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Urinary System

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