Urinary System Flashcards
What structures make up the urinary system?
2 kidneys, 2 ureters, urinary bladder and urethra
What process is responsible for the movement of urine down the ureters?
Peristalsis
Where do the ureters end?
Posterior wall of the bladder, enter obliquely and in line with the symphysis pubis bone.
What is the cell type that lines the renal pelvis, ureters and bladder?
Transitional epithelium
What is the advantage of transitional epithelium lining the urinary system?
It can stretch and relax meaning the volume of the structures can change.
What is micturition?
This is the process of urinary excretion
What happens during micturition?
As bladder volume increases the pressure increases. This causes the detrusor muscles in the bladder wall to contract and relaxation of the internal urethral sphincter muscle. Voluntary contraction of external urethral sphincter muscle allows passage of urine from the body.
What advice can be given to patients who need to improve their bladder control?
Pelvic floor exercises
These strengthen the pelvic floor muscles and help pt to regain control of contraction inhibiting urination.
What is the bladder trigone?
This is an anatomical section of the bladder consisting of the 2 posterior openings for the ureters and the anterior urethral orifice at the neck of the bladder.
What is bladder retention and what can cause it?
Inability to empty bladder despite being full.
May be caused by blocked urethra or weakening/impairment of the detrusor muscles allowing bladder contraction or relaxation of sphincter muscles.
What is the normal glomerular filtration rate (GFR) for a healthy male and female?
Male - 125ml/min
Female 105ml/min
List the 4 sections of the nephron?
- Bowmans capsule/glomerulus
- Proximal convoluted tubule
- Loop of Henle (ascending and descending limb)
- Distal convoluted tubule
Where are the proteins aquaporins found and what is their role?
These are found in the walls of the collecting ducts and allow the reabsorption of water back into the blood depending on how much the body needs.
What is the role of using contrast media during pre-treatment CT imagine?
Contrast media allows us to visualise the blood vessels easier. Blood vessels run alongside the lymphatic system therefore for patients who have lymph node involvement we can use contrast to get a better prediction of where the nodes are.
What two kidney functions need to be checked before administering contrast media?
Creatinine clearance
GFR
Give two things we tell patient to avoid if they are having frequent/excessive urination problems?
Caffeine (teas and coffees)
Alcohol
What is a diuretic ?
A substance that promotes urine production by reducing water reabsorption into the blood and therefore lowering blood volume.
What is ADH, where is it produced and what is its function?
Anti-diuretic hormone
Produced in the posterior pituitary
stimulates increased water reabsorption in the DCT and collecting ducts
Reduces volume of urine
What two hormones do the kidney produce and what are their function?
Erythropoietin - stimulates red blood cell production
Calcitriol - natural form of vitamin D, maintains calcium levels
What is renin?
An enzyme produced by the kidney involved in the control of blood pressure.
What is hydronephrosis?
A condition where one or both kidneys become stretched and swollen as a result of a build of urine inside them caused by a blockage downstream.
Give 4 etiological factors of bladder cancer
Tobacco
Age (being over 55)
Industrial carcinogens
Chronic bladder infections
Give 5 signs and symptoms of presenting bladder cancer
1.Haematuria
2.Pain when urinating (cystisis)
3.Difficulty passing urine (Dysuria)
4.Hydronephrosis
5.Acute retention
Give 3 signs and symptoms of advanced stage bladder cancer
Bone pain
Lower limb oedema
Reduced appetite/weight loss
Explain the difference between a CT urogram and a cystogram?
CT urogram - contrast media is injected into the vein to visualise the entire urinary system via CT scan
Cystogram - dye is injected into the bladder via a catheter and is used for an x-ray of the urinary bladder.
What is the name of the clinical investigative procedure that uses a camera on a flexible tube to look up the urethra?
Cystourethroscopy
What 3 things can a cystourethroscopy do?
- Visualise the internal anatomy of the urethra/bladder
- biopsy the tissue
- Surgical resection of tumour
What is the most common type of bladder tumour?
transitional cell carcinoma
What lymphatic nodes are commonly affected by bladder cancer spread?
- Obturator nodes
- External/internal iliac nodes
- Para-aortic nodes
How are non-muscle invasive bladder cancers treated?
Carcinoma in situ - no surgery, just immunotherapy with BCG
T1 and Ta - Surgery - trans urethral resection of the bladder followed by intravesical chemotherapy or intravesical BCG therapy (immunotherapy)
If patient is high risk of becoming muscle invasive they may have a cycstectomy - removal of bladder or part.
Describe the positioning of the kidneys:
- Right kidney is a cm lower than the left kidney due to liver
- Run from T12 to L3
- Rest on the anterior psoas muscle
Lie either side of the vertebral colum - run through the transpyloric place
Describe the position of the Ureters:
- 25/30cm tubes that transport urine from the kidney to the bladder
- Run from L1 to L5
- 5cm from midline
Describe the anatomical position of the bladder in males and females:
Male:
Posterior to the synthesis pubis
Anterior to the rectum
Superior to the prostate gland
Female:
Posterior to the synthesis pubis
anterior to the uterus and upper vagina
superior to the urethra and pelvic floor muscles
what is the % survival for bladder cancer at 10 years?
46%
What are the two types of bladder cancer?
- Non-muscle invasive
- Muscle-invasive
What stage can muscle invasive bladder cancer be?
2 , 3 or 4
Name two chemotherapy drugs that are used to treat muscle invasive bladder cancer
Fluorouracil 5-FU
and
Mitomycin
How is muscle invasive bladder cancer usually treated?
Primary treatment is surgery - TURBT
Followed by Radiotherapy/Chemotherapy or both
Cystectomy if necessary
Explain the T of the TNM system for staging bladder cancer
Non muscle invasive:
Carcinoma in situ - flat tumour in the urothelium
Ta - tumour no deeper than the urothelium but has penetrated out
T1- tumour that has spread to the lamina propria of the mucosa
Muscle invasive:
T2 - grown into muscle layer
T3 - grown into adventitia
T4 - grown into other structures organs beyond the bladder
What is a radical bladder cancer RT prescription?
52.5 -55Gy in 20#
