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Urological System
| Question | Answer |
|---|---|
| Name three Intra-Renal obstructive disorders. | Calculi, tumors, and congenital deffects. |
| Name the causes of calculi. | Immobilization, bone cancer, urinary stasis, dehydration, pH of urine. |
| What are the most common calculi? | Calcium stones |
| What is the definition of calculi? | Anything that increases bone resorption. |
| What are the early and later S/S of urological tumors? | None in the early stages and obstruction & Hematuria in the later stages |
| What are types of congenital intra-renal obstructive disorders? | Agenesis, hypoplastic or dysplastic kidneys. |
| What are the two main types of Extra-renal obstructive disorders? | Ureteral obstruction and Bladder obstruction. |
| What are some causes of ureteral obstruction? | Calculi, scarring, stenosis/kinking, congenital-abnormal placement causing reflux. |
| What are some types of bladder obstructions? | Neurogenic bladder, cystocele, tumors, BPH, prostate cancer. |
| What two types of bladder obstructions have the same S/S? | BPH and prostate cancer. |
| What does the word micturition mean? | Voiding or urination |
| What does the word incontinence mean? | The inability to control urination. |
| When does BPH (benign prostatic hypertrophy) begin? | About age 40. |
| Why does BPH occur? | Due to changes in levels of androgens and estrogen. |
| What are the complications associated with BPH? (6) | Increased bladder pressure, hydroureter, hydronephrosis, bladder diverticuli, altered kidney fxns, and infections. |
| An enlarged ASYMMetrical, nodular mass is usually indicative of what disorder? | Prostate Cancer |
| Where can high PSA level be seen, in BPH or in Prostate Cancer? | Both |
| What is the best diagnostic method for Prostate Cancer? | Biopsy |
| What type of obstructive pathologies can cause kidney damage? | Any obstructive pathology below the kidneys. |
| What is the riskiest of all urological diagnostic exams? | A Renal angiogram. |
| What is the normal pH of urine vs a pH indicative of Cystitis? | Normal pH 4.6-8.0 (usually 5-6). Abnormal is > 7. |
| What is the normal urine Osmolality? | 1.003-1.030 |
| How common is Urethritis? | It is very rare and is usually indicative of gonorrhea in men. |
| What are the two types of cystitis? | Bacterial (most common type) and non-bacterial. |
| What is the usual eitolgoy of bacterial cystitis? | Ascending bacteria such as E. coli, Klebsiella, Pseudomonas, and Proteus. |
| Which has a greater risk of causing a UTI, indwelling catheter or a suprapubic catheter? | Indwelling catheter |
| Confusion may be the only sign in the elderly for what type of manifestation? | Cystitis |
| What are common manifestations of cystitis? | Frequency, urgency, dysuria (painful urination) |
| What type of inflammation occurs in 25% of males and presents with frequency, urgency and dysuria that may be confused with cystitis? | Prostatitis |
| How common is cystitis in males? | Rare in males. |
| What is pyelonephritis? | It is an ascending UTI that has reached the pyelum (pelvis) of the kidney. |
| What is a manifestation of pyelonephritis? | CVA tenderness |
| What can chronic pyelonephritis lead to? | Scarring and atrophy |
| What is glomerular filtration? | Filtering of the blood by the glomerular capillary. |
| What is required for glomerular filtration? | Adequate blood flow to the kidneys AND an intact glomerular membrane. |
| What is the normal glomerular filtration rate (GFR)? | 120-125 ml/min |
| When and at what rate does GFR begin to decrease? | At 1 ml per year after age 40. |
| How does a normal GFR vary? | With the amount of muscle mass. |
| What is the most common cause of Acute glomerulonephritis in children? | Post streptococcal infection from strep throat or skin infection. |
| What is the overall pathology of acute glomerularnephritis? | Thickening of the membrane causing a decrease in GFR and a presence of RBC casts. |
| What are the manifestations of Rapidly Progressive Glomerulonephritis? | Idiopathic, proliferative inflammation/post strep infection with renal insufficiency present at diagnosis. |
| What type of Glomerularnephritis is linked to ischemia, Diabetes Mellitus, immune disorders, vascular disorders, and drugs/toxins? | Chronic Glomerularnephritis |
| What has occurred if RBC casts are present? | Glomerular damage |
| What are the complications of Chronic Glomerular Damage? | ESRF and nephrotic syndrome |
| How much protein is lost in proteinuria? | > 3.5 g protein/day |
| What occurs in Nephrotic Syndrome after proteinuria has occurred? | Hypoalbuminemia to a decrease in COP to edema. |
| In Nephrotic Syndrome, after the loss for Vitamin D transport globulin occurrs, what happens next? | A decrease amount of Vitamin D. |
| In Nephrotic Syndrome, after hypoalbuminemia causes an increase in lipoprotein synthesis by the liver, what happens next? | Hyperlipidemia to lipduria. |
| What does hypoalbumiemia do to antibodies? | It causes a decrease in antibodies increasing risk of infection. |
