hepatic duct.

A

Hepatic

72
Q

Where bile is stored

A

Gallbladder

73
Q

Enzymes backup to the pancreas and cause inflammation and that’s how we end up with ________

A

pancreatitis

74
Q

Metabolize carbohydrates, protein, and fats

Synthesize glucose, protein, cholesterol, triglycerides, and clotting factors

Store glucose, fats, and micronutrients and release when needed

A

Liver functions

75
Q

Detoxify blood of potentially harmful chemicals

Maintain intravascular fluid volume

Metabolize medications to prepare them for excretion

A

Liver functions

76
Q

Produce bile

Inactivate and prepare hormones for excretion

Remove damaged or old erythrocytes to recycle iron and protein

Serve as a blood reservoir

Convert fatty acids to ketones

A

Liver functions

77
Q

Bile is produced by the?

A

Liver

78
Q

Produces enzymes, electrolytes, and water necessary for digestion (lipase, protease, amalyase)
–Secreted into duodenum to help digest those foods

A

Exocrine functions (Pancreas)

79
Q

Produces hormones (insulin) to help regulate blood glucose

A

Endocrine function (Pancreas)

80
Q

Continues digestion

Absorbs nutrients and water

A

Lower GI Tract

Pathophysiology (4 decks)

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