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PC705- Module 8

Terms in this set (95)

Age Related Changes in Renal Function
Decreased kidney size, RBF & GFR, number of nephrons from renal perfusion changes, tubular transport, elimination of drugs, increased sclerotic glomerular capillaries-they are scared or hardened, excretion of glucose, and bladder systems-urgency, frequency, & nocturia
Plasma Creatinine
Normal 0.7-1.2
produced in the muscles. most valuable in monitoring chronic than acute. measures progressive renal dysfunction
Plasma Cystatin C concentration
Plasma protein is freely filtered at the glomerulus.
measures progressive renal dysfunction
Blood Urea Nitrogen: BUN
Normal for adult- 10-20.
Measures altered protein intake & catabolism.
POOR MEASURE of GFR.
Indicator of hydration Status-goes up with dehydration & kidney failure
Urinalysis
Leukocyte esterase & Nitrates-UTI. Protein- change in kidney: HTN & DM [nephropathy].
Casts- accumulation of cell precipitates-makes a sleeve in tubercle of kidney
KUB- x-ray
Hydronephrosis, kidney stones if Calcium
Intravenous urography/pyelography -IVP
Iodine dye flows through the system & is monitored as it is excreted.
The dye is neurotoxic so increased hydration is important.
Voiding Cystourethrogram- VCUG
Fluoroscopy looks at how urinary tract is flowing.
Catheter injected with contrast then they watch the patient void- looking for amount and if reflux exists
Hypospadias
Urethral meatus is on the ventral side of the penis- under side
Epispadias
Males: urethral opening is on the dorsal or top surface of the penis.
Females: cleft along the ventral urethra. usually extends to the bladder neck
Renal Agenesis/ Potter's Disease
One or both kidneys absent. unilateral is usually on left, bilateral is incompatible with life.
Facial anomalies- parrot beak nose, wide set eyes, low ears, & a receding chin.
Maternal- oligo- secondary to decreased or absent fetal urine output
Autosomal Recessive Polycystic Kidney Disease
Evident at birth with enlarged kidneys with multiple cysts.
Cystic changes in kidneys & liver will lead to need for renal replacement therapy during childhood/adolescents.
They will have systemic HTN.
Chromosomal abnormality in 6P
Autosomal Dominant Polycystic Kidney Disease
Cyst formation & obstruction accompanied by destruction of renal parikrama or body of kidney and interstitial fibrosis & loss of nephrons.
Most common form, be symptomatic later in life, 30's +.
Affects males and females and all races.
PKD1 on chromosome 16 & PKD2 on chromosome 4
Nephroblastoma- Wilms Tumor
Most common kidney cancer in children- <5, peak 2-3 years old.
Embriol tumor from proliferation of abnormal renal stem cells - metanephric blastema.
3 cellular components : Stromal, Epithelial, Blastemal.
Inherited and sporadic forms
Wilms Tumor Continued
2-hit hypothesis: 1 allele mutation of a tumor suppressor gene. only needs 1 more to cause the tumor. Manifestations: ranges from enlarging, asymptomatic upper abdominal mass in healthy child[most common], vague abdominal pain, hematuria, fever, and HTN.
WT1 is on chromosome 11.
Excellent cure rate.
Acute Pyelonephritis- mostly in women
Etiology: coliform, E-coli, WBC's & casts present.
Patho: acute infection of the ureter, renal pelvis, &/or renal parenchyma.
Manifestations: very sick, flank pain, fever/chills, CVA tenderness, purulent urine, decreased appetite, dehydration.
Acute Glomerulonephritis
Patho: immune complexes, antibodies, complement.
Manifestations: decreased GFR perfusion-blood flow as a result of inflammation, glomerular scarring, thickening of basement membrane, increased permeability to protein & RBC's leading to loss of protein
Berger Disease- most common type of glomerulonephritis in adults
Etiology: binding of IgA to mesangial in the glomerulus lead to injury and mesangial proliferation.
