Unit 3 Urinary Flashcards
What are the generic functions of the urinary system?
Vit D production (if low then leads to bone issues) BP regulation (aldosterone/renin) RBC production (erythropoietin) Elec balance (phos, calcium) Filters (urea) Ph balance
What are the 3 steps to filtration?
Glom filtration
Tubular Reabsorption
Tubular secretion
What substances are secreted and reabsorbed in the kidney, and where?
PROX tubule: Reabsor-Na, Cl, HCO3, K, H20, glucose, AA Secretes-H, organic acids/bases DEC LOOP HENLE: Reabsor-H2O ASC LOOP HENLE: reabsor-Na, Cl, K, Ca, HCO3, Mg Secretes-H DISTAL: Reabsor-Na, Cl, Ca, Mg LATE DISTAL: reabsor-Na, Cl Secretes-K ADH mediated H2O reabsorption
Describe the normal statistics/rates of the glomerular filtration with normal blood flow.
Blood flow thru kidney 1200ml/min 20% filtered to nephron 80% back into circulation 180L/day filtrate 125ml/min filtrate formation High pressure system
What is renal glycosuria?
Tubular failure of glucose Reabsorption.
What is hormonal response with too much or too little fluid?
Too much-inc hormone secretion
Too little-inc hormone secretion
What are normal tubular filtration rates?
180L/day into tubules
99% reabsorbed into bloodstream
1-2 L of Urine produced daily
Filtrate becomes concentrated in distal tubule and collecting ducts.
What is the job of ADH (vasopressin)?
Hormone released by post. Pit in response to blood Osmolality.
Acts on kidney, increases water Reabsorption decreasing blood Osmolality, dec urine output.
Note: dilute urine w/ fixed sp. grav 1.010 indicates inability to concentrate urine=kidney dz
What is the job of aldosterone?
Steroid Hormone synthesized by adrenal cortex By angiotensin 1 and 2 controls (which are controlled by renin enzyme). Regulates sodium volume excretion. Inc aldosterone allows reabsorbs Na. Dec Na in urine.
Note: allows k excretion to maintain BP also.
When ANP or BNP are produced, what occurs, and how is BP affected?
ANP- present when atria overstretched
BNP-Present when ventricles are overworked
Both cause kidney to stop reabsorbing NaCl, so NaCl and H2O are lost in urine decreasing volume therefore dec stretch and workload of the heart. (shuts down renin-angio-Aldos sys)
How long are the ureters? How much urine does the bladder need to stimulate an urge?
12 inches
200 ml (detrusor muscle)
Define the following terms: Anuria Dysuria Enuresis Frequency Oliguria Pyuria
Anuria:output less than 50ml/day Dysuria: painful/difficulty urinating Enuresis: invol. Voiding during sleep Frequency: voiding more than q 3hr Oliguria:output less than 0.5 ml/kg/h Pyuria: pus in urine (wbc's)
What are some common urinary changes in the older adult?
Dec of 1ml/min annually Dec renal reserve Dec med excretion Prone to hypernatremia and hypovolemia Dec muscle mass=urinary leakage Dec GFR and tubular function Incontinence
What are post cytoscopic expectations?
UTI, Hematuria, edema, pain, antibiotics.
What stimulates urination?
Urine storage?
Stretch receptors in bladder detrusor muscle stims urination by pons spinal reflex. PNS (micturition center) stims bladder contraction, external sphincter relaxes.
Cortical inhibition, stim SNS, relax detrusor, stim sphincter contraction.
What are the lower spinal cord centers that are stimulated for the urinary system?
T11-S4
Detrusor and bladder neck trigone
How much urine stims micturition reflex? How often times a day is normal?
150-250ml
8x/day
Diff the types of incontinence.
Stress:losing invol with intact urethra from cough/sneeze (pressure, dec estrogen, urethral wall thinning, prostate)
Urge:
Functional:no physical urinary issue, caused by other factors (immobility, dementia)
Iatrogenic:medication factors causing alpha adrenergic mimics stress incont (hypertensives and cholinergics)
What are the causes of urinary incontinence?
Neurological d/o Spinal cord injury/dysfunction Non neuro d/o: Bashful bladder Overactive bladder Overflow incont Surgery/radiation/interstitial cystitis
Diff neurological urinary incont for spastic and flaccid bladder.
Spastic:cannot store.
Upper motor neuron dysfunction
Flaccid: failure to empty.
Lower motor neuron dysfunction (stroke, sc injury, MS)
That bladder is only under _______ control. Visceral organs are under ______ control.
Autonomic
CNS
What is the causes of reversible urinary incont?
DIAPPERS Delirium Infection Atrophic vaginitis, urethritis Pharmacologic agents (iatrogenic) Psychological factors (bashful) Excessive urine production Restricted activity (functional) Stool impaction
What are the clinical manifestations for incont? Tx?
UTI/infection Constipation Dec fluid intake Dec bladder tone, capacity Inc residual urine Inc in urgency
Urodynamic
Bahavioral therapy-move q2hr
Pharm-overactive: anticholin (dec SNS), tricylates (dec contractions)
Surgery
How is a urodynamic performed?
Full bladder then urinate then insert Cath to measure bladder and then fill bladder with fluid to measure strength of bladder and voiding.
No caff/carbonation
What are some causes of urinary retention?
Poor contraction of detrusor Obstruction (BPH, stones, inflam) Aging over 60-dec det muscle, inc resid 50-100ml commonly, inc prostate Antidep, anticholin, antihyperten Pain Neuro d/o Pregnancy
What are clinical manifestations of retention?
(Retention and UTI s/s same) Frequency Dribbling Bladder fullness (sometimes) Distention Pain (low abd/back) Restlessness, agitation UTI s/s Poor stream Straining Inc BP, diaphoresis=call to dr for bladder scan, may need Cath
