A&P Test 5

Question 1

Urine flows from

Answer 1

the kidney pelvis and is propelled through the ureters by perstalic action

Question 2

The urge to void

Answer 2

Parasympathetic nerve response to stimulation by bladder wall stretch
-usually occurs after about 200-300 ml of urine has collected in the bladder

Question 3

Motor nerves to external urinary sphincter

Answer 3

When activated, the sphincter remains contracted, allowing voluntary control over urination

Question 4

Urinary retention

Answer 4

• an inability to void due to blockage of the urethra
• sufficient urine is being produced by kidneys but patient is unable to expel urine from the bladder
• Causes can be mechanical, congenital or functional

Question 5

Retention with overflow

Answer 5

• Pt will complain of full bladder with frequent small amounts of urine
• As the bladder overfills, the restraining capability of the sphincter is taxed
• Small amount of urine will be released to reduce pressure to the level where the sphincter can control the flow of urine again

Question 6

Normal Kidney Function

Answer 6

• Electrolyte balance
• Acid-base balance
• Metabolic regulation
• Body water regulation
• Excretory regulation

Question 7

Body water regulation:

Answer 7

Functional unit of the kidney is the nephron

• normal GFR is 125 ml/min (180 L/day)
• blood filtered across semipermeable membrane into Bowman’s capsule
• 99% of water is reabsorbed
• ADH and aldosterone help reabsorption in distal tubule-blood pressure regulation

Question 8

Acid base balance-

Answer 8

• Bicarb retention

* Eliminates excess H+ (acids)

Question 9

Excretory regulation-

Answer 9

• phosphates
• uric acid
• drug metabolites
• nitrogenous waste products
• urea
• creatinine

Question 10

Normal Renal BUN:

Answer 10

3-29

Question 11

Normal Creatinine

Answer 11

0.5-1.4

Question 12

Sodium:

Answer 12

135-148- more than 99% is reabsorbed

Question 13

Potassium

Answer 13

3.4-5.3 Excrete >90% of total daily K intake

Question 14

Cl

Answer 14

96-110

Question 15

Calcium

Answer 15

8.5-10.4 activate vitamin D and assist with calcium absorption

Question 16

Magnesium

Answer 16

1.4-2.5 excrete excess magnesium

Question 17

Phosphorus

Answer 17

2.5- 4.5 excrete phosphorus

Question 18

Kidneys produce and release:

Answer 18

erythropoietin

Question 19

Erythropoietin stimulates

Answer 19

bone marrow to make RBC

• vit D activation
• RAA

Question 20

Chronic renal failure def:

Answer 20

Progressive, irreversible destruction of the nephrons of the kidneys

• up to 80% of the GFR may be lost with few changes in the functioning of the body
• remaining nephrons hypertrophy to compensate
• gradual onset-months to years

Question 21

Stage 1

Answer 21

Signs of mild kidney disease with normal or better GFR- 90%

Question 22

Stage 2

Answer 22

mild kidney disease, decreased GFR 60-89%

Question 23

Stage 3

Answer 23

moderate chronic renal insufficiency- 30-59%

Question 24

Stage 4

Answer 24

severe chronic renal insufficiency 15-29%

Question 25

Stage 5

Answer 25

ESRD- less than 15%

Question 26

Gerontologic Considerations:

Answer 26

* Physiological changes in vascular bed affect renal function * Arteriosclerotic changes in the renal arteries cause renovascular pathology * Blood pressure changes in the elderly effect renal function * Prostatic hypertrophy common in older males * Muscle tone decreases and the pelvic organs put increasing pressure on the bladder-stress incontinence * 20-30% decrease in size and weight between ages of 30-90 years * by 70 yrs, 30-50% of glomeruli have lost their function * Blood flow to/within kidneys decreases * Periurethral muscle fibers become less elastic, more prone to urethral irritation, urethral/bladder infections, urinary incontinence

Question 27

Common nephrotoxins

Answer 27

* Anitbiotics- gentamycin, tobramycin, amphotericin, cephalosporins, vancomycin * Chemicals- methanol/gasoline, carbon tetrachloride, ethylene glycol, lead, lithium, mercury * Radiographic dye * Anesthetics * Drugs- NSAIDS, thiazides, dilantin, amphetamines, cisplatin * Other- transfusion reactions, crush injuries, heroin

Question 28

Urine studies-

Answer 28

* I&O and daily weight- best information r/t fluid balance * Urinalysis-visual, chemo, micro * Creatinine clearance (urine and blood) calculation corrected for body size, appears to decrease with age * Bladder scan * Urine culture- clean catch, midstream * 24 urine (on ice or with preservative)

Question 29

Diagnostics:

Answer 29

* KUB * Biospy (bladder or kidney) * Abdominal x-ray * Ultrasound (site) * CT/MRI (site) * Introvenous pyelogram * Cystoscopy * Urodynamics * IVP * Retrograde pyelogram * Cystogram/urethrogram

Question 30

Cystoscopy:

Answer 30

* Interior inspect with a tubular lighted scope - general anesthesia - monitor bleeding post scope

Question 31

Male external genitalia

Answer 31

penis, scrotum

Question 32

Testes:

Answer 32

male reproductive organs

Question 33

Glands:

Answer 33

produce and secrete seminal fluid, seminal vesticles, prostate gland, cowper's glands

Question 34

Ducts:

Answer 34

* Epididmysis * Ductus deferens (vas deferens) * Ejaculatory duct

Question 35

The testes in conjunction with

Answer 35

the hypothalamus and pituitary secrete hormones which stimulate production and maturation of sperm- Follicle stimulating hormone (FSH)- interstitial cell stimulating hormone (ICSH or LH)- Testosterone- the major gonadal male hormone

Question 36

Spermatogenesis continues

Answer 36

throughout life

Question 37

Gerontologic Considerations:

Answer 37

* Increase in prostate size * Decreased testosterone level and sperm production * Decreased scrotum muscle tone * decreased size and firmness of the testicles * erectile dysfunction and sexual dysfunction can occur as result of these changes

Question 38

Testes should feel

Answer 38

smooth and firm, oval and freely movable

Question 39

Seminiferous tubules

Answer 39

produce spermatozoa

Question 40

Epididymis

Answer 40

transport of mature sperm

Question 41

Vas deferens:

Answer 41

* sperm are stored | * joins the ducts of the seminal vesicles at the base of the prostate gland to form the ejaculatory duct