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Intro to urology
Clinical Medicine II
| Question | Answer |
|---|---|
| Nephrology | study of the nephron and kidney |
| Urology | study of the urinary drainage system |
| Do the kidneys move | yes, slightly w/ respirations, excess can produce renal colic |
| Where do we commonly find malignant tumors | in the renal vein |
| What is special about the L renal vein | it receives the left testicular vein in the male, (rarely) can become blocked and produced varicocele in the L scrotum |
| Most diseases of the kidney present how | painless (with HTN and DM ect) |
| 3 sites of ureter narrowing | pelviureteral jxn, pelvic brim, ureter enters the bladder |
| Where does colic come from | at the level of ureter d/t peristalsis |
| Congenital anomalies | double pelvis, bifid ureter, mega-ureter |
| How can we drain the bladder | urination, catherization, needle thru abd wall: can cause trauma and urine can leak into abd cavity |
| Where does support of the bladder come from, diminished how | levator ani muscle, diminished by labor and prostate surgery |
| Two parts to the nephron | Cortex: glomerulus is here and Medulla: loop of henle |
| What is included in the renal corpuscle | glomerulus and bowman’s capsule (in cortex) |
| Two parths to the nephrons | cortical and juxtamedullary |
| Two segments of the proximal tubule | convoluted, and straight (pars recta) |
| Two parts to the loop of henle | thick descending limb and thin limb ( only in juxtamedulla nephrons), thick ascending limb |
| What % of all nephrons are juxtumedullary nephrons | 20% |
| Where is the macula densa | in the distal tubule |
| Where does filtration and reabsorbtion occur | at glomerulus and at the proximal tubule ( a lot) |
| What seperates the cortex and medulla | the arcuate arteries and veins |
| Most important fxn of the kidney | regulate water |
| Indirect Fxns of kidney | protects/hydrates organs, transport nutrients, gets rid of H2O from breathing, regulates body temp, eliminates toxins |
| Water represents what % in muscle, brain, bone, blood | M: 75%, B: 75%, Bone: 22%, Blood:92, protects joints, and lubricate |
| Where is most of the water located within the body | intra cellular fluid (ICF) 66% |
| Direct fxns of the kidney | filtration, reabsorbtion, secretion |
| Movementof water and solutes from plasma in the glomerulus | filtration |
| Movement of molecules out of the tubules into peritubular blood | reabsorption (H20, NaCl, glucose, K+, AAs, HCO3, proteins, PO4) |
| Movement of molecules out of peritubular blood into tubule for excretion | secretion (H+, urea, K+, drugs, foreign substances) |
| Two endocrine fxs of the kidney | renin-aldosterone (BP) Ertythropoeitin (RBC) |
| Metabolic fxs of kidney | Vit D for calcium metabolism, Gluconeogenesis, metabolism of endogenous compuds like steroids, insulin, prostaglandins, kinins |
| Amount of plasma filtered per unit time | GFR glomerular filtration rate (related directly to blood flow) |
| Two ways to autoregulate blood flow | myogenic-stretc in afferent arteriole, tubuloglomerular feedback, macula densa (JGA cells in distal tubule) |
| What are the sympathetic nerves that innervate the kidneys, where | celiac ganglion and greater splanchinic nerves, innervates at afferent and efferent arterioles (flight or fight) |
| What does drop in BP in baroceptors do | causes reflex renal arteriole, and vasoconstriction ↓ renal BF |
| Where is renin released from, in response to 3 things | JGA cells 1) ↓ stretch from ↓ pressure in afferent arterioles, 2) Na+, concentration in DT 3) sympathetic n. stimulation |
| Fxn of renin | cleaves angiotensinogen to angiotension I (I→II by ACE) |
| What is angiotension II | stron vasoconstrictor notablyin afferent arterioles) |
| What does angiotensin II stimulate | aldosterone secretion from adrenal cortex and ADH from post pit. Inhibits renin release |
| What is ANP and where is it secreted | atrial natriuretic peptide and secreted by R atrium of heart in response to stretch (↑ vol, BP) |
| Fxn of ANP | inhibits renin secretion, angiotension mediated aldosterone secretion, causes afferent vasodilation, efferent vasoconstrictions |
| What do NSAIDS, ACE/ARBs, HCTZ, Lasix, Spirolactone all act on | N: afferent arterioles, ACE: efferent arterioles, HCTZ, just after LOH, L: ascending limb of loop of henly, S: DT |
