Term
|
Definition
1. formation and excretion of urine
2. removal of wastes and excessive fluid
3. acid/base balance
4. electrolyte balance
5. control of BP with renin
6. production of erythrooietin for RBC production
7. activation of vitamin D and Ca balance |
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Term
| Play a vital role in maintaining homeostasis of our bodies, failure to perform this funtion results in severe disorders or diseases which would require medical attention |
|
Definition
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Term
| Name 4 effects of aging on the renal/urologic system |
|
Definition
1. Increase in risk of hyponatremia (affecting muscular strength and nerve conductance)
2. Increase in the frequency of nocturnal urination due to reduction of bladder capacity
3. Aging women are at higher risk for urinary incontinence (pelvic floor disorder) resulting from hormonal changes on pelvic ms and aging of connective tissue, fascia, or collagen fibers.
4. Aging men are at high risk for benign prostate hyperplasia (BPH, enlargement of prostate) |
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|
Term
| Name 10 Common S&S of UT problems |
|
Definition
1. Urinary Frequency
2. Urinary urgency
3. Dysuria
4. Hematuria
5. Pyuria
6. Dyspareunia
7. Pain (shoulder, back, flank, pelvis, lower abdome)
8. Costovertebral tenderness
9. Fever and chills
10. Hyperesthesia of dermatomes |
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Term
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Definition
|
|
Term
|
Definition
|
|
Term
| White blood cells in urine |
|
Definition
|
|
Term
| Pain experienced during sex |
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Definition
|
|
Term
| Symptoms of this depend on the location of the infection in either the upper (kidney infection) of lower urinary tract (cystitis or bladder infection and urethritis) |
|
Definition
|
|
Term
| Are men or women at higher risk for UTI? |
|
Definition
|
|
Term
| Why are women more likely to get UTI? |
|
Definition
| Short length of urethra as well as it being located close to the vagina and anus |
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Term
| __ populations are at higher risk of UTIs mainly resulting from impaired bladder emptying, urinary tract instrumentation, and catheterization |
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Definition
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|
Term
| Bladder infection, or cystitis, in common in sexually active women. These are more rare in children, especially in boys, and this should prompt a search for congenital abnormalties. Infection rates in the elderly are higher and have a similar gender distribution. |
|
Definition
| Cystitis (bladder infection) |
|
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Term
| Mostly UTIs are caused by __ infection ascending from the urethra into the bladder. |
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Definition
|
|
Term
| The most common causative organism, accounting for 80% of UTI pathogens |
|
Definition
|
|
Term
| What are the classic symptoms of Cystitis? |
|
Definition
Urinary Frequency
Urgency
Dysuria
Nocturia
Suprapubic pain |
|
|
Term
| How can cystitis be diagnosed? |
|
Definition
| Based on clinical manifestation and urine analysis |
|
|
Term
| 6 ways to prevent cystitis |
|
Definition
1. Drinking at least 8 oz glass of water per day
2. Practice hygiene in the genital area
3. Urinate and wash genital area right after sexual intercourse
4. For female, wiping from front to back after urination or defecation, changing sanitary pads often during menstruation
5. Change diaper frequency, esp for female children wiping from front to back
6. For pts with urinary catheter, practice hygiene technique and pay attention to the appearance of the urine in the bag |
|
|
Term
| What is the treatment for cystitis? |
|
Definition
|
|
Term
| An infectious, inflammatory disease of kidney parenchyma |
|
Definition
|
|
Term
| An infection of the renal pelvis |
|
Definition
|
|
Term
| Typically due to a bacterial infection |
|
Definition
| Acute pyelonephritis and pyelitis |
|
|
Term
| Causes irregular scarring and deformation of calices and overlying parenchyma, may be responsible for up to 25% end-stge renal disease |
|
Definition
|
|
Term
| The majority of cases of acute pyelonephritis are usually due to __, which ascends fromt he lower urinary tract. Obstruction and urinary stasis predispose a person to infection |
|
Definition
|
|
Term
