Patho Exam 3 (Urinary/Reproductive)

What does the urinary system regulate?

fluid volume, BP, metabolic waste and drug excretion, vit D conversion, acid-base balance, hormone synthesis

Where are the kidneys located?

either side of the vertebrae in retroperitoneal space

Define renal capsule.

connective tissue surrounding the kidney

Define renal cortex.

area immediately beneath the capsule, which contain nephrons

Define renal artery.

supplies each kidney with blood

Define renal hilum.

opening in the kidney, renal artery and nerves enter, renal vein and ureter exit

Define renal sinus.

cavity forms the renal pelvis

Define calyces.

tubes through which urine drains into the renal pelvis

Define ureters.

transport urine from calyces to bladder

Define bladder.

muscular structure that serves as a reservoir for urine until it can be excreted

Define urethra.

transports urine from bladder to urinary meatus, 1.5in long in women and 6-8in long in men

What are nephrons responsible for?

functional unit, multiple sections, filtering specific substances

Define Bowman’s capsule.

double membrane surrounding glomerulus

Define glomerulus.

cluster of capillaries, blood enters through afferent arteriole and leaves through efferent

Define ADH in regards to nephron function.

increases water permeability and reabsorption in last segment of distal tubule and along the entire length of collecting ducts

Define aldosterone in regards to nephron function.

stimulates the epithelial cells of the distal tubule and collecting duct to reabsorb sodium and increases the excretion of potassium and hydrogen ion

Define natriuretic peptides in regards to nephron function.

ANP and BNP inhibit sodium and water absorption by kidney tubule, inhibit secretion of renin and aldosterone, vasodilate afferent arterioles, constrict efferent arterioles (results in increase urine formation leading to decrease in blood volume and BP)

Define diuretics in regards to nephron function.

interfere with renal sodium reabsorption and reduce extracellular fluid volume

Define spermatogenesis.

generates and transports sperm

What are the structures of the male reproductive system?

penis, scrotum, testes, duct system, and accessory glands

Define foreskin.

sheath of loose skin covering the penis

Define smegma.

oily secretion produced by the glans combined with dead skin

Define meatus.

opening in the glans that allow for ejaculation and urination

Define ejaculation.

propulsion of sperm-containing fluid

Define scrotum.

sac of skin that contain testes, epididymis, and lower spermatic cords; maintain testicular temp for spermatogenesis

Define testes.

produce sperm and sex hormones, spermatogenesis develops in most males by age 16, epididymis stores sperm until ejaculation, testosterone

What are the structures of the duct system in the male reproductive system?

epididymis, vas deferens, spermatic cord, ejaculatory duct, urethra

What are the glands included in the accessory glands of the male reproductive system?

prostate gland and Cowper’s gland

What are the functions of the female reproductive system?

oogenesis (generation), ovulation (transport), impregnation (fertilization), gestation (fetal development), parturition (delivery of fetus), lactation

What structures are included in the female reproductive system?

ovaries, fallopian tubes, uterus, vagina, external genitalia, mammary glands

What is enuresis?

involuntary urination by a child after 4-5 years, nocturnal, causes can be psychological and structural

What is overactive bladder?

urge incontinence; sudden and intense urge to urinate followed by an involuntary loss of urine

What are the causes overactive bladder?

UTI, bladder irritants, bowel conditions, smoking, Parkinson’s disease, Alzheimer’s disease, stroke, injury, and nervous system damage

What is reflex incontinence?

urinary incontinence caused by trauma or damage to the nervous system, detrusor hyperreflexia, urgency is generally absent

What is mixed incontinence?

occurs when symptoms of more than one type of urinary incontinence are experienced

What is overflow incontinence?

inability to empty the bladder or retention, dribbling urine and a weak urine system, chronic overdistension

What are the causes of overflow incontinence?

bladder damage, urethral blockage, nerve damage, and prostate conditions

What is functional incontinence?

occurs in many older adults who have a physical or mental impairment that prevents toileting in time

What is transient incontinence?

urinary incontinence resulting from a temporary condition

What are the causes of transient incontinence?

delirium, infection, atrophic vaginitis, certain meds (diuretics and sedatives), psychological factors, high urine output, restricted mobility, fecal impaction, alcohol, caffeine

What is gross total incontinence?

continuous leaking of urine, day and night, or the periodic uncontrollable leaking of large volume of urine; bladder has NO storage capacity

What are the causes of gross total incontinence?

anatomic defects, spinal cord or urinary system injuries, fistulas between the bladder and an adjacent structure (such as vagina)

What are the risk factors for incontinence?

female gender, advancing age, being overweight, smoking, renal disease

What are the complications of incontinence?

skin breakdown, recurrent UTIs, negative psychological consequences, interruption of usual activities

What is neurogenic bladder?

bladder dysfunction caused by an interruption of normal bladder nerve innervation

What are the causes of neurogenic bladder?