S/S: hematuria- RBC casts, smoky brown urine, proteinuria- 3-5 gm/day, low serum albumin, edema, nephrotic sediment- proteins & lipids, nephritis sediment- blood, RBC & WBC casts & protein
Children- post streptococcal infection
After throat infection with strep A, antigen/antibody complexes & compliment occur. Deposited on the glomerulus & initiate inflammation & glomerular injury. Type III hypersensitivity.
S/S: sudden hematuria, proteinuria, salt & water retention= edema & HTN, severe cases: Azotemia- decreased GFR
Nephrolithiasis Risks
greater than 50 years old, DEHYDRATION, diet high in phosphorus- chips & soda= lead to calcium stones, acidic food can lead to uric acid stones
Nephrolithiasis Etiology
Stones are made of crystals, proteins, & mineral salts.
Block from the renal pelvis to the ureter.
Calcium is the most common type of stone. 70-80%- calcium oxalate or calcium phosphate
Nephrolithiasis Manifestations
Hydronephrosis/hydro ureter or both.
Tubulo interstitial fibrosis or cellular destruction & death or nephrons of kidney.
Renal colic comes & goes as stone is trying to move.
Magnesium & potassium citrate will help prevent stone formation
Ureterolithiasis
stone in ureter
Overactive Bladder- OAB- chronic syndrome of detrusor muscle or over activity in the absence of infection. Risk for UTI's & risk for falls in older adults.
S&S: urgency with involuntary detrusor contractions during bladder filling.
Spontaneous/provoked, associated with hyperexcitable nerves, involuntary reflexes, frequency, & nocturia. Detrusor too weak to empty the bladder. overflow or stress incontinence.
Urge Incontinence- most common in older adults. Involuntary loss of urine associated with an abrupt & strong desire to void.
Often associated with involuntary contractions of the detrusor. When associated with neurologic disorder= detrusor hyperreflexia. No neurologic disorder= detrusor instability. May be associated with decreased bladder wall compliance.
Stress Incontinence- most common in women <60 & men with prostate surgery
Involuntary loss of urine during coughing, sneezing, laughing or other physical activity associated with increased abdominal pressure.
Overflow Incontinence
Involuntary loss of urine with over distention of the bladder. Associated with neurologic lesions below S1, polyneuropathies, & urethral obstruction- like an enlarged prostate
Mixed Incontinence- most common in older women
A combination of stress & urge incontinence
Functional Incontinence
Involuntary loss of urine caused by dementia or immobility
Enuresis- urinary incontinence mostly in children: nighttime wetting. Involuntary passage of urine by a child who is beyond the age when voluntary bladder control should've been acquired, usually before age 5.
Influenced by culture/parents.
Daytime & Nighttime incontinence can occur together.
Boys more than girls.
Causes: organic behavior, physiologic & psychological.
Genetics possible factor- high frequency among parents & siblings
Cystitis- infection/inflammation of bladder epithelial lining. caused by coliform bacterial infections such as e coli or pseudomonas.
Risks: premature infants, females, spermicide users, antibiotic treatment, catheters, hormone deficient, DM, & bladder dysfunction.
S&S: asymptomatic in pregnancy & elderly, dysuria, frequency, burning, low back pain, & supra pubic pain. Elderly- lethargy, confusion, anorexia, & anxiety
Urinary Tract Infection- UTI
inflammation of the urinary epithelium after invasion and colonization by some pathogen in the urinary tract
UTI Causes and Manifestations
Causes: Bacteria enters the urethra then travels to the bladder and may progress to ureters and eventually to the kidney.
S&S: dysuria, frequency, burning, low back pain, and supra pubic pain
Interstitial Cystitis
Chronic condition in women aged 20-30 that may be an autoimmune derangement of the bladder mucosa with Hunner ulcers.
