Extra patho notes

Glomerulonephritis

infection of kidney that makes glomerus hold onto toxins and release goods and leads to inflammation (prolonged strep infection)

Glomerulonephritis problem

fluid overload

Glomerulonephritis loss of

protein and RBC

Glomerulonephritis Symtoms

• 5 cardinal

• headache

• flank pain

• urine output decrease (oliguria = < 40 ml a day to anoria (<100 ml/day)

Glomerulonephritis diagnostics

• GFR

• BUN

• Creatine

• WBC

• KUB with X-ray (large kidney bilaterally)

• CRP

Glomerulonephritis Treatment

• Tylenol for pain

• amoxycillin if allergic to penicillin

• diuretic (furosemide)

• daily weight

Cystitis (UTI)

Bacterial infection of the lower urinary causes cysts inflammation of urthra and bladder.

Cystitis (UTI) risk factors

• catheters

• females

• diabetes (sugar)

• inadequate fluid intake

• urinary retention

• non good sex hygiene

• hormonal change (pregnancy)

Cystitis (UTI) symtoms

• Suprapubic pain

• painful urination *

• alter status major symptoms to diagnosis of elderly*

• discharge in men

• pruitis

• urinary change

Cystitis (UTI) Treatment

• Tylenol for pain

• Phenazopyridine (AZO)

• drink lots of fluids

• cranberry juice or blueberry juice

CAUTI (catheter associated UTI prevention tips

• remove catheter once patient can walk

• below bladder bag

Pyelonephritis

advanced UTI that moved from bladder to kidney

Pyelonephritis (symtoms)

• everything same as UTI

• Castrovertebral tenderness

Pyelonephritis treatment

• antibiotics

• tylenol

Pyelonephritis prevention

• void after sex

• avoid bubble baths

• catheter care

• limit alcohol

Pyelonephritis increases risk for

uro sepsis

Signs of Uro sepsis

• increase HR

• worsening fever

Renal calculi (kidney stones)

hard deposits of mineral and acid salts that stick together in concentrated urine

Renal calculi (kidney stones) risk factors

• UTI

• dehydration

• urinary retention

• high calcium diet (hypercalcemia)

• high intake of purines

Stones that are due to diet

• calcium and phosphate renal calcium

• Uric acid stones

Other two stone types

• struvite stones (from UTI)

• Cystine stone (family history/genetic)

Renal calculi (kidney stones) symtoms

• colic pain *

• vommiting

• blood in pee*

• Tachycardia, HTN, unilateral

Renal calculi (kidney stones) diagnostics

• <5.5 uric stone (urinalysis)

• >7 struvite (urinalysis)

• Pus and RBC shown (urinalysis)

• CAT scan with no contrast

• cystoscopy (camera in pee hole)

• Retrograde pyelogram

• ESLW (shock waves for stones)

Renal calculi (kidney stones) Treatment

• oral/iv fluids (vommiting)

• Tylenol (pain)

• strain pee and collect stone*

Renal calculi (kidney stones) treatment continued

• stent in ureter

• neohrolithotomy scope in back that remove the kidney stones

Renal calculi (kidney stones) intervention if uric or calcium stone

• limit calcium intake

• avoid high oxalate foods

• increase fluid and citrus

Avoid these nephron toxic drugs ( NSAIDS)

• ibuprofen (Motrin)

• ketorolac (turaclol/IV)

• naproxen

Hydronephrosis

urine is backup into kidney and enlarges and inflames kidney

Hydronephrosis causes

• blood clot

• cancer

• BPH

• neurogenic bladder

• infection

• uterine prolapse

• endometriosis

Hydronephrosis diagnostic

• urinalysis

• GFR decrease

• BUN elevated

• creatine elevated

• KUB for enlargement

Hydronephrosis treatment

• urinary catherization

• meds (antibiotics for infection, analgesics for pain)

• surgical removal

Benign Prostate Hypertrophy/Hyperplasia

prostate gland starts to enlarge that compresses the urethra, causing urinary obstruction

Hydronephrosis symtoms

• steam weaken

• dribbling

• hesitance

• incomplete empty

Hydronephrosis insect and palpate

• inspect; mass on pubic

• palpate; enlarge warm prostate

Hydronephrosis diagnosis

Biopsy

Hydronephrosis treatment

• meds (proscar/ Flomax, doxazosin/ cardura, silodosin/ rapaflo, tadalafil/ calls, tamsulosin/flomax, teraozin/hytrin)

• remove prostate

Incontinence

unintentional loss of urine

Incontinence risk factors

• postpartum

• menopause

• BPH

• prostatic cancer

• increase age/weight

• smoking

• UTI/ family history

• neuro disorder

Incontinence types

• stress (pee when laugh,cough)

• urge (have too pee badly)

• overflow (bladder can’t empty)

• mixed (stress and urge)

Incontinence treatment

• kegal exercises (hold for 5 seconds then relax then hold for 10)

