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Chapter 13

Chapter 13. Urinary System Diseases and Disorders. Anatomy and Physiology. Kidneys Remove waste products from bloodstream Ureters Tubules that run from kidney to bladder Transport urine. Anatomy and Physiology. Bladder Muscular organ that holds urine Urethra

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Chapter 13

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  1. Chapter 13 Urinary System Diseases and Disorders

  2. Anatomy and Physiology • Kidneys • Remove waste products from bloodstream • Ureters • Tubules that run from kidney to bladder • Transport urine

  3. Anatomy and Physiology • Bladder • Muscular organ that holds urine • Urethra • Carries urine to outside of body

  4. Anatomy and Physiology • Urine normally: • Clear, but slightly yellow to gold • Free from sediments • Distinct odor, but not foul-smelling • Specific gravity of 1.005 to 1.030 • pH of 6 • Changes in values indicate disease

  5. Animation Click Here to Play Urine Formation Animation

  6. Common Signs and Symptoms • Hematuria • Pyuria • Proteinuria • Dysuria

  7. Common Signs and Symptoms • Nocturia • Oliguria • Anuria • Frequency/urgency

  8. Diagnostic Tests • Urinalysis • Urine culture and sensitivity • Blood tests • Including blood urea nitrogen (BUN) and creatinine clearance • Intravenous pyelogram (IVP) • Kidney, ureter, and bladder (KUB)

  9. Diagnostic Tests • Cystogram • Cystoscopy • Bladder and kidney biopsy • Catheterization

  10. Cystoscopy

  11. Urinary Tract Infections (UTIs) • Broad diagnosis covering infections of urinary tract • Including urethra, bladder, and kidneys • Most often caused by bacteria • Can be caused by virus and fungi • E. coli • Most common bacteria

  12. UTIs • More common in females • Female urethra shorter and opening closer to rectum • Some females have improper toilet habits • Vaginal secretions may harbor bacteria while male prostatic secretions have antibacterial effect

  13. UTIs • More common in females • Sexual intercourse may cause trauma to urethra and bladder leading to inflammation and infection • Pregnant females more susceptible due to pressure of uterus on urinary tract

  14. UTIs • Diagnosis by urinalysis and culture of urine specimen • Treatment usually antibiotics

  15. UTIs • Urethritis • Inflammation of urethra • More common in males • Commonly occurs with cystitis • Symptoms: • Swelling of urethra • Dysuria • Urethral discharge

  16. UTIs • Cystitis • Inflammation of bladder • Also known as bladder infection • Honeymoon cystitis • Occurs in females as they become sexually active

  17. UTIs • Cystitis • Treatment usually antibiotics • Antispasmodic medications may decrease bladder spasms • E.g., Pyridium • May cause urine to turn reddish-orange

  18. UTIs • Pyelitis • Inflammation of kidney pelvis • Result of ascending infection from bladder • Rapid diagnosis and treatment imperative to prevent spread of infection

  19. UTIs • Pyelonephritis • May be due to ascending or hematogenous infection • May affect one or both kidneys

  20. UTIs • Pyelonephritis • Symptoms: • Sudden onset of fever and chills • Flank pain • Hematuria • Treated effectively with antibiotics

  21. Diseases of the Kidney • Acute glomerulonephritis • Inflammation of glomerulus or filtering unit of kidney • Most common kidney disease • Occurs one to four weeks after strep infection

  22. Diseases of the Kidney • Acute glomerulonephritis • Symptoms: • Flank pain • Fever • Loss of appetite • Malaise

  23. Diseases of the Kidney • Acute glomerulonephritis • Symptoms: • Edema of eyes and ankles • Oliguria • Hematuria

  24. Diseases of the Kidney • Acute glomerulonephritis • Treatment: • Antipyretic • Diuretic • Salt restriction • Protein restriction • Fluid restriction

  25. Diseases of the Kidney • Chronic glomerulonephritis • Repeated bouts lead to chronic condition • Symptoms include those of acute glomerulonephritis and hypertension • Uremia may occur during late stages • Treatment: • Peritoneal • Hemodialysis

  26. Diseases of the Kidney • Hydronephrosis • Urine in renal pelvis due to obstruction leading to dilation and distention of kidney pelvis • Diagnosis by pyelogram • Treatment: • Draining of kidney pelvis by surgery • Relief of obstruction

  27. Hydronephrosis

  28. Diseases of the Kidney • Renal calculi • Also known as kidney stones • Form in kidney pelvis • Symptoms: • Hematuria • Renal or urinary colic • Extreme spasmodic flank pain

  29. Renal Calculi

  30. Diseases of the Kidney • Renal calculi • Diagnosis by IVP, KUB, and renal ultrasound • Treatment: • Pain medication • Increased fluid intake • Strain urine • Surgery

  31. Diseases of the Kidney • Polycystic disease • Inherited disease causing enlargement of kidneys due to grape-like cysts • Slow, progressive disease • Symptoms: • Lumbar pain • Hematuria • Recurrent UTIs

  32. Diseases of the Kidney • Polycystic disease • Treatment: • Management of hypertension and UTIs • Dialysis and kidney transplant • No cure

  33. Diseases of the Kidney • Renal failure • Failure of kidneys to cleanse blood of waste products • BUN and creatinine measure kidney function • May be acute or chronic • Symptoms not significant until 75 percent of kidney function destroyed

  34. Diseases of the Kidney • Renal failure • Treatment: • Management of cause of failure • Limitation of sodium and protein • Measure I & O (intake and output) • Antihypertensives • Diuretics • Antibiotics

  35. Diseases of the Kidney • Renal failure • Long-term treatment: • Dialysis • Transplant

  36. Arteriovenous (AV) Shunts

  37. Diseases of the Kidney • Adenocarcinoma of the kidney • Risk factor: • Cigarette smoking • Frequently metastasizes to liver, brain, and bone before symptoms appear

  38. Diseases of the Kidney • Adenocarcinoma of the kidney • Symptoms: • Painless hematuria • Flank pain • Fever • Diagnosis by KUB, IVP, CT scan, and biopsy

  39. Diseases of the Kidney • Adenocarcinoma of the kidney • Treatment: • Nephrectomy • Chemotherapy • Radiation

  40. Diseases of the Bladder • Urinary incontinence • Loss of urine flow control • Types: • Stress • Urge • Overflow

  41. Diseases of the Bladder • Urinary incontinence • Treatment: • Empty bladder • Perform Kegel exercises to strengthen pelvic muscles • Have collagen injections near external sphincter to narrow urethra • Have Marshall-Marchetti-Krantz procedure

  42. Diseases of the Bladder • Transitional cell carcinoma of the bladder • Most common neoplasm of urinary tract arising from lining of bladder • Diagnosis by cystoscopy and biopsy • Treatment depends on stage of tumor, transurethral resection (TUR), and cystectomy

  43. Trauma • Straddle injuries • Neurogenic bladder

  44. Rare Diseases • Goodpasture syndrome • Interstitial cystitis • Nonbacterial cystitis due to inflammation of inner lining of bladder

  45. Effects of Aging • Urinary incontinence • Prostatic hypertrophy • Older males • Dribbling, frequency, pain or burning, and difficulty starting urine flow

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