Nonbacterial can be from radiation or chemical drugs
Interstitial Cystitis Causes & Manifestations
Cause: cystitis for > 6 weeks with a negative urine culture.
S&S: chronic & very painful, decreased bladder capacity, scarring of the bladder lining
Vesicoureteral Reflux
Reflux from the bladder to the kidneys with potentially infected urine and may lead to frequent pyelonephritis.
Pyelonephritis- graded from 1-5 with the lower grades resolving spontaneously
Vesicoureteral Reflux Causes & Manifestations
Congenital abnormality or ectopic insertion of the ureter into the bladder. Family history of VR or frequent UTI's.
Diagnosis: voiding cystourethrogram, intravenous pyelogram.
S&S: asymptomatic or recurrent UTIs or unexplained fever, irritability, feeding problems, poor growth & development
Kidney Stones
Renal colic- moderate to severe pain often originating in the posterior flank & radiating to the groin= obstruction of the renal pelvis or proximal ureter.
Colic radiates to the lateral flank or lower abdomen= obstruction in mid ureter.
Urgency, frequent voiding, urge incontinence (lower tract symptoms)= ureter or ureterovesical junction obstruction.
May be accompanied by N/V, gross blood in urine or microscopic hematuria
Neurogenic Bladder
Overactive or hyper-reflexive bladder
Overactive Bladder
urgency, frequency, urge incontinence, increased risk for urethral turbulence and UTI
Underactive Bladder
retention of urine, bladder distention. symptoms of stress and overflow incontinence
Obstruction of Urine Flow- Tumors
Renal- hematuria, dull & aching flank pain, & palpable flank mass in thinner individuals. Elderly- weight loss, fatigue, intermittent fever, anemia, polycythemia, HTN, alterations in liver function.
Bladder- gross painless microscopic hematuria, lower UT symptoms, daytime voiding frequency, nocturia, urgency, urge urinary incontinence. Flank pain if tumor obstructs.
Acute Cystitis
inflammation of bladder: frequency, dysuria/painful urination, supra pubic & low back pain, hematuria, cloudy & foul smelling urine, flank pain. 10% of people have no symptoms. Elderly may be confused & have vague abdominal discomfort.
Acute Pyelonephritis
infection of one or both upper urinary tracts, ureter, renal pelvis, kidney interstitium. acute onset, fever, chills, flank or groin pain, frequency, dysuria, costovertebral tenderness. Elderly- low-grade fever and malaise.
Chronic Pyelonephritis
persistent or recurrent infection leads to scarring of kidney. frequency, dysuria, flank pain, HTN, inability to conserve NA leads to hyperkalemia & metabolic acidosis. Progression to renal failure.
Nephrotic Syndrome
Edema, hyperlipidemia, lipiduria, vitamin D deficiency, hypothyroidism, and thromboembolic events, particularly in young adults.
Acute Kidney Injury
symptoms depend on underlying cause/trauma= rapid increase in BUN, hyperkalemia, metabolic acidosis. Fluid retention may cause edema, symptoms of CHF, N/V, diarrhea accompany fatigue, uremia, and electrolyte imbalance.
Acute Kidney Injury Phases
Initiation phase- reduced perfusion or toxicity, 24-36 hours.
Maintenance or oliguric phase- established renal injury/dysfunction, week to months. Urine output is lowest during this phase, increased creatinine, BUN, & potassium. Metabolic acidosis, salt & water overload. Anuria.
Recovery phase- interval when renal injury is repaired. GFR returns to normal, diuresis, decreased creatinine, increased creatinine clearance. Polyuria. Risk for hypokalemia. Return to normal may take 3 to 12 months.
Chronic Kidney Disease
Azotemia & uremia. Alterations in fluid & electrolytes, metabolic acidosis, anemia, hypophosphatemia, hypokalemia, HTN, anorexia, N/V, diarrhea, constipation, malnutrition & weight loss, pruritus, edema, neurologic and cardiovascular disease, and skeletal changes.
