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Transcript of Urinary tract disorders,powerpoint.ppt
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Urinary System Disorders
Dahler Bahrun,Sp A(K
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Overview
Incontinence andRetention
Dianostic !ests" Urinalysis
" Blood tests" Other tests
Diuretic Drus Dialysis Disorders o# the Urinary
System" Urinary !ract In#ections" In#lammatory Disorders
$lomerulonephritis
Urinary !ractO%structions" Urolithiasis" !umors
Renal &ailure" Acute" 'hronic
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Incontinence and Retention
oss o# voluntary control
o# %ladder
Stress incontinence
" Increase in intra)a%dominal
pressure
&orces urine throuh
sphincter
" auhin
" 'ouhin
" &emales wea*ened
Spinal cord in+uries, %rain
damae
Ina%ility to empty %ladder
ay accomp over#low
incontinence
Spinal cord in+ury Ina%ility to control
manaed %y pads, %rie#s
'atheter
" !u%e inserted in urethra" Drains urine #rom %ladder
to collectin %a
" 'ommon source o# U!I
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'atheter
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Dianostic !ests-Urinalysis
'onstituents, characteristics o# urine vary w.dietary inta*e, drus, care o# specimen
/ormally clear, straw)colored0 p1 234)536
Appearance" 'loudy
7resence o# l amts protein, %lood cells, %acteria, pus
" Dar* color
1ematuria (%lood8, e9cessive %iliru%in, hih concentration o#urine
" Unpleasant, unusual odor in#ection
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Dianostic !ests-Urinalysis
A%normal constituents (hih in num%ers8" Blood (hematuria8
Small, microscopic amts" In#ection, in#lammation, tumors o# U!
: RB'" Increased lomerular permea%ility or hemorrhae in tract
" 7rotein (7roteinuria8 ea*ae o# al%umin into #iltrate
" In#lammation, increased lomerular permea%ility
" Bacteria (Bacteriuria8 and 7us (7yuria8 Indicates U!I
" Urinary casts
icroscopic mold o# tu%ules" 'onsists o# one or more cells, %acteria, protein In#lammation o# tu%ules
" Speci#ic ravity A%ility o# tu%ules to concentrate urine ow is related to renal #ailure
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RB' 'ast
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Dianostic !ests-Blood !ests
1ih serum urea and creatinine" Indicate #ailure to e9crete / wastes
Due to low $&R
eta%olic acidosis" Indicates low $&R, #ailure o# tu%ules to control acid.%ase %alance
Anemia" Indicates low erythropoietin secretion and.or %one marrow depression
Due to accumulatin wastes
;lectrolytes Anti%ody level
" Antistreptolysin O (ASO8 or antistrepto*inase (ASK8
Renin levels" Indicate cause o# hypertension
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Dianostic !ests-Other !ests
'ulture and sensitivity tests" Urine specimens
ID oranism and select dru treatment
'learance tests" 'reatinine, insulin clearance" Used to asses $&R
Radioloic tests" Intravenous pyeloraphy (I
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I
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Anioraphy, Ultrasound
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'!
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'!, RI
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Diuretic Drus
Removes e9cess /a ion and water #rom %ody" Increase e9cretion o# water thru *idneys and urinary vol
!a*e in mornin
7rescri%ed #or many disorders" Renal disease, hypertension, edema, '1&, pulmonary edema
ost commonly used dru roup inhi%its /a'lrea%sorption
a+or side e##ect is e9cess loss o# electrolytes
" any cause e9cessive loss o# potassium" 'ause muscle wea*ness or cardiac arrhythmias
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Dialysis
7rovides ?arti#icial *idney@
" Sustains li#e a#ter *idney #ails
Acute renal #ailure or end)stae renal #ailure (those
waitin #or a transplant8
#orms
" 1emodialysis
" 7eritoneal dialysis
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1emodialysis
1ospital, dialysis center
7ts %lood moves #rom implanted shunt in armarterytu%emachinee9chane o#
wastes, #luids, electrolytes" Semipermea%le mem%rane separates pts %lood #rom
dialysis #luid 'onstituents move %etween the compartments
" ;9C wastes in %looddialysate
%icar%onate in dialysate%loodBlood cells, proteins remain in %lood
ovement %y ultra#iltration, di##usion, osmosis
Blood to pt vein
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1emodialysis
1eparin (anticoaulant8
Re>uired Es.wee* #or )2 hrs
7otential complications" Shunt %ecomes in#ected
" Blood clot #orms
" Blood vessels %ecome damaed ust move to new site
" Increased ris* o# hepatitis, 1I
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7eritoneal Dialysis
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Disorders o# the Urinary SystemC
Urinary !ract In#ections (U!I8
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U!I-;tioloy
&emales more anatomically vulnera%le
" Short urethra
" 7ro9imity to anus
" &re>uent irritation to tissues
!ampons, %u%%le %ath, se9ual activity
Older males with prostatic hypertrophy
and retention o# urine prone to U!I
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U!I-;tioloy
Incontinence Bladder retention o# urine O%struction o# urine #low
