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Urinary System
| Question | Answer |
|---|---|
| urinary system consist of what | -two kidneys -two ureters -one urinary bladder -one urethra |
| what is another name for the urinary system | excretory system |
| nephro | kidney |
| renal | kidney |
| suprarenal or adrenal glands have no functional relationship to urinary system, but they secrete __________ and __________ | -epinephrine -cortical hormones |
| what are the functions of the urinary system | -remove waste from blood -maintain fluid and electrolyte balance -secretes substances hat effect blood pressure; such as renin |
| what are the measurements of a typical kidney | -4.5" long -2 to 3" wide -1.25" thick |
| which kidney is slightly longer and narrower | left |
| where are the kidneys located | -retroperitoneal, in contact with posterior abdominal wall -lie in oblique plane 30 degrees anteriorly toward aorta -extend from T12-L3 |
| how much movement of the kidneys is there on inhaltion, and when moving from supine to upright position | -1" -2" |
| renal capsule | outer covering that is made of fibrous connective tissue:protects kidneys and is continuous with ureters |
| adipose capsule | surrounds kidneys and holds them in place |
| renal fascia | attaches the kidneys to the diaphragm and peritoneum |
| renal cortex | outer layer of renal tissue |
| renal medulla | inner layer of renal tissue, composed of 8-15 cone-shaped segments of collecting tubules called renal pyramids |
| renal columns | extensions of cortex between renal pyramids |
| nephron | essential microscopic component of kidney. the parenchyma of the kidney. the kidney contains about 1 million nephrons |
| what does the nephron consist of | -renal corpuscle -renal tubule |
| what does the renal corpuscle consist of | -glomerular capsule(bowmans capsule) -glomerulus(formed by tiny branch of renal artery entering capsule and dividing into capillaries |
| afferent arteriole | vessel entering capsule |
| efferent arteriole | vessel exiting capsule |
| peritubular capillaries | branches of the afferent arterioles, form networks around renal tubules, responsible for reabsorption |
| glomerulus | filter for blood, allowing fine particles and water to pass into bowmans capsule. basic filtration unit of the kidney |
| renal tubule | continuous with bowmans capsule |
| what does the renal tubule consist of | -proximal convoluted tubule -loop of henle -distal convoluted tubule(opens up into the collecting ducts)>reflexively releases renin |
| what are the processes involved in the secretion of urine in the nephron | -filtration -reabsorption - secretion |
| what is involved in the filtration process of urine | water and solutes are filtered from the blood plasma in glomerulus, and moved across glomerular capsule membrane into filtering space of capsule |
| what is involved in the reabsorption process of urine | water is reabsorbed into blood via peritubular capilaries |
| vasopressin | antidiuretic hormone produced by the pituatary gland which stimulates reabsorption of water in the kidney |
| selective reabsorption | process which assures enough sodium chloride and glucose are reabsorbed to meet body requirements |
| what is involved in the secretion of urine | all solutes not required by the body are secreted in to tubules. urea, creatinine and other toxins are excreted in this manner |
| urea | final product of protein metabolism; it is the chief nitrogenous constitute of urine |
| creatinine | colorless, crystalline substance found in blood and muscle. it is the end product of creatinine metabolism(non-protein). doesnt allow kidneys to filter correctly. increased amounts causes renal failure. |
| what are normal lab values for BUN and creatinine | -BUN=5 to 21(will not give contrast above 65) -creatinine=.6 to 1(will not give contrast above 1.6) |
| renin | -enzyme secreted in renal tubule(distal convuluted tubule) reflexively to control blood pressure(when BP spikes less renin is made and when it drops more is made) -renin also causes blood to generate a chemical called angiotensin |
| angiotensin | -causes the blood compartment to constrict therefore raising blood pressure -dispatches a separate message to the adrenal gland to release a cortical hormone that circulates to the tubules to absorb more salt and water from urine and ease BP |
| diseases of the ______ can adversely influence blood pressure, and blood pressure may alter _______ function | kidney |
| collecting ducts | -converge to form a central tubule within the pyramid -opens at renal papilla(nipple like end of renal pyramid) -drains into minor calyces |
| calyces | cup shaped stems that enclose one or more papilla(usually fewer calyces than pyramids) |
| minor calyces unite to form _______ | major calyces |
| major calyces unite to form _______, which lies within _________ | -renal pelvis -hilum |
| hilum | longitudinal slit in medial border for transmission of blood vessels, nerves, lymphatic vessels and ureter |