Azotemia
increasing levels of serum urea, creatinine, and other nitrogenous compounds.
Uremia
pro-inflammatory state
Age-related changes to the skin
Structurally, skin becomes thinner, less elastic, drier, and wrinkled with a change in pigmentation. Cellular changes: flattening of dermoepidermal junction with a shortening and decrease in number of capillary loops. Fewer melanocytes, resulting in decreased UV protection.
Age-related changes to skin
Decreased Langerhans cells reduces skin's immune response. Thickness of dermis reduced causing paper-thin translucent skin. Dry skin: decreased vasculature, lymphatic drainage, atrophy of eccrine, apocrine, and sebaceous glands. Wrinkling- loss of elastin. Decreased ability to stretch: collagen fibers become fragmented and fibroblasts decrease in number.
Age-related changes to skin
Delayed wound healing: decreased cell proliferation, diminished blood supply, depressed immune responses. Graying: loss of melanocytes from hair bulbs. Hair thinning from gradual decline in number of hair follicles and growth of finer hair. Epidermal cells change shape, barrier function of stratum corneum is reduced.
Age-related changes to skin
Increased permeability and decreased clearance of toxic oxidative substances from dermis related to decreased vascularity and can cause skin irritation. Temperature regulation compromised with increased risks for heat stroke and hypothermia. Sensory perception reduction- pressure and touch receptors and free nerve endings decrease in number. Infection and delay in would healing.
Alopecia
Autoimmune disorder with well demarcated hair loss and baldness. Variation in the androgen receptor gene that clusters in families. Can be related to low estrogen levels in women.
Hirsutism
Excessive androgen hormone as seen in PCOS. Facial, body, and pubic hair in a male pattern.
Paronychia- Acute or chronic infection of the cuticle
Staphylococci, Streptococci, & occasionally candida. Acute: rapid onset, painful inflammation of the cuticle after minor trauma. Abscess may form needing I&D. Chronic: slow development with tenderness & swelling around the proximal or lateral nail fold. Skin: edema, painful, pus with infection, nail plate may get discolored and develop ridges with chronic infections.
Onychomycosis- fungal or dermatophyte infection of the nail plate
Turns yellow or white- infection. elevated as a result of the accumulation of hyperkeratotic debris within the plate.
Herpes Simplex- Type 1 cold sores; can also have in genital area. Type 2 genital.
Initial or prodromal- fever, aches, and pains. Recurrence: burning and tingling. Vesicles: redness and erythema, crusts form over the ulcer after rupture. Treatment: antiviral and analgesia.
Herpes zoster
Chickenpox caused by Varicella zoster virus. Starts off with dew drop vesicles then they scab over.
Shingles (also varicella zoster virus)
Acute localized unilateral inflammation. Runs along a dermatomal area of the skin. Very painful.
Warts- Verrucae
Benign from the DNA papillomavirus. Stratum corneum is irregularly thickened. Most will resolve on their own depending on immune system.
Measles, 7 day hard measles, or Rubeolla
Viral. Macular blotchy on face, moving to limbs. Koplic spots on the oral mucosa. High fever, photosensitivity, and cold symptoms.
Tick bite. Rocky Mountain Spotted Fever/Rickettsia rickettsii- spirochete.
Burrows it's head into the epidermis and feeds on blood passing on a possible virus. Appears as a papule or macule with or without a central puncture mark after tick is removed. Headache, fever, N/V, muscle aches, macular or popular rash on wrist and ankles.
Tick Bite- Lyme Disease, Borrelia burgdorferi
Deer or mouse tick. Fever, headache, fatigue. Erythema migrans- a bullseye rash that appears at day 3 to 30. Usually around day 7. Reaches up to 3 inches in diameter. Warm to the touch, rarely itchy or painful. If left untreated can affect the joints, heart, and nervous systems.