'onenital a%normality 7renancy, scar tissue, *idney stones,
vesicourethral re#le9" Urine does not #low #reely
Decreased host resistance (immunosuppression8 Impaired %lood supply to %ladder (ain8 Dia%etes mellitus
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U!IC 'ystitis-7athophysioloy
Bladder wall and urethra in#lamed, red, swollen
" Decreased %ladder capacity
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U!IC 7yelonephritis-
7athophysioloy
G or %oth *idneys involved In#ection #rom ureterrenal pelvismedullary
tissue (tu%ules and interstitial8 7urulent e9udate #ills *idney pelvis and calyces A%scess and necrosis seen in medulla
" ay e9tend thru corte9 to capsule" Severe may compress renal artery and vein and
o%struct urine #low to ureter
Bilateral o%struction results in acute renal #ailure Recurrent chronic in#ection
" 'an lead to #i%rous tissue over caly9 oss o# tu%ule #unction
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U!IC 7yelonephritis-Sins and
Symptoms Sins o# cystitis
7ain
" Dull achin in lower %ac*
" Results #rom renal capsule
stretchin
Urinalysis
" Similar to cystitis
" ;9cept urinary cast
eu*ocytes or renalepithelial cells present
" Involvement o# renal
tu%ules
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U!I-!reatment
Anti%iotics (Bactrim8
Increase #luid inta*e
" ;specially cran%erry +uice
!annin decreases a%ility o# E. colito adhere to
%ladder mucosa
In#ection reoccurs unless predisposin
#actors removed
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Disorders o# the Urinary SystemC
In#lammatory Disorders
$lomerulonephritis
" any #orms
Acute 7oststreptococcal $lomerulonephritis
(A7S$/8" &ollows streptococcal in#ection
H Oriinates as upper resp in#ection, middle ear
in#ection, strep throat
"7rimarily a##ects *ids ) (especially %oys8
" develops wee*s a#ter previous in#ection
In#lammatory DiseasesC
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In#lammatory DiseasesC
$lomerulonephritis-
7athophysioloy Antistreptococcal anti%odies create antien)anti%odycomple9" !ype III hypersensitivity r9n
" ode in lomerular capillaries
'ause in#lammation in %oth *idneys" Increase cap perm and cell proli#eration
H ea*ae o# proteins and erythrocytes into #iltrate
Severe in#lammation" 'onestion and proli#eration inter#ere w. #iltration in *idney
Decrease $&R and retention o# #luid and wastes" I# %lood #low impaired, acute renal #ailure
ow %lood #lowincrease reninincrease %p and edema
" Scar tissue on *idney
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$lomerulonephritis-Sins and
Symptoms
Bac* pain
" Stretchin renal capsule
Dar*, cloudy urine
Oliuria
&acial edema, then enerali=ed
" ow osmotic pressure o# %lood
" Salt, water retention $enerali=ed sins o# in#lammation
Increased %p
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$lomerulonephritis-Dianostic
!ests
Blood tests
" 1ih serum urea and creatinine and
decreasin $&R
" Streptococcal anti%odies, ASO, ASK
" eta%olic acidosis
ow serum %icar%onate, low p1
Urinalysis" 'on#irms presence o# proteinuria, erythrocyte
casts
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$lomerulonephritis-!reatment
Sodium restriction
$lucocorticoids
Anti%iotics
Recovery w. minimal damae" Imp to prevent #urther e9posure to streptococcal
in#ection and recurrent in#lam
"Adults more di##icult
Acute renal #ailure in J 'hronic lomerulonephritis in G6J
" $radually destroys *idneys
7ostrecovery testin should %e done
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Urinary !ract O%structionsC
Urolithiasis
Also calledC
" 'alculi
" Kidney stones
&re>uently reoccur i#not treated
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'alculi-7athophysioloy
'an develop anywhere in U!0 l or small
Once any solid material or de%ris #orms
!end to #orm whenC" e9cessive amts o# relatively insolu%le salts are in #iltrate
" Insu##icient #luid inta*e creates hihly concentrated #iltrate
4J composed o# calcium salts" RemainderC uric acid, struvite, o9alate
Usually cause mani#estations only when o%struct #low o#
urine" In#ection i# stasis o# urine
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Kidney Stones-7athophysioloyC
!ypes o# Stones 'alcium stones
" &orm when calcium levels hih in urine 1ypercalcemia
i9ed inoranic salts" In#ection
De%ris #rom in#ection %ein deposition o# crystals
" Urine p1 al*aline
Uric acid stones" Develop w. hyperuricemia
Due to out, cancer chemo
'alcium o9alate" 'ertain veetarian diets" 1ih levels o# o9alate in urine
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Kidney Stones
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'alculi-Sins and Symptoms
Stones in *idney.%ladder #re>uently
asymptomatic
O%struction o# ureter causes attac*
" ?renal colic@
'onsists o# intense spasms in %ac* and roin
7ain caused %y viorous contractions o# ureter
" ;##ort to pass the stone
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'alculi-!reatment
Small stones eventually passed out
arer stones
" ;9tracorporeal shoc*)wave lithotripsy (;S8
Decreases need #or invasive surery
" Some drus can partially dissolve
/eed to prevent recurrences
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;S
U i ! t O% t ti !