| renal sinus | central cavity; fat filled space surrounding renal pelvis and calyces; continuation of hilum |
| renal pelvis in continuous with the ________ | ureter |
| ureter | -10 to 12" long -musculomembraneous tube that passes from kidney to urinary bladder -moves urine from renal pelvis to urinary bladder through peristalsis |
| where do ureters enter bladder | posteriolatteral at level of ischial spines(aprox) |
| urinary bladder | -musculomembranous sac -serves as a reservoir for urine(adult bladder can hold up 500 ml of urine) -apex is anterosuperior aspect -neck is lowest part |
| where is urinary bladder located | imediately poserior to superior aspect of pubic symphysis, anterior to rectum in males and females and anterior to vaginal canal in females |
| trigone | triangular area of bladder base between three openings (two for ureters and one internal urethral orifice) |
| urethra | -musculomembranous tube that carries urine out of body -1.5" long in females -7 to 8" long in males |
| prostate | -small glandular body surrounding the proximal part of the male urethra(actually part of reproductive system) -located posterior to inferior portion of symphysis -attaches to inferior surface of bladder |
| what role does the prostate play in the reproductive system? | secretes milky white fluid, which makes up part of semen, that is enters urethra through ducts |
| bladder neck obstruction(BNO) | -blockage at base of bladder that reduces flow of urine into urethra -there can be many causes of BNO |
| what are some causes of BNO | -benign prostatic hyperplasia(BPH)or enlarged prostate -bladder calculi(stones) -urethral stricture(scar tissue) -bladder tumors -pelvic tumors(cervix,prostate, uterus, rectal) |
| what are symptoms of BPH | -intermittant flow during urination -frequent urination due to bladder not fully emptying -lack of pressure or flow of urine -leakage and feeling of never really finishing urinating |
| transurethral resection of the prostate(TURP)or adenomectomy or prostectomy | procedure where dr. inserts tool into urethra via penis opening and scrapes excess capsule material that is restricting flow and then area is cauderized |
| renal agenesis | failure of one or both of the kidneys to develop during embryonic growth and development |
| ectopic, pancake, or pelvic kidney | kidney does not ascend as it should in childhood development(not harmful, but can develop complications) |
| hypospadias | a birth defect of the urethra in males that involves an abnormally placed urinary meatus |
| epispadias | a rare type of malformation of the penis in which the urethra ends in an opening on the upper aspect of the penis |
| oliguria and anuria | the decreased or absent production of urine, respectively. could by cause by dehydration, renal failure or obstruction |
| urinary retention or ischuria | lack of ability to urinate |
| uremia | term used to loosely describe the illness accompanying kidney failure |
| staghorn calculus or struvite | crystallities in urine, which is a type of stone that is caused by bacterial infection that hydrolyzes urea to ammonium and raises urine ph to neutral or alkaline |
| nephroptosis or floating kidney or renal ptosis | an abnormal condition in which the kidney drops down into the pelvis when the patient stands up |
| micturation | urination |
| how much urine does the urinary system usually excrete per day | 1 to 2 liters |
| vesicoureteral reflux | backward flow of urine from the bladder to the ureters |
| why are contrast studies done | to demonstrate the renal parenchyma. contrast is introduced and followed by xray or CT |
| what are the two filling techniques with contrast | -antegrade(with flow) -retrograde(against flow) |
| urography | imaging of the renal drainage and collecting system |
| hydronephrosis | dilatation of renal pelvis and calyces as a result of obstruction |
| antegrade urography | contrast is enered into kidneys in direction of normal flow. -contrast enters bloodstream and conveyed into glomerulus and then the bowmans capsule and exreted in urine |
| percutaneous antegrade urography | contrast is administered through percutaneous puncture of the renal pelvis |
| intravenous urography(IVU) | excretory technique; most commonly done; demonstrates function and structure of entire urinary system |
| pyelography or IVP | demonstration of renal pelvis and calyces |
| nephrotomography | looking at different slices of kidney |
| nephrourography | looking at kidneys and urinary system together |
| retrograde urography | -contrast enters against the normal flow by either ureteral or urethral cath.(most commonly done in OR by urologist) contrast injected into pelvicaliceal system -improves opacification of renal collecting system -done for renal issue or contrast allerg |
| what kind of contrast is used for contrast studies of the urinary system on pt with risk factors for reaction | nonionic iodinated contrast |