Lice
Pediculosis pubis- crab lice. Pediculosis corporis- body lice. Pediculosis capitis- head lice. The parasites can be seen. Nits- a sticky substance that attaches to the hair where the parasite lays its eggs.
Scabies- Sarcoptes scabiei mite
The female burrows into the stratum corneum, lays eggs that hatch into larvae in 3-4 days. Very contagious- shaking hands, bed linen. Seen in groin, underarms, and on the hands. Papules with dry scale and linear burrows. Very itchy even after treatment due to eggs and excrement under the skin. May take a couple of weeks to get rid of.
Chiggers
Common in the south in the summer. Mites in grass and bushes. They puncture the skin and feed on blood, then drop off and leave papule that itches. These can lead to bacterial infection due to scratching.
Impetigo
Acute contagious vesicles, pustules, yellow crust. From staph and strep. The crusts start small and spread outward.
Folliculitis
Infection of hair follicle. Bacterial, fungal, or viral, common Staph Aureus. Proliferation of organisms around the hair follicle, then spreads into the follicle. Pustules with area of erythema. Scalp, extremities, and rarely causes systemic symptoms. Due to prolonged skin moisture, occlusive clothing, topical agents, skin trauma like shaving, and poor hygiene.
Furuncle-boil
Inflammation of a hair follicle. Usually Staph Aureus or community acquired MRSA. Initial lesion: deep, firm, red, painful nodule 1-5 cm in diameter. Has only one head. Is raised with redness around the base. May drain large amounts of pus and necrotic tissue.
Carbuncle
Inflammation of a collection of hair follicles. Has many pus pockets. Erythema, painful swollen mass that drains through many openings. Chills, fever, malaise are systemic symptoms.
Cellulitis
Can be caused by MRSA or group B streptococci. Associated with chronic venous insufficiency, stasis dermatitis DM, insect bite, immune suppression, tinea pedis, and edema. Redness, firm, painful, warm, swollen, erythematous, and edematous. It is a soft tissue infection. Can move into lymph nodes and become systemic.
Tinea- ringworm
Capitis- scalp, facia- face, corporis- body, manus-hands, cruris- groin, pedis- feet, unguium- nails, barbae- beard. Three infectious agents- microsporum, trichophyton, epidermophyton. Annular scaly plaques in superficial basal cell epithelium. Erythematous macules or plaques with central clearing and peripheral scales.
Candidiasis- candida albicans most common
Thrush- infants and on mother's nipple. Intertrigo- diaper rash, bed ridden patients, in areas where skin sits on skin and maceration occurs. Mucocutaneous- in the mouth or esophagus in immunocompromised patients. Vaginitis candidiasis- when pH becomes more basic and there is no protective flora. Can be from a new sexual partner, antibiotic treatment, or douching.
Contact dermatitis
From chemical exposure such as poison ivy. Type 4 hypersensitivity. Cutaneous reaction to a topical irritation or allergy. Poison Ivy- linear distribution. Erythema and pustules.
Atopic dermatitis
Genetic, IgE mediated, type 1 hypersensitivity. Most common in children and improved with age. Itchy, oozing, crusts on the antecubital surface, wrists, face, and behind ears. Scratching leads to thickening of skin called Lichenification.
Seborrheic dermatitis
Looks like a stuck on patch, it is oily and benign. Not contagious. Recurrent, does not threaten health, not a sign of poor hygiene. Scalp- scaly, itchy, red skin, and stubborn dandruff. Infants- scalp. Cradle cap. Face- in the nasolabial folds. Upper chest and back- with sebaceous gland.
Psoriasis
Inherited inflammatory condition. Lesions will occur where skin may have been injured: knees, elbows, low back, scalp, and nails. Papules and plaques with silvery scales. Exacerbations and remissions.