| Clinical manifestations of this include abrupt onset of fever and chills, flank pain, N&V are the classic symptoms. During examination, there is costovertebral tenderness (Murphy's sign) on the affected side. There may be associated symptoms of lower UTI including dysuria, urinary frequency and urgency. |
|
Definition
| Pyelonephritis and pyelitis |
|
|
Term
| Used to test for costovertebral angle tenderness. Indirect first percussion causes the tissues to vibrate. To assess the kidney, position the client prone or sitting, and place one hand over the rib at the acute angle formed between the 12th rib and the vertebral column on the back. Thump that hand with the ulnar edge of your other fist. The person normally feels a thud but no pain. |
|
Definition
|
|
Term
| How can you diagnose and treat Pyelonephritis and pyelitis? |
|
Definition
Dx-medical history, phys exam, and urinalysis (presence of WBC casts in urine
Tx-medical, anibiotics |
|
|
Term
| An adenocarcinoma, is the most common renal (kidney) tumor in adults accounting for approx 80-90% of renal tumors. It occurs twice as often in males as in females, with a peak range of incidence between 60-70 yrs. It is the most malignant urologic tumor resulting in death in more than 35% of all cases. |
|
Definition
| RCC (Renal Cell Carcinoma) |
|
|
Term
| Clinical manifestation of this is the classic triad: hematuria, flank pain, and an abdominal mass. Other symptoms include HTN, fever, and weight loss. It is the most common metastatic tumor to the sternum. |
|
Definition
| Renal Cell Carcinoma (RCC) |
|
|
Term
|
Definition
| IV pyelogram (IVP), ultrasound, CT and MRI can help identify the extent of the tumor |
|
|
Term
| How can RCC be clinically managed? |
|
Definition
| Surgery of localized disease is the curative option |
|
|
Term
| The most common malignant renal tumor in children. Most of these tumors occur in children under age 5, and occur equally in boys and girls. Bilateral tumors are present in 10% of patients. |
|
Definition
|
|
Term
| Clinical manifestations of this include abdominal mass, ab pain, hematuria, HTN. Weight loss and fever may also occur. |
|
Definition
| Wilm's Tumor (nephroblastoma) |
|
|
Term
| How can Wilm's Tumor be diagnosed? |
|
Definition
| Abdominal ultrasound and CT scan |
|
|
Term
| How can Wilm's Tumor be clinically mangaged? |
|
Definition
| Surgical resection and chemo. Prognosis is generally good, especially with younger children. |
|
|
Term
| A cavity filled with fluid or renal tubular elements making up a semisolid material |
|
Definition
|
|
Term
| Renal cysts can lead to degeneration of renal tissue and obstruction of tubular flow. The cysts may vary in size. |
|
Definition
|
|
Term
| ame the 4 types of renal cystic diseases |
|
Definition
Polycystic Kidney Disease
Medullary Sponge Kidney
Acquired Cystic Disease
Single or Multiple Cysts |
|
|
Term
| One of the most common hereditary disorders in the US, affecting more than 500,000 Americans. It is an autosomal dominant disorder that causes multiple, bilateral renal cysts, resulting in large but poorly functioning kidneys. Some patients have associated intracranial and aortic aneurysms. 10% will lead to end-stage renal failure (ESRD) |
|
Definition
| Polycystic Kidney Disease |
|
|
Term
| Clinical manifestation: the disease is usually asymptomatic until childhood. Characteristics include chronic UTIs, episodic gross hematuria (due to ruptured cysts or dislodged stones), and ultimately, uremic syptoms. HTN is common, and 15% of pts will have subarachnoid hemorrhages. In advanced stages, he kidneys may be palpable. Proteinuria, hematuria and pyruria are common in urinalysis findings. |
|
Definition
| Polycystic kidney disease |
|
|
Term
| How might you diagnose for polycystic kidney dz? |
|
Definition
| Ultrasound, IV urogram or CT shows large kidneys with multiple cysts |
|
|
Term
| How can polycystic kidney dz be clinically managed? |
|
Definition
| Supportive. Aggressive management of UTIs and HTN extends kidney function. Dialysis or transplantation is required to treat kidney failure. Familial donation of kidneys may be difficult since hlf of family members will also have the dz. Genetic counseling. |
|
|
Term
| The third most common urinary tract disorder, exceeded only by UTIs and prostate dz. |
|
Definition
|
|
Term
| Where urinary stones develop in the kidneys |
|
Definition
|
|
Term
| The stone can dislodge from kidney, cause urinary tract obstruction resulting in severe pain or renal colic |
|
Definition
|
|
Term
| Commonly occurs at the following 3 sites (1) the ureteropelvic junction, (2) as the ureter crosses over the iliac vessels and (3) the ureterovesical junction. |
|
Definition