brain or spinal cord injury, nervous system tumors, brain or spinal cord infections, dementia, Parkinson’s, spina bifida, DM, stroke, meds, vaginal childbirth, MS, chronic alcoholism, systemic lupus erythematosus, heavy metal poisoning, herpes zoster

What are the manifestations of neurogenic bladder?

symptoms of an overactive and underactive bladder

What is interstitial cystitis/bladder pain syndrome?

chronic bladder condition, more common in women and aging people, causes pain and pressure in suprapubic/pelvic/abdominal area, exact cause unk;5% experience symptoms for 2+ years and 5% develop end stage disease where bladder hardens, capacity is low, and pain worsens

What are the manifestations of interstitial cystitis/bladder pain syndrome?

pain in urinary tract (often worse w pressure), frequency and nocturia, urgency (often constant, worsened by stress), sexual dysfunction

What are urinary tract infections?

most common bacterial infections encountered in clinical practice, most commonly an ascending infection

What are the risk factors of UTIs?

female, sexually active, use of diaphragm with spermicide, hx of DM, recent instrumentation (catheters), structural abnormalities, improper personal hygiene, immobility

What are cystitis UTIs?

infections in bladder, bladder and urethra walls become red and swollen, bacteria ascent to the bladder via urethra and possibly further up to the kidneys, E. coli accounts for 75-95% of UTIs; infections and irritants

What are the typical manifestations of lower UTIs?

burning on urination, urgency, dysuria, frequency, low back pain, foul smelling urine, cloudy urine, hematuria, fever

What are the typical manifestations of upper UTIs?

flank pain, fever, N/V, increased BP, may have symptoms of cystitis

What is pyelonephritis?

acute or chronic infection that has reached one or both kidneys, kidneys become grossly edematous and fill with exudate compressing renal artery and potentially developing abscesses or necrosis

What are the complications of pyelonephritis?

renal failure, recurrent UTIs, sepsis

What are the manifestations of pyelonephritis?

severe UTI symptoms, flank pain, and increased BP

What are renal and urinary calculi urinary tract obstructions?

presence of renal calculi, hard crystals compressed of minerals that the kidneys normally excrete, in real pelvis, ureters, or bladder; more common in men and white people; most frequent type contain calcium

What are the risk factors for renal and urinary calculi urinary tract obstructions?

pH changes, excessive concentration of insoluble salts in urine, urinary stasis, family hx, obesity, hypertension, diet

How are renal and urinary calculi urinary tract obstructions described?

calcium oxalate (most common), calcium phosphate (alkaline urine, hyperparathyroidism), struvite (UTIs, proteus organisms), uric acid (gout), cystine (acidic urine)

What are the manifestations of renal and urinary calculi urinary tract infections?

colicky pain in flank area that radiated to lower abdomen and groin, bloody urine, cloudy urine, foul smelling urine, dysuria, frequency, genital discharge, N/V, fever, chills

What is hydronephrosis urinary tract obstructions?

abnormal dilation of renal pelvis and calyces of one or both kidneys

What are the causes of hydronephrosis urinary tract obstructions?

urolithiasis, tumors, benign prostatic hyperplasia, strictures, stenosis, congenital urologic defects

What are the complications of hydronephrosis urinary tract obstructions?

atrophy, necrosis, glomerular filtration cessation

What are the manifestations of hydronephrosis urinary tract obstructions?

colicky, flank pain or pressure, bloody urine, cloudy urine, foul smelling urine, dysuria, decreased urine output, frequency, urgency, N/V, abdominal distension, UTIs

What is renal cell carcinoma?

most frequently occurring kidney cancer in adults; metastasis to liver, lungs, bone, or nervous system is common

What are the risk factors of renal cell carcinoma?

male, smoking, obesity, HTN, other kidney disease

What are the manifestations of renal cell carcinoma?

asymptomatic in early stages, painless hematuria, abnormal urine color, dull and achy flank pain, urinary retention, palpable mass over the affected kidney, unexplained weight loss, anemia, polycythemia, HTN, paraneoplastic syndromes, fever

What is bladder cancer?

metastasis is common to pelvic lymph nodes, liver, and bone; recurrence in about 40% of cases

What are the risk factors of bladder cancer?

advancing age, men, white ppl, working with chemicals, smoking, excessive use of analgesics, experiencing recurrent UTIs, long term catheter placement, chemotherapy, radiation

What are the manifestations of bladder cancer?

painless hematuria, abnormal urine color, frequency, dysuria, UTIs, and back or abdominal pain

What is benign prostatic hyperplasia?

common, nonmalignant enlargement of the prostate gland that occurs as men age; exact cause is unk, may result in urinary stasis and UTIs; declining T and increasing E, as prostate expands in presses against the urethra and obstructs urine flow

What are the manifestations of benign prostatic hyperplasia?

frequency, urgency, retention, difficulty initiating urination, weak urinary stream, dribbling urine, nocturia, bladder distension, overflow incontinence, ED

What is polycystic kidney disease?

