urinary system Flashcards
urinary system
eliminates organic wastes and maintains the water and electrolyte balance of the body
urinary system consists of
2 kidneys
2 ureters
1 urinary bladder
1 urethra
right kidney
more inferior than the left because of the liver
adrenal glands
on the upper medial border of each kidney
have no functional relationships with the kidneys
ureters
follow the natural curve of he vertebral column
most of each ureter lies anterior to its kidney
the ureters enter what aspect of the bladder
posterolateral aspect
urethra
exits the from the body inferior to the pubic symphysis
retroperitoneal structures
kidneys
ureters
infraperitoneal structures
distal ureters
urinary bladder
urethra
hilum of the kidney
the dividing point between the upper and lower poles of the kidney
where the ureter, blood vessels, lymphatic vessels, and nerves leave the kidney
what is the average size of the kidney
4-5 inches long
2-3 inches wide
1 inch thick
about the size of a bar of soap
the kidneys form a vertical angle of what from the MSP
20 degree angle
the kidneys are rotated how much from the coronal plane
30 degrees
are the kidneys higher or lower in a hyperstenic patient
higher
are the kidneys higher or lower in an asthenic patient
lower
top of the left kidney is at what level
T11-T12
bottom of the right kidney is at what level
L3
what is the fatty tissue surrounding each kidney
adipose capsule or perirenal fat
protects from trauma and maintains its normal position
when one inhales deeply or stands upright, the kidneys will
drop about one lumbar vertebrae or 2 inches
nephroptosis
excessive downward movement of kidney when erect
can cause kinking or twisting of the ureters
what is the primary function of the urinary system
the production of urine and its elimination from the body
during the production of urine what do the kidneys do
- remove waste products from the blood
- regulate water levels in the body
- regulate acid-base balance and electrolyte levels in the blood
uremia
the presence of excessive amounts of urea and other nitrogenous waste products in the blood, as occurs in renal failure
how much of the blood is pumped from the heart with each beat that passes through the kidney?
25%
the average water intake for humans during each 24 hour period is about
2.5 L
the kidneys normally excrete about how many L of urine per day
1.5 L or 1500 mL
the outer covering of each kidney is called the
renal capsule
renal cortex
the outer smooth textured reddish area
renal medulla
the deep reddish brown region
consists of 8-18 renal pyramids
the renal cortex and renal pyramids of the renal medulla make up what
the parenchyma of the kidney
renal parenchyma
the total functional portion of the kidneys
papillary ducts
urine formed by the nephrons drain into these ducts h
minor/major calyx
cuplike structures where the papillary ducts drain into
how many minor calyces in a kidney
8-18
how many major calyces in a kidney
2-3
renal pelvis
where the major calyx drains urine into
the first major collecting area of urinary waste
3 basic processes the nephrons are involved in
- filtering blood
- returning useful substances to the blood
- removing substances from the blood that aren’t needed
the individual nehpron is composed of what 2 things
a renal corpuscle and a renal tubule
renal corpuscle consists of
double walled membranous cup called glomerular capsule/ bowmans capsule and glomerulus
glomerulus
cluster of blood capillaries
serves as a filter for the blood
afferent arteriole
the vessel entering the glomerular capsule
efferent arteriole
the vessel leaving the glomerular capsule
3 parts of the renal tubule y
proximal convoluted tube
nephron loop (loop of henle)
distal convoluted tube
collecting system
nephrons - renal pyramids - renal papilla - minor calyces - major calyces - renal pelvis - ureter
when is the filtrate termed urine
by the time it reaches the minor calyx
glomerular filtrate goes from
glomerular capsule - proximal convoluted tube - loop of henle - distal convoluted tube - minor calyx
renal sinus
cavity within the kidney where the calyces, blood vessels and nerves lie
what is the size of the ureter
10-12 inches long
1 mm - 1 m in diameter
where do the ureters enter the bladder
the posterolateral part
what are the 3 constricted points along each ureter
also the 3 most common spots for obstruction
- Uretteropelvic junction UPJ
- brim of the pelvis
- ureterovescial junction UVJ
UPJ
the point the renal pelvis funnels down into small ureter
where the renal pelvis becomes the ureter
UVJ
where the ureters join the bladder
most kidney stones passing down the ureter tend to hang up where
the UVJ
urinary bladder
musculomembranous sac that serves as a reservoir for urine
location of bladder in males
directly anterior the the rectum
location of bladder in females
anterior to the vagina and inferior to the ureters and posterior to pubic symphysis
shape of the bladder
depends on how much urine it contains
trigone
small triangular area in the floor of the bladder
has a smooth appearance
micturition
discharge of urine
also called urination or voiding
when does the desire for micturition occur
when the volume of urine reaches about 250 mL
is voluntary
T or F
normally some urine is present in the bladder at all times
TRUE
the total capacity of the bladder is
350 - 500 mL
incontinene
unable to hold urine
dysuria
pain in urination
anuria
absence of urine formation
polyuria
passage of large volume of urine in relation to fluid intake during a given period
diuresis
increased excretion of urine
hematuria
blood in the urine
urethra
musculomembranous tube with a sphincter at the neck of the bladder
male urethra length
7-8 inches
female urethra length
1 and a half inches
male urethra divides into 3 portions
- prostatic
- membranous
- spongy
the kidneys in the adult are located
midway between xiphoid process and iliac crest
urography
radiographic examination of the urinary system in general
before withdrawing contents from any vial or bottle, you must confirm…
correct contents of container
route of administration
amount to be administered
expiration date
iodinated contrast agents may be administered in what 2 ways
bolus injection
drip infusion
bolus injections