|
|
Term
| Risk factors for this include gender, age, geography, climate, diet, genetics, and environment. |
|
Definition
|
|
Term
| What might increase the incidence of stones? |
|
Definition
| Excess intake of supplemental ca, oxalate, and purines |
|
|
Term
| What is the onset of age of renal calculi? What gender is affected more often? |
|
Definition
30-50 years old
Men and women 4:1 |
|
|
Term
| Most kidney stones contain what? |
|
Definition
|
|
Term
| Predisposes the patient to the formation of Ca stones. |
|
Definition
|
|
Term
| 10-15% of urinary tract stones are __ stones (mg ammonium phosphate) and develop when UTIs with a urea-splitting bacteria Proteus or Pseudomonas makes the urine basic enough to precipitate struvite. |
|
Definition
|
|
Term
| Clinical Manifestation: Acute, excruciating pain may be in the flank, abdomen, groin or perineal areas; pain may be referred tot he inner thigh, the testicle or scrotum in male and the labia majora in females, depending on the location of the blockage. The pain typically lasts 20-60 min. N&V, urinary urgency and frequency, hemoturia, or dysuria, may also be present. |
|
Definition
|
|
Term
| How can Renal Calculi be diagnosed? |
|
Definition
| Abdominal x-rays will reveal Ca stones (radiopaque, visible on x-ray film), CT, ultrasound, or IVP |
|
|
Term
| How can you clinically manage renal calculi? |
|
Definition
| Pain meds or narcotics are often necessary to relieve pain; antibiotic therapy. Onset of a fever and chills during this period is a medical emergency. Stones 5-6 mm in diameter will pass spontaneously. If it does not happen, lithotripsy (ultrasound) can shatter small stones and allow them to be passed thru the system. Other more impressive procedures may be used if lithotripsy fails |
|
|
Term
| How can Renal Calculi be prevented? |
|
Definition
| Adequate water intake and reducing supplemental Ca intake decreases the risk and recurrence of Ca stones. Pts with Ca oxalate stones need to reduce their intake of foods high in oxalate, including spinach, cocoa, chocolate, pecans, and peanuts, or eat Ca and oxalates together because the 2 compounds bind in the stomach and are epelled in the stool. If the stones are associated with underlying diseases such as hyperparathyroidism, treat the disease. |
|
|
Term
| Gradual loss of renal function due to a variety conditions that result in permanent loss of nephrons (loss 90%nephrons), which cause progressive deterioration of glomerular filtration (GFR falls below 20 ml/min) and the loss of tubular function and endocrine functions of the kidney. |
|
Definition
|
|
Term
| As __ __ results in fluid and electrolyte embalances, azotemia, buildup of toxins, depletion of necessary substances and other renal functions are some of the wide variety of symptoms that may develop. |
|
Definition
|
|
Term
| An abnormal increase in the concentration of urea and other nitrogenous substances in the blood plasma |
|
Definition
|
|
Term
| What is the etiology of chronic renal failure? |
|
Definition
| HTN, diabetes mellitus, glomerulonephritis, tubulointestinal dz, polycystic kidney dz, and obstructive uropathy |
|
|
Term
| What are the general clinical manifestations of chronic renal failure? |
|
Definition
| Fatigue, weakness, decreased alertness, inability to concentrate, decreased urinary output, swelling, anemia |
|
|
Term
| What are the GI system clinical manifestations for chronic renal failure? |
|
Definition
| Anorexia, N&V, GI bleeding, an unpleasant taste in the mouth |
|
|
Term
| What are the cardiovascular clinical manifestations of chronic renal failure? |
|
Definition
| HTN, and congestive heart failure |
|
|
Term
| What are the integumentary clincal manifestaions of chronic renal failure? |
|
Definition
| Itching, yellow-brown color, uremic frost and urine odor on skin |
|
|
Term
| Urea from sweat crystallized on the skin |
|
Definition
|
|
Term
| What are the neurologic symptoms of chronic renal failure? |
|
Definition
| These develop first including drowsiness, impaired menttion, asterixis, encephalopahty, and seizures. Peripheral neuropathy. |
|
|
Term
|
Definition
|
|
Term
| What are the musculoskeletal clinical manifestations of chronic renal failure? |
|
Definition
| Common and secondary to abnormalities in calcium, phosphate, and vitamin D metabolism resulting in osteodystrophy: bone pain, fracture, osteomalacia, osteosclerosis, osteoporosis and soft tissue and vascular calcification |
|
|
Term
| How can chronic renal failure be diagnosed? |
|
Definition
| Elevated BUN and creatinine in the presence of symptoms |
|
|
Term