| what are some mild reactions to contrast media | -sensation of warmth -metallic taste -sneezing -flushing -a few hives |
| moderate contrast media reactions | -nausea -vomiting -itching |
| severe contrast media reaction | anaphylactic shock |
| reactions to contrast media usually occur in what time period after administration | 5 min |
| what emergency equipment should be present when administering contrast | -O2 -suction -crash cart -doctor |
| what information must we gather from pt before giving contrast | -hx of allergies -current medications -surgical hx -past and current disease processes -lab values |
| how should adults be prepped for contrast studies of the urinary system | -intestinal tract free of gas or fecal matter -when possible, low residue(fiber)diet for 1 to 2 days -non gas forming laxative 1 day prior when indicated -NPO after midnight day of exam -well hydrated(esp. pt's with diabetes, mult. myeloma or ^ uric a |
| what special prep is required for retrograde urography | drink 4 to 5 cups several hours before exam |
| what prep is needed for exams of lower urinary tract | none |
| equipment needed for urinary studies | -xray room is ok for antegrade urography and most retrograde studies of bladder and urethra -cystoscopic-radiographic unit needed for RUG procedures that require cystography -tomo unit for infusion nephrourography -time & body markers -crash cart -IV |
| what soft tissues must be defined | -kidneys -lower border of liver -lateral margin of psoas muscle |
| are immobilization devices recomended | -no -control of motion is controlled by exposure time and pt cooperation |
| when would we use ureteral compression | -in excretory urography compression can be used to retard urine flow -compression centered at level of ASIS |
| what can be done to simulate effect of compression | 15 degree trendelenburg |
| when would compression be contraindicated | -urinary stones -abdominal mass -aortic aneurysm -colostomy -suprapubic catheter -traumatic injufy |
| what respiration should be use | exhalation unless specified otherwise (image should be marked if done other than exhalation) |
| what is the purpose of our scout film | -check GI tract prep -technique -positioning -check for stones |
| what are the two types of cystogram | -voiding -non voiding |
| indications for intravenous or excratory urography(IVU) | -eval abdominal mass, renal cysts, and tumors -urolithasis -pyelonephritis -hydronephrosis -trauma -preop eval -renal hypertension |
| contraindications for IVU | poor renal function or allergy to contrast |
| which risk factors may be overcome by use of non ionic iodinated contrast | -asthma -previous reaction -circulatory or cardiovascular disease -elevated cratinine level -sickle cell -diabetes -multiple myeloma |
| should pt empty bladder prior to IVU | yes |
| during IVU postvoid films of bladder are taken for what reason | -to check for small tumor masses or enlarged prostate -demonstrates retention of contrast/urine in the bladder |
| when may we need delayed films during IVU | in cases of hydronephrosis |
| in an oblique position the kidney closest to IR is ________ and kidney furthest away is ________ | perpendicular and parallel |
| where is your central ray for oblique | 2" lateral to midline on elevated side and iliac crest |
| AP axial bladder is performed how | -same as AP coccyx -pt supine, no rotation with CR entrance 2" superior to pubic symphysis and 10 to 15 degree caudal angle |
| PA axial bladder is performed how | -pt prone, no rotation -CR angled 10 to 15 degrees cephalad -CR entrance 1" distal to coccyx |
| AP oblique bladder | -40 to 60 degree posterior oblique(merrils) -35 degree at HMC -CR enters 2" above symphysis -extend & abduct elevated thigh -perp. to center of IR -CR at level of symphysis for voiding studies -10 degree caudal if looking @ bladder neck/proximal ure |
| nephrotomography and nephrourography | -tomo done immediately after contrast is given -demonstrates nephrons and collecting ducts -images labeled 1,2,3 minute -indications are renal hypertension and renal cysts and tumors |
| which procedure is considered operative and done using aseptic conditions | retrograde urography |
| indications for cystography | -vesicoureteral feflux -recurrent lower urinary tract infectrion -neurogenic badder -bladder trauma -lower UTI -urethral stricture -posterior urethral valves |
| prostography | -looking at prostate through cystography -angle 10-15 degrees cephalically |
| female cystourography(VCUG) | -uses bead chain -done to investigate abnormalities causing incontinence |
| urolithiasis | stones of the urinary tract or kidneys |
| pyelonephritis | infection of the upper urinary tract |
| Neurogenic badder | dysfunction of the urinary bladder due to disease of the central nervous system or peripheral nerves involved in the control of micturition (urination) |
Created by:
bigad1982
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