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Urinary !ract O%structionsC !umors
-Renal 'ell 'arcinoma 7rimary, silent tumor
Arises #rom tu%ule epithelium
Asymptomatic in early stae" O#ten metasti=e to liver, luns, %ones, '/S at time o# dianosis
'ommon a#ter 46" ore #re> in males and smo*ers
Initial sin is painless hematuria
Other mani#estations
" Dull achin #lan* pain, palpa%le mass, anemia !reatment is *idney removal
" 4 yr survival rate 46J
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R l & il A t R l & il
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Renal &ailureC Acute Renal &ailure
-7athophysioloy ay #ail suddenly #or di##erent reasons
&ailure reversi%le i# primary pro%lem success#ully treated
Dialysis re>uired
Develops rapidly
;itherC" Directly decreases %lood #low to *idney
" In#lammation and necrosis o# tu%ules cause o%struction and%ac* pressure
$reatly decreases $&R and oliuria
Blood tests show hih / (*idneys not removin wastes8
I# cause not promptly treated, chronic
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Acute Renal &ailure-;tioloy
Acute %ilateral *idney disease" $lomerulonephritis
ow $&R
Severe proloned circulatory shoc* or heart #ailure" Results in tissue necrosis" BurnsC 1% accum in tu%ules L o%struction
/ephroto9ins" Drus, chemicals, to9ins
Aspirin, /SAIDs, penicillin
" 'ause tu%ule necrosis and o%struction o# %lood #low
echanical o%struction" 'alculi, %lood clots, tumors" Bloc* urine #rom leavin *idney
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Acute Renal &ailure-!reatment
Important to reverse primary pro%lem
>uic*ly
Dialysis
Recovery evidenced %y increased urine
output
" ay ta*e couple months %e#ore renal tu%ules
#ully recover
'h i R l & il
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'hronic Renal &ailure-
7athophysioloy $radual, irreversi%le destruction o# *idney nephrons
ay result #romC" 'hronic *idney disease
Bilateral pyelonephritis
" Systemic disorders 1ypertension
Dia%etes
" on term e9posure to nephroto9ins
Asymptomatic until well advanced
" Due to reserve #unction o# nephrons" 'ant %e stopped once in advanced
Scar tissue and loss o# #unctional orani=ation" &urther deenerative chanes
'h i R l & il
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'hronic Renal &ailure-
7athophysioloyC Staes
Decreased reserve
" M6J nephron loss
" ow $&R, hih creatinine levels
Both still in normal rane
" /ormal urea levels
" /o apparent clinical sins
" Remainin nephrons adapt Increase capacity #or #iltration
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Staes
Renal Insu##iciency" 4J nephron loss
" 'hanes in %lood chemistry and mani#estations
" $&R decrease to 6J o# normal
" Sini#icant retention o# / wastes in %lood
" Decrease tu%ule #unction &ailure to concentrate urine and control secretion #or
e9chane o# acids and electrolytes
" ;9cretion o# l vol o# dilute urine" 1ih %p
" 'ardiovascular system compensates
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Staes
Uremia (;nd)stae renal #ailure8
" FN6J nephron loss
" nelii%le $&R
" &luid, electrolytes, wastes retained in %ody
All systems a##ected
" Oliuria or anuria
" Reular dialysis or transplant needed tosustain li#e
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'hronic Renal &ailure Sins and
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'hronic Renal &ailure-Sins and
Symptoms ;arly sins
" Increase urine output (polyuria8" $eneral sins" Increase wastes and altered %lood chemistry
Bone marrow depression, impaired cell #unction
" Increase %p
Uremic sins" Oliuria" Dry, hyperpimented s*in" 7eripheral neuropathy (a%norm sensations in lower lim%s8" alesimpotence, decrease li%ido0 #emalesirre menstrual cycle" ;ncephalopathy (lethary, memory lapses, sei=ures, tremors8" '1&, arrhythmias
" &ailure o# *idneys to activate vitamin D eads to hypocalcemia, osteodystrophy, osteoporosis, tetany
" Uremic #rost on s*in, urine)li*e %reath" Systemic in#ection
pneumonia
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'hronic Renal &ailure Dianostic
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'hronic Renal &ailure-Dianostic
!ests
eta%olic acidosis %ecomes decompensated
" Serum p1 %elow 34
" ow $&R
" !u%ule #unction lost A=otemia
" 7resence o# / wastes in %lood
Severe anemia
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'hronic Renal &ailure
A##ects all %ody systems Di##icult to maintain control o# %lood chemistry
and %ody #luid levels Drus to treatC
" 1ypertension, arrhythmias, heart #ailure" Dosaes ad+usted %.c decreased a%ility to e9crete
them
Su%+ect to many complications
"A##ect uremia" In#ection increases wastes in %ody0 compromises all
%ody systems