| How can chronic renal failure be clinically managed? |
|
Definition
| Slow the deterioration of remaining renal function, control HTN; monitor electrolytes; erythropoietin injection for treatment of anemia. Renal replacement: hemodialysis or renal transplantation if conservative measures fail |
|
|
Term
| Name 2 categories of glomerular lesions |
|
Definition
|
|
Term
| Includes a group of conditions characterized by increased basement membrane permeability of glomeruli, permitting the urinary loss of plasma proteins, particularly low-weight proteins, such as albumin. |
|
Definition
|
|
Term
| what is the etiology of nephrotic syndrome |
|
Definition
| Immune origin including (1) injury secondary to deposition of soluble circulating antigen-antibiody complexes in the glomeruli, (2) injury secondary to antibodies reacting with insoluble fixed glomerular antigens |
|
|
Term
| The disorders that manifest during or cause nephrotic syndrome include: (6) |
|
Definition
1. Minimal change dz (lipoid nephrosis): most often in yound kids (1.5 to 4 years old)
2. Focal and segmental glomerulosclerosis: occurs in older pts
3. Membranous glomerulonephritis: major primary cause of the nephrotic syndrome, is an immune complex dz of unknown etiology; highest incidence in teens and young adults
4. Diabetic nephropathy
5. Renal Amyloidosis
6. Lupus Nephropathy |
|
|
Term
| Clinical Manifestations: Massive proteinuria (>3 grams/day), hypoalbuminemia, generalized edema, hyperlipidemia, and hypercholestrolemia. |
|
Definition
|
|
Term
| How can Nephrotic syndrome be diagnosed? |
|
Definition
| Proteinuria greater than 3 grams per day with the associated clinical manifestation |
|
|
Term
| How can nephrotic syndrome be clinically managed? |
|
Definition
| Supportive, medication usually including corticosteroids, high-proten, low-salt diet. Dialysis or transplantation for those in renal failure |
|
|
Term
| A immune complex mediated dz that presents as acute glomerulonephritis. |
|
Definition
|
|
Term
| In __ __, group A beta-hemolytic streptococcal antigen-antibody complexes deposit in the glomerular capillary walls and trigger an immune response that increases the permeability of the glomerular basement membrane. This condition is usually preceded by several weeks with an infection such as tonsillitis, streptococcal impetigo, or infected insect bites with nephritogenic strains of group A beta-hemolytic streptococci. It is most common in children over age 3. |
|
Definition
| Post streptococcal glomerulonephritis |
|
|
Term
| What are the clinical manifestations of acute poststreptococcal glomerulonephritis |
|
Definition
| Oliguria, azotemia, HTN, hematuria. Mild proteinuria and edema |
|
|
Term
| What is the prognosis and management for acute poststreptococcal glomerulonephritis? |
|
Definition
| Supportive, most cases often improve on their own and require no specific treatment; for patients with HTN, treatment with antihypertensive medications |
|
|
Term
| Approx 95% of urinary tract cancers occur where? |
|
Definition
|
|
Term
| The 4th leading cause of cancer and 7th leading cause of death in men in the US |
|
Definition
|
|
Term
| Are males or females affected with bladder cancer more often? |
|
Definition
|
|
Term
| The most common urinary tract cancer in women |
|
Definition
|
|
Term
| Majority involves the bladder epithelium in which most of these cancers are transitional cell carcinomas. Risk factors include male gender, age 55 or older, cigarette smoking, occupational exposures to certain chemicals and environmental carcinogens, history of chronic bladder infections |
|
Definition
|
|
Term
| Clinical manifestation: hematuria is the most common finding. Onset of hematuria is often sudden and frequently intermittent. Frequency or dysuria may occur; especially as the tumor grows and occupies the bladder space or invades the bladder wall. A suprapubic mass may be palpable. |
|
Definition
|
|
Term
| How can bladder cancer be diagnosed? |
|
Definition
| Urine cytology shows malignant cells, IV urogram may reveal the presence of a mass. Cystoscopy and biopsy provide definative diagnosis. |
|
|
Term
| How can bladder cancer be clinically managed? |
|
Definition
| Surgical resection, radiation, and chemo. Bladder tumors tend to recur, so pts should be carefully monitored |
|
|
Term
| Urinary dysfunction resulted from interrupted sensorimotor innervation of the urinary bladder. This includes dimiished bladder capacity,a constricted external bladder sphincter, an atonic bladder that is unable to contract, a hyperactive detrusor muscle, and loss of perception of bladder fullness. |
|