Pityriasis rosea
Rash of unknown origin. Not contagious. Mostly young adults. Salmon pink single lesion patch on the trunk: herald or mother patch. Progresses to oval lesions on the trunk in 2 weeks. A Christmas tree distribution. Lasts 2-8 weeks, no residual effects. 50% have itching.
Acne Rosacea
Chronic form of dermatitis of the face in the middle portion of the face. Red with small red lines caused by dilation of capillaries.
Urticaria
Hives, allergic contact dermatitis. Type 1 hypersensitivity. IgE stimulated. Raised erythema with central pallor with generalized distribution. Blanches with pressure.
Seborrheic Keratosis
Benign proliferation of cutaneous basal cells. Smooth or warty elevated lesions. Tan to waxy yellow, flesh colored, or dark brown-black. Oval and greasy appearing with a hyperkeratotic stuck-on scaly appearance.
Actinic keratosis
Premalignant lesions. Caused by prolonged exposure to UV radiation. Rough or scaly, poorly defined pink to reddish or reddish brown papules that are felt more than seen.
Keloids
Rounded, elevated scar like tissue with firm irregular claw like marks. It is larger than the original wound.
Basal cell carcinoma
Most common. Risks- sun exposure, trauma, and radiation. Rolled edges with well defined borders.
Squamous cell carcinoma
Can metastasize. Risks- sun exposure, trauma, and radiation. Scaly spot that doesn't heal and it may bleed.
Melanoma
Lethal without treatment. Risks- sun exposure, trauma, and radiation.
ABCDE of skin cancer
A: Asymmetrical- does it have two parts that look different? B: Border- are irregular and jagged. C: Color- uneven. D: Diameter- larger than a pea. E: Evolving- changes in the spot over weeks or months.
Pressure Ulcer Grades
1. Nonblanchable erythema of intact skin, usually over bony prominence. 2. Partial thickness skin loss involving epidermis or dermis presenting as a shallow open ulcer with a red-pink wound bed, without slough. 3. Full thickness skin loss involving damage or necrosis of sub-q tissue that may extend to, but not through underlying fascia. 4. Full-thickness tissue loss with exposure of muscles, bone, or supporting structures. Can include undermining and tunneling. Suspected Deep Tissue Injury- localized with purple/maroon discolored intact skin or blood-filled blister caused by underlying soft tissue damage from pressure and/or shear. Unstageable- full-thickness tissue loss with base of ulcer covered by slough or eschar, or both in the wound bed.
Rubella- 3 day measles, German measles
Enlarged cervical and postauricular lymph nodes, low-grade fever, headache, runny nose, cough. Rash begins 1-4 days after start of symptoms & is faint-pink to red, coalescing maculopapular that develops on face, with spead to trunk & extremities, sparing palms of hands and soles of feet. Rash subsides in 2-3 days and generally not contagious after development of rash.
Roseola- contagious viral infection
Sudden onset of high fever that last 3-5 days and may have cold-like symptoms. After fever an erythematous nonpruritic macular rash lasts 24-48 hours that develops mostly over trunk, neck, and arms. Children usually feel well, eat normally, and have few symptoms.
Measles- "Rubeola", 7 day Measles
Highly contagious, acute viral illness spread by droplets. Prodrome of high fever, malaise, enlarged lymph nodes, runny nose, conjunctivitis, photosensitivity, and barking cough. 3-4 days an erythematous maculopapular rash develops over head and spreads distally over trunk & upper/lower extremities. Subsides in 3-5 days. Pinpoint white spots surrounded by an erythematous rink develop over buccal mucosa. Koplik spots that precede the rash by 1-2 days; often missed.
Scarlet Fever
Systemic reaction from toxins produced by group A beta-hemolytic strep. Characterized by popular sandpaper-like pink, punctate rash on chest, neck, axilla, groin, & thighs. Flushing of face with pallor around mouth, high fever, N/V, strawberry tongue. Complications- rheumatic fever or glomerulonephritis.
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