• dietary (no more water after 8pm_

• urinating every 2-3 hours

• meds (oxybutynin (ditropan XL), tolerodine (detrol), migrabegron/ myretriq)

• keep skin clean and dry

Bladder cancer

tumor of the bladder due to mitotic division

Bladder cancer risk factor

• smoking

• chemical exposure

• chronic irritation

• decrease fluid

• old age

Bladder cancer symptoms

• painless hematuria *

• pubic pain

• flank pain

• weight loss

Bladder cancer Diagnostic

• cystoscopy and biopsy *

• MRI

• Urinalysis

Syndrome of inappropriate antidiuretic hormone (soaked inside)

a disorder that excess ADH

Syndrome of inappropriate antidiuretic hormone (soaked inside) reasoning

antidiuretic to high causing inappropriately hold on water so that’s making patient not pee and sodium gets diluted

Syndrome of inappropriate antidiuretic hormone (soaked inside) signs

• decrease urinary output

• increase blood volume

• decrease sodium (NEURO ISSUE)

• increase potassium (NEURO ISSUE)

Syndrome of inappropriate antidiuretic hormone (soaked inside) cause

trauma too head

Syndrome of inappropriate antidiuretic hormone (soaked inside) treatment

• diuretics

• fluid restriction *

• daily weight

Diabetes Insipidus

Deficient ADH (losing way too much water)

Diabetes Insipidus signs

• increase urinary output

• decrease blood volume

• decrease blood pressure

• increase sodium

• decrease potassium

Diabetes Insipidus vitals

• hypertension

• hyperthermia

• tachycardia

Diabetes Insipidus diagnostic

• increase serum sodium

• BUN increase

Diabetes Insipidus treatment

• synthetic vasopressin (nasal spray, injection)

• increase fluids

• daily weights (need to gain)

Hyperthyroidism

overproduction fo thyroid hormone (hormone T3,T4)

Hyperthyroidism process

• when T3 and T4 is low it triggers process

• hypothalamus talks to anterior pituitary and releases TSH in blood supply and travels to thyroid TSH gland and stimulates T3 and T4

T3 and T4 facts

• T3 and T4 are metabolic rate (gas pedal for your metabolism)

• hyper = too fast T3 and T4

• hypo= too slow T3 and T4

Hyperthyroidism primary

decrease of TSH due to antibodies attaching the thyroid and acting as T3 and T4 and stimulating it to release

Hyperthyroidism secondary

tumor in anterior pituitary increase TSH

Hyperthyroidism treatment

• Beta blockers

• daily weight

• tumor removed

• antithyroid meds (shrinks and destroys thyroid)

• remove thyroid glands

Hypothyrodism

low T3 and T4

Hypothyrodism problem

antibodies don’t stimulate they shrink and destroy T3 and T4 and anterior pituitary try to jump start it to get it back but TSH gets increase levels

• increase TSH, decrease T3 and T4

Hypothyrodism signs

• loss of thyroid tissue (after surgical removal hyper became hypo)

• meds (lithium, antithyroid, radiation from cancers)

Hypothyrodism Secondary

tumor in anterior pituitary that suppresses TSH (decrease T3, T4, TSH)

Hypothyrodism Symptoms

• cold skin

• weight gain

• bradycardia (fluids needed)

• enlarged heart

• constipated

• dry skin

Hypothyrodism treatment

• sythroid and levothyroxine for loss of hormone

• teach patient about symptoms of hypothyroidism

Cushing Disease

stress hormones in the adrenal cortex are all high (cortisol, aldosterone, androgens)

Cortisol

increase blood sugar, turn off go tract/immune system/reproductive

Cushing Disease primary

tumor in adrenal cortex and increases all hormones but decreases ACTH from anterior pituitary

Cushing Disease treatment

adrenalectomy

Cushing Disease secondary

increases all hormones and increases ACTH (bronze skin)

Cushing Disease signs due to taking steroids daily

• buffalo hump

• moon face

• skin fragile and can rip

Cushing Disease symptoms

• hypertension

• remove tumor (2 = remove from nose 1 = remove from adrenal gland)

• sugar (diet, insulin)

• edema (aldosterone)

Cushing Disease diagnosis

• increase sodium

• decrease potassium

• increase glucose

• increase cortisol

• CT/MRI *

Addison’s primary

tumor in adrenal cortexall hormones decrease, ACTH increases

Addison’s secondary

tumor in anterior pituitary that suppresses ACTH, and decreases all hormones

symtoms for Addison’s secondary

transphenoid surgery

Addison’s diagnostic

• increase potassium

• decrease sodium

• decrease glucose

Addison’s classic symtoms

fatigue (can’t respond to stressors)

Addison’s symptoms

• alopecia

• emaciation (extremely thin)

• HTN

Addison’s Treatment

• HTN (fluids)

• Increase calorie count (more sugar and salt)

• hydrocortisone

Insulin dependent Diabete Mellitus (IDDM)

Your body does NOT make insulin at all so sugar is stuck in blood

Beta cells make

insulin

alpha cells make g