inherited disorder characterized by numerous grape like clusters of fluid filled cysts in both kidneys, cysts enlarge the kidneys while compressing and eventually replacing the functional kidney tissue; exact trigger unk

What are the manifestations of polycystic kidney disease?

hematuria and nocturia, drowsiness

in neonates: potter facies, large/symmetrical masses on flank, respiratory distress

in adults: HTN, abdominal girth/swelling/tenderness, grossly enlarged/palpable kidneys

What are the complications of polycystic kidney disease?

pyelonephritis, cyst rupture, retroperitoneal bleeding, renal failure, anemia, HTN, renal calculi

What is glomerulonephritis?

acute or chronic bilateral inflammatory disorder of the glomeruli that typically follows a streptococcal infection, leading cause of renal failure, affects more men than women. inflammatory changes impair kidneys ability to excrete waste and excess fluid, nephritic and nephritic syndromes are more prevalent forms

What is nephrotic syndrome?

results from antibody-antigen complexes lodging in the glomerular membrane triggering activation of the complement system, glomeruli do not properly filter the protein albumin; increased glomerular capillary permeability leading to proteinuria, lipiduria, hypoalbuminemia, anasarca

What are the causes of nephrotic syndrome?

systemic disease, gold therapy, idiopathic

What are the manifestations of nephrotic syndrome?

hypoalbuminemia, dark and cloudy urine, immunoglobulins in urine

What are the complications of nephrotic syndrome?

risk for infection and atherosclerosis

What is nephritic syndrome?

inflammatory injury to the glomeruli that can occur because of antibodies interacting with normally occurring antigens in glomeruli, glomeruli do not properly filter RBCs

What are the causes of nephritic syndrome?

diseases that initiate the inflammatory response

What are the manifestations of nephritic syndrome?

gross hematuria, urinary casts and leukocytes, low GFR, azotemia (increased BUN & Cr), oliguria, high BP

What are the complications of nephritic syndrome?

impaired renal functions

What is acute kidney injury?

sudden loss of renal function, often critically ill hospitalized patients, generally reversible

Define prerenal conditions regarding acute kidney injury.

extremely low BP or blood volume, cardiac dysfunction

Define intrarenal conditions regarding acute kidney injury.

reduced blood supply in kidneys, hemolytic uremic syndrome, renal inflammation, toxic injury

Define postrenal conditions regarding acute kidney injury.

ureter obstruction, bladder obstruction/dysfunction

What are the risk factors of acute kidney injury?

advancing age, autoimmune disorders, liver disease

What are the phases of acute kidney injury?

1. asymptomatic

2. oliguric: daily output <400ml, electrolyte disturbances, fluid volume excess, azotemia, metabolic acidosis

3. diuretic: daily output >5L, electrolyte disturbances, dehydration, hypotension

4. recovery: glomerular function gradually returns to normal

What is chronic kidney disease?

gradual loss of renal function that is irreverible

What are the causes of chronic kidney disease?

DM, HTN, urine obstruction, renal diseases, renal artery, stenosis, ongoing exposure to toxins and nephrotoxic meds, sickle cell disease, systemic lupus erythematosus, smoking, advancing age

What are the stages of chronic kidney disease?

stage I: damage present but GFR >90

stage II: damage worsens as GFR falls (60-89)

stage III: function significantly impaired as GFR is between 30-59

stage IV: function barely present with GFR 15-29

stage V: failure as GFR is less that 15, pt begins dialysis

What are the manifestations of chronic kidney disease?

HTN, polyuria with pale urine, oliguria or anuria with dark color, anemia, bruising and bleeding, muscle twitches and cramps, electrolyte imbalances, pericarditis, pericardial effusion, pleuritis, pleural effusion, congestive heart failure, respiratory distress, abnormal breath sounds, sudden weight change, edema of feet and ankles, azotemia, peripheral neuropathy, restless leg syndrome, seizures, N/V, anorexia, malaise, fatigue and weakness, headache, sleep disturbances, decreased mental alertness, flank pain, jaundice, persistent pruritus, recurrent infections

What is end stage renal disease?

final/permanent stage of chronic kidney disease (GFR<15), kidneys unable to excrete metabolic wastes and regulate fluid and electrolyte balance adequately, may require dialysis or renal transplant to survive

What is epispadias?

urethral meatus occurs in dorsal surface on penis and may extend the entire length of the penis (can also be on clitoris of females), more likely to cause urination and sexual dissatisfaction, increased risk for UTIs

What is hypospadias?

urethral meatus located on ventral surface of the penis and extending length of penis, risk increases with maternal factors (age, obesity, fertility tx, hormone therapy), does not usually affect females; cause is mostly unk

What is cryptorchidism?

one or both testes do not descent from abdomen to scrotum

What are the risk factors for cryptorchidisim?

prematurity, low birth weight, small size for gestational age, family hx of problems of genital development, multiple fetuses, maternal estrogen exposure during 1st trimester, maternal alcohol use, maternal cigarette smoking or secondhand exposure, maternal diabetes, parental exposure to pesticides