rapid introduction of contrast into the venous system at one time
for maximum contrast enhancement
rate of bolus injection is controlled by:
gauge of needle amount of contrast viscosity of contrast stability of vein force applied
drip infusion
where contrast media is introduced into venous system by connective tubing attached to an IV
controlled by a clamp
equipment and materials for injection
emergency cart stocked sharps container tourniquets alcohol pads gauze tape gloves contrast various sizes of butterfly needle syringes IV tubing arm board
for most IVU’s veins where are recommended
antecubital fossa
in front of the elbow
other veins that may be used for injection site
cephalic vein on lateral wrist and veins on posterior hand or lower forearm
type and size of needle used on an adult
18 - 20 gauge butterfly needle
type and size of needle used for pediatrics
23 - 25 gauge needle
what is the expected outcome of injected contrast media
temporary hot flash
metallic taste in mouth
passes quickly
adult creatinine level
0.6 - 1.5 mg/dl
adult BUN level
8 - 25 mg/100 ml
metformin hydrochloride
drug given for the management of non insulin dependent diabetes
if mixed with contrast may increase risk for renal failure
metformin should be withheld for how long after the procedure
48 hours and only resumed if kidney function is normal
pre medication protocol
some pts. may be given a combo of benadryl and predinisone 12 hrs before procedure to help reduce liklihood of reaction
4 categories of contrast media reactions
- mild
- moderate
- severe
- organ specific
- mild reaction
nonallergic reaction
does not typically require medical attention
symptoms:
anxiety, nausea, light head, metallic taste, vomiting, redness
treatment: breathe slowly, provide cold cloth, observe and monitor
- moderate reaction
true allergic reaction (anaphylactic)
symptoms: urticaria, trouble breathing, bronchospasm, tachycardia, bradycardia, hypotension
may lead to life threatening
need medical assistance
adult creatinine level
0.6 - 1.5 mg/dl
adult BUN level
8 - 25 mg/100 ml
extravasation treatment
elevate affected extremity above heart
use cold compress followed by warm compress
document the incident
metformin should be withheld for how long after the procedure
48 hours and only resumed if kidney function is normal
pre medication protocol
some pts. may be given a combo of benadryl and predinisone 12 hrs before procedure to help reduce liklihood of reaction
4 categories of contrast media reactions
- mild
- moderate
- severe
- organ specific
- mild reaction
nonallergic reaction
does not typically require medical attention
symptoms:
anxiety, nausea, light head, metallic taste, vomiting, redness
treatment: breathe slowly, provide cold cloth, observe and monitor
- moderate reaction
true allergic reaction (anaphylactic)
symptoms: urticaria, trouble breathing, bronchospasm, tachycardia, bradycardia, hypotension
may lead to life threatening
need medical assistance
- severe reaction
also known as vasovagal
fast and prompt response required
symptoms: low BP, bradycardia, convulsions, loss of concsciousness, cardiac arrest
possible hospitalization
- organ specific reaction
specific organs are affected by the contrast media injection
symptoms: renal shutdown, vascular system(venous thrombosis) seizure induction, extravasation (leakage of contrast outside the vessel)
may not occur until 48 hours after the study
extravasation treatment
elevate affected extremity above heart
use cold compress followed by warm compress
document the incident
Intravenous urogram IVU
visualizes the minor and major calyces, renal pelves, ureters and urinary bladder after injection of contrast media
is a functional test
urinary tract infection
infection caused by bacteria/ urinary reflux
IVU contraindications (10)
- hypersensitivity to contrast
- anuria
- multiple myeloma
- diabetes
- severe hepatic or renal disease
- congestive heart failure
- phechromocytoma
- sickle cell anemia
- pts. taking glucophage, metformin, etc
- renal failure
diuretic
an agent that increases excretion of urine
lasix
brand name for a diuretic
lithotripsy
therapeutic technique that uses sound waves to shatter kidney stones so they can be passed
if you cannot use a ureteric compression what could be done instead?
put the patient in trendelenburg
urinary incontinence
involuntary passage of urine through urethra
urinary reflux
backward or return flow of urine from bladder into ureter and kidney
urinary tract infection
infection caused by bacteria/ urinary reflux
patient prep for an IVU
light evening meal prior bowel cleansing laxative NPO after midnight enema on morning of exam void prior to procedure all clothing removed
prep of radiographic equipment and supplies
correct type and amt. of contrast empty container of contrast media selection of needles alcohol wipes gloves tourniquet support for elbow shaps container male gonadal sheild emesis basin eminephrine or benadryl ureteric compression cold towel oxygen and suction devices
ureteric compression
allows renal collecting system to retain contrast longer
hydronephrosis
distention of the renal pelvis and calyces of the kidneys as a result of some obstruction of the ureters or renal pelvis
if you cannot use a ureteric compression what could be done instead?
put the patient in trendelenburg
how long does injection usually take
between 30 secs and 1 minute
when do most reactions occur
within the first 5 minutes following injection
how many mL of contrast is typically used for adults
30 - 100 mL
after beginning of injection how long does it take to see the contrast in the pelvicalyceal system
2-8 minutes
the greatest concentration of contrast medium in the kidneys normally occurs when
15 - 20 minutes after injection
IVU protocol basic routine
nephrogram / nephrotomogram (taken immediately after injection) 5 minute image 10-15 minute image 20 minute obliques postvoid
hydronephrosis
distention of the renal pelvis and calyces of the kidneys as a result of some obstruction of the ureters or renal pelvis
6 exams of the urinary system
- IVU
- hypertensive intravenous urography
- retrograde urography
- retrograde cystography
- voiding cystourethrography
- retrograde urethrography (only for males)
