Week 6 Flashcards
what is in the upper urinary system?
- kidneys
- ureters
what is in the lower urinary system
- urinary bladder
- urethra
- urethral meatus
which kidney sits lower and why?
Right lower than left because the right one sits under liver
What vertebrae are the kidneys located at?
Approx T12-L3
What is a visual landmark for T12
approx level of of umbillicus
Where are the adrenal glands what what do they secrete?
Sit on top of kidneys secrete: - Catecholamines - Androgens - Corticosteroids
What is the urinary bladder?
Hollow organ to hold urine before excretion
What is commonly injured from the lower seat-belt in MVA?
Urinary bladder
What is the difference between the male and female urethra?
Urethra is longer in male
18-23 cm
Urethra is considerably shorter in females (3-8cm)
What causes an increase in the size of prostate?
Puberty
- @40 it begins to grow again called Benign Prostatic Hyperplasia
What is Benign Prostatic Hyperplasia?
Growth of prostate after the age of 40
- Causes problems with urinary retention/infection
What is Hypospadias?
Abnormality of the penis and urethral meatus.
Opening of urethra is abnormally positioned on the ventral surface affecting urine stream/erections
What is one of the main reasons for increased UTI’s in females?
- Smaller urethra
- proximity of meatus to vagina and anus
What happens with a vaginal prolapse?
Common problem where th ebladder, uterus or bowel protrudes in to the vagina
What is the largest cause of vaginal prolapse?
pregnancy
What are some indications for a colostomy or ileostomy?
- bowel obstruction
- Trauma
- Ischaemic bowel
- Perforated bowel
- Infection
- IBS
- Diverticulitis
- Colorectal/anal cancer
What are some indications for an ileal conduit?
- bladder cancer and cystectomy
- traumatic bladder injurt
- severe urinary incontinence
- neurogenic bladder
What are some indications for a faecal diversion system
- burns
- sacral pressure injuries
- infective diarrhoea
What is inflammatory bowel disease/crohns disease?
subacute and chronic transmural inflammation of the bowel
- commonly develops in adolescents
- occurs more commonly in women
What is ulcerative collitis?
recurrant ulcerative and inflamatory disease of the mucosal and submucosal layers
- begins in rectum and then spreads proximally
What are some key differences found in Chrohns disease compared to ulcerative colitis?
Location: Ileum, ascending colon Bleeding: Unusual Fistulas: Common Rectal involvements: 20% Diarrhoea: Mild (2-5 motions)
What are some key differences found in Ulcerative collitis disease compared to Chron’s disease?
Location: Rectum, decending colon Bleeding: Common and severe Fistulas: Rare and mild Rectal involvements: 100% Diarrhoea: Severe (10-20 motions)
what are the three types of bladder cancer?
- urothelial carcinoma
- squamous cell carcinoma
- adenocarcenoma
what is the most common symptom of bladder cancer?
Haematuria
blood in urine
What is the most common injury to the bladder? What symptoms would be seen?
Blunt trauma
Pt presents with:
- gross haematuria
- suprapubic pain
What is diarrhoea?
Increased fluidity or frequency of bowel motions
What is a gastrointestinal stoma?
opening into the abdominal wall to allow evacuation of doo doo following bowel surgery
What type of gastrointestinal stomas can be used?
- Colostomy
- Ileostomy
What happens with a renal stoma?
ureters are resected from the bladder and anastomosed to a resceted part of the ileum
- known as urostomy
what are the differing types of colostomies and ileostomy?
Single barrelled/double barrelled / loop
How do you visually identify a urostomy?
- Flatter appearance
- round shape stoma
- right hand side of umbilical
- urine output
How do you visually identify a colostomy?
- shorter in length
- round shaped
- left hand side of umbilicus
- has soft output
How do you visually identify an ileostomy?
- Longer in length
- cone shaped
- right side of lower abdomen
- liquid output
What is the actual name for a bag attached to a stoma?
Ostomy pouch or ostomy appliance
What type of ostomy appliance is common for colostomy?
one piece
what type of ostomy appliace is common for an ileostomy?
two piece
What can cause stoma necrosis ? and when is it most common?
venous or arterial insufficiency
Most common: first 5 days post op
What is stomal prolapse?
when the bowel is externally displaced.
what are some considerations for the assessment and managment of a stoma as paramedics?
Call stoma support nurse
- always ask about normal stoma appearance/function and output
- has patient attempted to resolve problem
- listen for bowel sounds with stethoscope to confirm peristalsis
- assess stoma for colour, warmth, activity, mucous and odour
what to consider when caring for a patient with a urinary catheter?
- past medical history
- reason why catheter was inserted
- where abouts was it inserted
- when
- what type
- what size?
what are the different types of urinary catherterisaton techniques?
Intermittent - drains urine in bladder
Continuous - semi-permanent for output monitoring
Suprapubic - long-term inserted through abdomen
Condom - condom with draining tube basically
What are the indications for intermittent urinary catheters?
- drains urine remainign in bladder after voiding
- prevents urinary incontinence
- post-operatively
- used in community to avoid continuous
- specimen collection in elderly
- enlarged prostate
What are the indications for continuous urinary catheters?
- measure hourly output
- allows draining is meatus is swollen
- used for patients with epidural /spine block
- pts with neurogenic bladder problems
- autonomic dysreflexia
What are the indications for supra-pubic urinary catheters?
- failed urethral catheter insertions
- long term or permanent urinary catheterisation required
- pt wants to maintain sexual relationship
- sustained urethral trauma
What are the indications for condom urinary catheters?
- non-invasive
- easily applied
- wants sexual relationship
- palliative care with urinary incontinence
- pts with sacral pressure wounds
What are the contraindications of urinary catheterisation?
- recent urological trauma
- recent urological surgery
- has previously been know to be difficult to catheterise
- known urethral stricture or narrowing
- urethral meatus bleeding or current frank haematuria
- male with phimosis that prevents meatus visualisation
what is phimosis?
tight foreskin making visualisation of meatus difficult
what size catheter do you use for males and females?
Male - 14 - 16 french gauge
Female - 12 - 14 french gauge
What can cause difficult urinary catheter insertion?
- Prostatic urethra
- Urethral spasm
What is the most common complication of urinary catheterisation?
UTI
What is paraphimosis?
foreskin retracted to insert catheter, then not returned… becomes a surgical emergency
What are common causes of blocked urinary catheter?
bladder neck spasm sediment and encrustation blood clots low flow granulation tissue
What can a blocked catheter and distended bladder cause?
autonomic hyperreflexia in spinal cord lesions above T5
What should you do to dislodge any sediment in a urinary catheter?
rotate 360 degrees