| Condition characterized by ↑ retention of nitrogen byproducts | azotemia: causes ↑urea and BUN |
| Where do NSAIDS, ACEi/ARBs, HCTZ, Lasix and spirolactone work | N: afferent arteriole, Ace: efferenct arterioles, HCTZ: just after the loop, Lasix: ascending limb of the loop of henle, S: distal tubule |
| Azotemia | abnormally high nitrogen products: urea, creatine, |
| When is it a prerenal problem | azotemia d/t ↓ perfusion of kidney d/t vol deletion, hemorrhage, shock and CHF |
| When is it an intrarenal problem | azotemia d/t intrinsic kidney failure (uremia) renal failure, glomerulonephritis, acute tubular necrosis |
| When is it a postrenal problem | azotemia d/t blockage of urine in urinary track |
| Product of muscle metabolism, helps monitor what | creatinine, asses for dehydration, renal failure, muscle atrophy/dystrophy |
| Nl creatinin and BUN | C: .7-1.2mg/dl BUN: 10-20mg/dl |
| What two lab values are inverserly related | Cr and GFR |
| Measures urea nitrogen | BUN: end produce of protein break down in the blood |
| What does BUN reflect | glomerular filtration and urine concentration capacity, asses for dehydration, renal failure, catabolic states, GI bleeding w/ reabsorption of blood, liver dz |
| Two labs for additional renal knowledge | BUN/Cr ratio, FENA (Fractional exretion of Na+) |
| FENA >3% suggests what | intrarenal dysf: ↑ Na+ lost d/t tubular damage or glomeruli damage resulting in hypervolemia |
| How can we predice GFR w/o urine specimine | Cockcroft-Gault equation |
| When do we see glucose in the urine | glucose >200mg/dl |
| When do ketones show up in the urine | indicates metabolism s dependent upon fatty acids rather than glucose for energy |
| When does ketonuria occur | diabetic acidosis, starvation, fasting, alcoholic ketoacidosis |
| Why do we want to examine urine w/i30mins | casts may disintegrate |
| Dark yellow to green urine | bilirubin |
| Red to black urine | erythrocytes, hemoglobin, myoglobin |
| Purple to brown on standing to light | porphyrins |
| Nl urine pH | 4.6-6.0 |
| What do we need to interpret urine pH | serum pH to compare to identify where the infx is |
| Causes of increased pH | infx w/ urea-spitting organism (proteus), systemic alkalosis,renal tubular acidosis, carbonic anhydrase inhibitors |
| What does a fixed specific gravity indicate | (Isosthenuria), damage to renal medulla, severe renal damge |
| Causes of fixed specific gravity | gout, Sickle Cell, myeloma kidney, prolonged K+ def, hypercalcemia |
| Nl protein, causes of mild and severe elevation | 5-15mg/dl, Mild: Bening orthostatic proteinuria, fever, glomerulonephritis, pyleonphtritis, severe elevation: >3.5, Renal v. thrombosis, amyloidosis, SLE, DM, glomerunephritis |
| +bilirubin suggests what | obstructive jaundice (Intrahepatic and extra) Hepatitis |
| Hemateuria causes | infx, kidney damage, stones, malignancy: requires more tests |
| Reasons for renal US | size, shape, location of kidneys, renal masses, obstruction, fluid collections, MAY detect nephrolithliasis |
| Indications for US | hematuria, renal failure, flank pain safe during pregnancy |
| Indications for intravenous pyelogram (IVP) | hematuria, suspected nephrolithiasis, obstruction or other abnormalities |
| Do we alwaysuse IVP | rarely d/t the CT |
| MC used test for kidneys, indications | CT scan, Evaluate for 1)nephrolithiasis (no contrast) 2) renal, prostate, other intraabd masses |
| If contrast is used in any test, what do we need to measure 1st | creatnine level |
| When would we use a MRI/MRA over a CT | abno tissues/masses such as malignancies |
| CIs for MRI | metal in body: pacemakers, aneurysm clips, stents, values |
| VCUG | voiding cystourethrogram: study to invision urine from bladder to urethra |
| Indications for VCUG | recurrent UTIs, bladder trauma/rupture, suspected obstruction (CI: untreated UTI) |
| Indications for cystoscopy | frequent UTI, hematuria, incontinence or overactive bladder, unusual cells in UA, painful urination, pelvic pain, intersticial cystitis, suspect malignancy. Invasive |
| Diagnostic test for masses | biopsy: US guided, often done during surgery |
Created by:
becker15
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