Definition
| Neurogenic Bladder Disorders |
|
|
Term
| The dysfunction of the bladder can lead to serious complications such as ascending UTIs, vesicoureteral reflex that can damage the kidney, and urinary stones. |
|
Definition
| Neurogenic Bladder disorders |
|
|
Term
| Backward flow of urine from bladder into ureter |
|
Definition
|
|
Term
| PTs provide care for people who have sustained spinal cord injuries and strokes or who have myelomeningocele, MS, and brain tumors. What is one of the complications associated with these conditions? |
|
Definition
| Neurogenic Bladder Disorders |
|
|
Term
| What is the etiology of neurogenic bladder disorders? |
|
Definition
| Bladder control requires intact sensation (to feel when bladder is full), motor function (to initiate emptying the bladder), and cerebral control (to time it all correctly). Damage at any level of this complex loop would result in neurogenic bladder disorders |
|
|
Term
| Neurogenic lesions above the sacral micturition reflex center level result in spastic bladder dysfunction including reflex neurogenic bladder, spastic neurogenic bladder, cord bladder, and uninhibited bladder. |
|
Definition
| Spastic Bladder Dysfunction |
|
|
Term
| Lesions at the level of the sacral micturition reflex center or affecting the peripheral innervation of the bladder result in what? |
|
Definition
| Flaccid bladder dysfunction |
|
|
Term
| What are the causes of spastic bladder dysfunction? |
|
Definition
| Cerebrovascular accident, demenia, Parkinson's, multiple sclerosis, and brain tumors; secondary to SC lesions including SCI, herniated intervertebral disk, vascular lesions, spinal cord tumors, and myelitis; local irritation in the presence of vaginitis, perineal inflammation, urethral inflammation, and chronic prostatis |
|
|
Term
|
Definition
|
|
Term
| What are the causes for flaccid bladder dysfunction? |
|
Definition
| Secondary to meningomyelocele, spina bifida, diabetes mellitus, and anxiety or depression |
|
|
Term
| Clinical manifestation: partial or complete urinary retention, incontinence, urgency, or frequent urination |
|
Definition
| Neurogenic Bladder Disorders |
|
|
Term
| After a stroke, or in early stages of MS, what can develop? |
|
Definition
|
|
Term
| The urine strea will be normal, but th bladder capacity is diminished. Lesions that affect the micturition center in the brain stem or impair the reflex between the micturitio center and the SC can affect to coordinated activity of the detrusor ms and the external bladder sphincter, a condition termed detrusor-sphincter dyssynergia - the external sphincter tightens during micturition as the detrusor ms in contracting, resulting in increased intravesicular pressure and vesicoureteral reflux |
|
Definition
|
|
Term
| In acute SCI, all reflexe are ___. An atonic, distended bladder with overflow dribbling occurs. Catheterization is essential to prevent overdistnsion of the bladder.One to two months after injury, an autonomous bladder develops. The bladder fills and empties by reflex, and there is no cerebral control. The reflexes become hyperactive, and frequently, spontaneous detrusor contractions result in a small hyperactive bladder. The voiding is interrupted, involuntary, or incomplete. The high pressure voiding can cause vesicoureteral reflux and renal damage |
|
Definition
|
|
Term
| Occurs in 43-87% of Type I diabetes patients. Initially, the sensory supply of the bladder is affected, resulting in decrease urinary frequency and a distended bladder. Later, uinary hesitancy, weakness of stream, dribbling, and a sensation of the bladder not being fully emptied occurs. Vescoureteral reflex and ascending UTIs are potential complications |
|
Definition
| Diabetic Bladder Neuropathy |
|
|
Term
| If the motor component is damaged, as in polio and some cases of tumor invasion, the patient can sense full bladder but cannot initiate what? |
|
Definition
|
|
Term
| How can neurogenic bladder disorders be diagnosed? |
|
Definition
| Evaluation includes urodynamic studies to assess bladder sensation, capacity, and sphincter control. Voiding cystourethrogram is used to identify obstruction and reflex |
|
|
Term
| How can neurogenic bladder disorders be clinically managed? |
|
Definition
| The goals for treatment include preventing incontinence, bladder overdistention, UTIs, and renal damage. Treatment modalities include catheterization, bladder training, surgery, and pharmacologic interventions that improve sphincter control, decrease detrusor spasticity, or increase autonomic stimulation |
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