| Can acute renal failure be reveresed? | Yes it may be reversible. |
| What are the three Etiologies of Acute Renal Failure? | Pre-renal, intra-renal, and post-renal. |
| Decreased Blood volume or decreased blood pressure from shock is an etiology of what type of Acute Renal Failure-- Pre-Renal,Intra-Renal, or Post Renal? | Pre-Renal |
| Severe fluid loss from burns, the GI, or diuresis is an etiology of what type of Acute Renal Failure-- Pre-Renal,Intra-Renal, or Post Renal? | Pre-Renal |
| What is azotemia? | Abnormal urea and creatine in the blood due to insufficient filtering of the blood by the kidneys. |
| Azotemia is a sign and symptom of what type of disease? | Abnormal urea and creatine in the blood due to insufficient filtering of the blood by the kidneys. |
| What is azotemia? | Oliguria (inability to void), diuresis, and then recovery. |
| What is ATN and what does it cause. | Acute Tubular Necrosis. It causes Acute Renal Failure and the Intra Renal level. |
| What is the GFR diagnostic indicator of glomerular function? | 120 ml blood/min in females and 140 ml/min in males. |
| What is the creatinine diagnostic indicator of glomerular function? | Normal is 0.6-1.2 (males) and 0.5-0.9 (females). |
| What is needed in high risk pt's since creatinine is not sensitive enough to diagnose glomerular fxn? | A calculated GFR. |
| What is a normal BUN? | 10-20 mg/dl |
| What pathologies other than kidney disease does urea increase in? | Bleeding, dehyration, fever, protein intake. |
| Is urea by itself a specific indicator for kidney disease? | No |
| What is the number one etiology of Chronic Renal Kidney Failure? | Diabetes Mellitus |
| What is the prevalance of CRF in adults? | 10-13% of US adults. |
| What other etiologies besides DM cause CRF? | Polycystic Kidneys and Tuberculosis. |
| When is kidney disease considered Chronic Renal FAILURE? | When the GFR is < 15ml/min (at Stage 5). |
| What is the GFR for Stage 1 & 2 kidney disease? | GFR is normal or at a mild decrease. |
| CRF is the same as what stage in kidney disease? | Stage 5 |
| At what stage is chronic kidney disease when the GFR is 29-15 ml/min? | Stage 4 with Renal Insufficiency and s/s of uremia. |
| At what stage is chronic kidney disease when the GFR is 59-30 ml/min? | Stage 3 with Renal Insufficiency. |
| What stage is renal fxn at 50%? | Stage 3 |
| What is the GFR rate in Stage 5 CKD? | < 15 ml/min |
| When is a pt considered to have CKD? | When GFR < 60ml/min for >3 months OR kidney damage for > 3 months. |
| What type of diseases are CKD pts at risk for? | Cardio Vascular Diseases |
| What populations are at HIGH RISK for CKD? | Elderly, those with DM HTN CVD albuminuria family HX, Autoimmune Smokers |
| What data does the Cockcroft-Gault equation need? | Age, gender, ht/wt, serum creatine |
| What data does the Levey equation need? | Positive BUN, race, albumin |
| Is ESRF reversible? | No it is IRREVERSIBLE. |
| What is needed inorder for a pt to live while in ESRF? | Dialysis |
| When is chronic kidney disease considered renal failure? | At Stage 5 |
| What is a pt with ESRF unable to do? | Excrete metabolic wastes, secrete/excrete or reabsorb certain electrolytes, excrete excess H2O. |
| What does the inability to excrete excess H2O put the pt at risk for? | Increased risk for Left Ventricular Hypertrophy (LVH) leading to heart failure. |
| What level of creatinine do ESRF pt's have? | 6 or > |
| What level of BUN do ESRF pt's have? | 100 or > |
| In ESRF pt's, is uric acid decreased or increased? | Increased Uric Acid |
| What are two urine ESRF manifestations? | Oliguria (output < 400ml/day) and Anuria (< 100 ml/day) |
| This ESRF manifestation has increased creatinine and BUN, fatigue, anorexia, nausea, vomiting, pruritis, and neurological changes. | Uremic Syndrome |
| This type of ESRF manifestation deals with fluid, what is it? | FVE or fluid volume excess |
| Name the ESRF manifestations for electrolytes. | ↑K, ↑ or ↓ Na, ↓Ca, ↑PO4 |
| What does an ↑K put the pt at risk for? | Dysrhytmia |
| What does a ↑ or ↓ Na put the pt at risk for? | Seizures |
| Why does a ↓Ca occur in pts? | B/c of ↓ Kidney activation of Vit D which ↓CA absorption from the GI. |
| What does a ↑PO4 do to Ca? | It inhibits Ca absorption plus binds w/ Ca causing calcification's in soft tissues. |
| What causes ↑ or ↓ Na? | Damage to the Loop of Henle and FVE. |
| What causes ↑PO4? | ↓ secretion/excretion of PO4 |
| What causes ↑K? | ↓ secretion/excretion of K |
| What are some causes of Anemia? | ↓ erythropoietin, ↑ Metabolic toxins that shorten RBC life, and Hgb < 10. |
| What does ↓ erythropoietin cause? | Normocytic or normochromic RBC's. |
| What Hgb amount will be present in anemia if untreated? | 7-8 |
| What does a Hgb of < 10 cause? | ↑ Heart rate causing LVH to heart failure. |
| In HTN r/t ESRF, what causes ↑ BP? | FVE, ↑ vasoconstriction, ↑ H2O |
| In HTN r/t ESRF, what happens after ↓ renal perfusion? | ↑ Renin causing ↑ angiotensinogen. |
| What does ↑ aldosterone cause? | ↑ Na to ↑ H2O |
Created by:
jesusrvillarreal
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