E4: urinary disorders

Question 1

Some causes of obstructions that occur inside the urinary tract

Answer 1

• stones
• tumors
• trauma
• infection
• congenital neurogenic bladder
• congenital reflux

Question 2

Some causes of obstructions that occur outside the urinary tract (and cause pressure on the urinary
tract)

Answer 2

• benign prostatic hypertrophy
• pregnancy
• cancer with pressure
• inflammation of the gastrointestinal tract

Question 3

what are the two main problems with urinary tract obstructions

Answer 3

1. stasis of urine

2. increased hydrostatic pressure

Question 4

patho chain for stasis of urine

Answer 4

stasis of fluid behind obstruction–> infection–>damage of the organs ivolved

Question 5

patho chain for increased hydrostatic pressure

Answer 5

obstruction–> increased hydrostatic pressure behind obstruction–>dilation of the involved tissues–> organ damage–> renal failure

Question 6

hydroureter

Answer 6

accumulation of urine in ureter

Question 7

hydronephrosis

Answer 7

accumulation of urine in renal collecting system

Question 8

nephrolithiasis

Answer 8

masses of crystals and protein which are one of the most common causes of obstruction

Question 9

what are contributing factors to nephrolithiasis

Answer 9

• dehydration/inadequate fluid intake
• increases intake of substances that form stones
• urine pH
• various diseases, drugs

Question 10

nidus

Answer 10

crystal caused by substances that come together and blocks ureters. it then attracts for crystals together and grown into stones

Question 11

alkaline urine is prone to

Answer 11

calcium carbonate and phosphate stone formation

Question 12

acidic urine is prone to

Answer 12

uric acid stone formation (esp below 5.5 and decreased volume)

Question 13

either pH urine is prone to

Answer 13

calcium oxalate and cystine formation of stones

Question 14

clinical mani of nephrolithiasis in ureters

Answer 14

causes distention

“colicky pain” as ureters try to advance stone

Question 15

clinical mani of nephrolithasis above ureters

Answer 15

asymptomatic unless infection or obstruction is present

-dull, achy and constant pain

Question 16

general clinical mani of nephrolithias

Answer 16

• flank or groin pain
• nausea/vomiting (stimulation of visceral receptors)
• hematuria related to trauma

Question 17

neurogenic bladder

Answer 17

-interruption of nerve supply to bladder resulting in a functional obstruction to urine passage

Question 18

cause of neurogenic bladder

Answer 18

• May have CNS or spinal cord origin

* May be result of trauma, diseases, tumors, congenital anomalies

Question 19

two types of neurogenic bladder

Answer 19

1. upper motor neuron damage (CNS)

2. lower motor neuron damage (spinal cord)

Question 20

upper motor neuron damage neurogenic bladder

Answer 20

• at or below the cerebral cortex and above the sacral level (CNS)
• Reflex Arc intact-arc senses fullness but the sensation isn’t felt so can’t inhibit voiding
• “Reflex” Bladder

Question 21

lower motor neuron damage in neurogenic bladder

Answer 21

• Disruption of the reflex arc at the Sacral level, with loss of sensation of bladder fullness
• “Atonic” Bladder

Question 22

type of incontinence with lower motor

Answer 22

• Retention with overflow incontinence – loss of voluntary and involuntary control of voiding

Question 23

what type of incontinence with upper motor

Answer 23

• Frequent incontinence with urinary retention – loss of voluntary control of voiding

Question 24

who is upper motor usually seen in

Answer 24

• Many times seen in quadriplegics

Question 25

who is lower motor usually seen in

Answer 25

• Many times seen in paraplegics

Question 26

polycystic kidneys

Answer 26

kidneys with multiple fluid filled cysts

Question 27

in infants with polycystic kidneys the kidneys can be....

Answer 27

be up to 10% of the child's weight • Infants born with autosomal polycystic kidney disease can die at birth or shortly after. - - - About 25% do survive to childhood.

Question 28

cause of polycystic kidneys

Answer 28

* Usually genetic involvement--cysts begin forming in utero * Adult onset is autosomal dominant * Child onset is autosomal recessive

Question 29

children who have polycystic kidneys frequently also have

Answer 29

hepatic abnormalities

Question 30

clinical mani of polycystic kidneys

Answer 30

* Abdominal Mass * Failure to Thrive * UTI's * Hematuria * Renal Insufficiency

Question 31

causes of UTI

Answer 31

* Gram negative-E. Coli (80-90 percent of all initial UTI"S). * More than 100,000 bacteria/ml. present * Can happen anywhere along the urinary tract * 20-50 percent of all women have lower urinary tract infections

Question 32

Defenses against UTI:

Answer 32

* Frequent voiding -- thus not allowing stasis, retention * Acidic urine (a low pH has a bacteriocidal effect) * Vesicoureteral junction (this normally closes during bladder contraction preventing reflux) * Long urethra in males * Prostatic secretions * Good personal hygieneCystitis

Question 33

cystitis

Answer 33

inflammation of bladder (most common UTI)

Question 34

increased risk for cystitis with

Answer 34

* sexually active females * pregnant females * "honeymoon cystitis" * indwelling catheters * kidney stones * tumors * neurogenic bladder * poor hygiene * benign prostatic hypertrophy (BPH) * diabetes mellitus

Question 35

cystitis clinical mani

Answer 35

• Frequency, urgency, dysuria • Pain -- low-back, flank, or suprapubic • Hematuria/cloudy urine • 10% with bacteriuria are asymptomatic • Children and the elderly may be asymptomatic. (If children have s/s -- these would be bedwetting, redness in females, scratching in the area)

Question 36

acute pyelonephritis

Answer 36

1. Infection of the renal pelvis -- usually of bacterial origin (e.g. E.Coli). -Pseudomonas or Proteus may be cause after urinary tract surgery. - More frequent in women. -Involves one or both kidneys.

Question 37

cause of acute pyelonephritis

Answer 37

• Obstruction (e.g. stones) with reflux of urine into the ureters • Vesicoureteral reflux in children -- (urine ascends into the ureters when the child voids because of malplacement of ureters in the bladder)

Question 38

increased risk of acute pyelonephritis with

Answer 38

* Neurogenic bladder * Trauma * Pregnancy * Catheters, endoscopes * Infection may be spread to kidneys through the blood stream

Question 39

acute pyelonephritis usually affect what

Answer 39

the tubules but not the glomeruli

Question 40

patho of acute pyelonephritis

Answer 40

• Focal inflammatory process with WBC infiltration, edema and purulent urine • If infection continues, tubule destruction results in the formation of scar tissue and atrophy of affected tubules which can lead to chronic pyelonephritis

Question 41

clinical mani of acute pyelonephritis

Answer 41

* Usually acute * Chills * Fever * Flank/groin pain * Dysuria * Older adults and children usually have non-specific s/s (malaise, fever, decreased appetite)

Question 42

chronic pyelonephritis

Answer 42

A recurrent or persistent autoimmune infection of the kidney resulting in tubular destruction and scarring. Results in decreased renal function and can cause renal failure.

Question 43

cause of chronic pyelonephritis

Answer 43

* More likely to occur in renal infections associated with obstructive conditions (e.g. stones, reflux) * May result from recurrent acute pyelonephritis, ischemia, irradiation * Drug toxicity (phenacetin, ASA, acetaminophen) * Progression may continue for years until renal failure occurs

Question 44

clinical mani of Chronic Pyelonephritis

Answer 44

* Minimal and vague * May have hypertension * May mimic acute pyelonephritis -- pain, dysuria, frequency * Urine is dilute (unable to concentrate)