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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 to transport urine Bladder Muscular organ that holds urine Urethra Carries urine to outside of body.

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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 to transport urine Bladder Muscular organ that holds urine Urethra Carries urine to outside of body

  3. 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

  4. Common Signs and Symptoms Hematuria Pyuria Proteinuria Dysuria Nocturia Oliguria Anuria Frequency/urgency

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

  6. Diagnostic Tests Intravenous pyelogram (IVP) Cystogram Cystoscopy Bladder and kidney biopsy Catheterization

  7. Cystoscopy

  8. Urinary Tract Infections (UTIs) Broad diagnosis covering infections of urinary tract that includes urethra, bladder, and kidneys Most often caused by bacteria Can be caused by viruses and fungi E. coli is the most common bacteria found in UTIs

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

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

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

  12. UTIs Cystitis Inflammation of bladder Also known as bladder infection Honeymoon cystitis Occurs in females as they become sexually active Treatment usually antibiotics Antispasmodic medications may decrease bladder spasms E.g., Pyridium May cause urine to turn reddish-orange and stain clothing After treatment, urine C&S to determine elimination of bacteria

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

  14. UTIs Pyelonephritis May be due to ascending or hematogenous infection May affect one or both kidneys Symptoms: Sudden onset of fever and chills Flank pain Hematuria Treated effectively with antibiotics

  15. Diseases of the Kidney Acute glomerulonephritis Inflammation of glomerulus or filtering unit of kidney Most common kidney disease that occurs 1 to 4 weeks after strep infection Not suppurative, inflammation is a result of tissue destruction caused by immune system (antigen–antibody reaction)

  16. Diseases of the Kidney Acute glomerulonephritis Symptoms: Flank pain Fever Loss of appetite Malaise Edema of eyes and ankles Oliguria Hematuria

  17. Diseases of the Kidney Acute glomerulonephritis Treatment: Antipyretic Diuretic Salt restriction Protein restriction Fluid restriction Prevention Prompt and proper antibiotic treatment for streptococcal infections

  18. Diseases of the Kidney Chronic glomerulonephritis Repeated bouts of acute glomerulonephritis lead to chronic condition include those of acute glomerulonephritis plus hypertension Uremia may occur during late stages Treatment: Control hypertension Dietary restrictions End stage may require hemodialysis or kidney transplant

  19. 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

  20. Hydronephrosis

  21. 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 “Worst pain in life”

  22. Renal Calculi

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

  24. 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 Treatment: Management of hypertension and UTIs Dialysis and kidney transplant

  25. Diseases of the Kidney Renal failure Failure of kidneys to cleanse blood of waste products May be acute or chronic Symptoms Not significant until 75% of kidney function destroyed Acute symptoms plus Infertility / impotence Bone weakness / fractures Diagnosis Creatinine and BUN

  26. 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 Long-term treatment: Dialysis Transplant

  27. Arteriovenous (AV) Shunts

  28. Diseases of the Kidney Adenocarcinoma of the kidney Risk factor: Cigarette smoking Frequently metastasizes to liver, brain, and bone before symptoms appear Symptoms: Painless hematuria Flank pain Fever Diagnosis by KUB, IVP, CT scan, and biopsy

  29. Diseases of the Kidney Adenocarcinoma of the kidney Treatment: Nephrectomy Chemotherapy Radiation Prevention – may not be preventable Might be helpful to control risk factors such as: Not smoking Increase intake of fruits and vegetables Stay active; maintain normal body weight Control blood pressure

  30. Diseases of the Bladder Urinary incontinence Loss of urine flow control Common in females age 60 and older Types: Stress Urge Overflow

  31. Diseases of the Bladder Urinary incontinence Diagnosis Urinalysis CBC Urodynamic testing Postvoid residual volumes Treatment: Kegel exercises to strengthen pelvic muscles Collagen injections near external sphincter to narrow urethra Marshall-Marchetti-Krantz procedure

  32. Diseases of the Bladder Transitional cell carcinoma of the bladder Most common neoplasm of urinary tract Arises from lining of bladder Usually occurs in males after age 60 Risk factor is cigarette smoking Diagnosis by cystoscopy and biopsy Treatment Depends on stage of tumor Transurethral resection (TUR) Radical cystectomy

  33. Trauma Straddle injuries Commonly cause injury to the urethra More common in males Accidents include walking a fence or beam, riding a horse or motorcycle Neurogenic bladder Dysfunction of the bladder related to nervous system injury Spinal cord injury – MVA Other causes – stroke, herniated lumbar disks, diabetes

  34. Rare Diseases Goodpasture’s syndrome An autoimmune disorder characterized by glomerulonephritis and pulmonary hemorrhage Interstitial cystitis Nonbacterial cystitis due to inflammation of inner lining of bladder

  35. Effects of Aging Urinary incontinence The most common problem Prostatic hypertrophy Older males Dribbling, frequency, pain or burning, and difficulty starting urine flow

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