Survey Exam 10-13

What are the organs of the urinary system?
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1. filter blood and excrete BUN (blood, urea, nitrogen) and metabolic waste
2. secrete renin (part of the renin angiotensin system for maintaining blood pressure)
3. regulate blood pressure, volume, and osmolarity by controlling blood secretions
4. maintain electrolyte and acid balance of body fluids
5. secrete erythropoietin to stimulate red blood cell production in the bone marrow
6. control pH and blood pressure
Which two hormones play an important role in the regulation of the nephron's ability to reabsorb salt and water?aldosterone and antidiuretic hormoneWhat are the minor organelles of the the kidney?1. medulla- divided into renal pyramids 2. outer cortex- contains renal pelvis as well as blood vessels, lymphatics, nerves, and urine-collecting structures 3. minor calyx- the renal pyramid tips end in this cup-like structure which collects urine 4. major calyx- a coalescent of minor calyx 5. renal pelvis- holds urine collected from renal pyramids 6. ureter- drains renal pelvis to the bladderWhat are the characteristics of the renal angiotensin system?1. angiotensin I is converted to angiotensin II by ACE (angiotensin converting enzyme) 2. angiotensin II is a potent vasoconstrictor and will raise blood pressure. It increases tubular reabsorption of water and sodium, it also stimulates the adrenal gland to release aldosterone which acts at the renal tubes and increases reabsorption of sodium chloride and water 3. the net effect is higher blood pressure due to increased fluid in the bloodstreamWhat is the process of the renal angiotensin system?1. kidney releases renin into the blood, the liver produces and releases angiotensin in the blood 2. renin acts on angiotensin to convert it to angiotensin I 3. angiotensin I circulates in the blood through the lungs where it is acted upon by ACE which converts it to angiotensin II 4. angiotensin II goes to the adrenal glands and stimulates the release of aldosterone from the adrenal cortex 5. aldosterone goes to the kidney tubules and stimulates the absorption of sodium and water which increases blood volumeWhat are the common diagnostic tests and procedures to identify problems with the kidney?1. history (presence of hypertension, diabetes, and UTIs) 2. physical exam (edema, disorientation, changes in consciousness, 3. urinary and lab tests - creatinine - uric acid - blood, urea, nitrogen (BUN) - urinalysis - dipstick - color, clarity, odor, pH, specific gravity 4. imaging techniques (CT and Ultrasound)What is the most important thing a kidney needs to function properly?Adequate blood supply and unobstructed urine flowWhat are common acute kidney injuries?-shock (interrupts blood flow to the kidneys) - tubular necrosis (results in many diseases) - obstructed urine flow ( kidney stones, inflamed prostate, tumor)What are the signs and symptoms of acute kidney injury?oliguria (low urine output) sudden drop in urine volume a complete cessation of urine production (anuria) nausea vomiting diarrhea odor of ammonia on the breath headaches drowsiness confusion neuropathy seizures comaHyperkalemiaelevated blood potassium levels which can cause cardia arrestDiagnosis of acute kidney injuryhistory, blood tests, urinalysisTreatment of acute kidney injurydiet low in protein, sodium, and potassium; restricted fluid intake, dialysis if neededWhat causes Urinary Tract Infections (UTI)?bacteria from the skin or colon ascending the urethra and can infect the bladder and kidneysWhat are risk factors for developing a UTI?reduced urine flow, catheterization, poor hygieneWhat are the types of lower UTIs?urethritis and cystitisWhat is urethtitis?Lower UTI which causes inflammation of the urethraWhat are the risk factors for developing urethritis?being female, having multiple sex partners, having an STIWhat are the symptoms of urethritis?discharge from the urethra, itching sensation at the opening of the urethra, burning sensation during urinationWhat is cystitis?bladder infectionWhat are symptoms of cystitis?urinary frequency, sense of urinary urgency, dysuria, painful burning sensation during urinationWhat is the treatment for lower UTIs?antibioticsHow can lower UTIs be prevented?staying hydrated, practicing front-to-back wiping, practicing safe sexWhat is pyelonephritis?Inflammation of the kidneysWhat are the types of upper UTI infections?PyelonephritisWhat are the risk factors for pyelonephritis?being female, having kidney stones, having a urinary catheter, or immunodeficiencyWhat are the symptoms of pyelonephritis?chills, high fever, sudden back pain that spreads to the abdomen, dysuria, hematuria, and pyuriaWhat is pyruia?pus in the urineWhat is dysuria?burning during urinationWhat causes pyelonehpritis?pyogenic (pus forming) bacteria such as e. coli, streptococci, and staphylococciWhat is the treatment for pyelonephritis?antibioticsWhat is glomerulonephritis?inflammation of the glomerulusWhat causes inflammation of the glomerulus?antigen:antibody complexes accumulate within the glomeruliWhat are the 4 types of causes of glomerulonephritis?1. immune complex glomerulonephritis usually follows a beta strep infection 2. autoimmune diseases like lupus have trapped circulating antigen:antibody complexes 3. IgA complex accumulation in the glomerulus 4. anti-glomerular basement membrane glomerulonephritis (the antibodies developed against the membrane and immune cells attack)In what cases can acute GN affect children?1-4 weeks following streptococcal infection of the skin or throatWhat are the risk factors for developing glomerulonephritis?diabetes, hypertension, and streptococcal infectionWhat are some examples of inflammatory kidney diseases?lupus nephritis, IgA nephropathy, glomerulonephritis, acut post-streptococcal glomerulonephritisWhat are signs and symptoms of acute glomerulonephritis?chills, fever, weakness, hematuria (blood in urine), casts (protein accumulation in tubules), edema in face and ankles, albuminiria (protein in urine)What are the signs and symptoms of lupus nephritis?hematuria, hypertension, and joint painHow do you diagnosis lupus nephritis?patient history, physical exam, evaluation of symptoms, urinalysis, blood test, ultrasound, kidney biopsyHow do you treat lupus nephritis?anti-inflammatory drugs, immune suppressants, renal transplantWhat is IgA nephropathy and what causes it?inflammatory disease of the kidney caused by immunoglobulin A deposition in the glomeruliWhat causes acute post-streptococcal golumerulonephritis?inflammation of the GN caused by an antigen:antibody reaction that occurs approximately 1-4 weeks after a streptococcal skin or throat infectionWhat is the pathological process associated with acute post-streptococcal glomuerulonephritis?antigens from the streptococci and the antibodies form complexes in the bloodstream that become trapped within the glomeruli which triggers an immune response and damage to the glomerulus which impairs filtration functionWhat are the signs and symptoms of acute post-streptococcal glomerulonephritis (APSGN) ?chills, fever, loss of appetite, general feeling of weaknessHow is APSGN diagnosed?patient history, urinalysis, physical exam, renal biopsyHow do you treat APSGN?anti-inflammatory drugs and immunosuppressantsWhat are the 3 types of renal calculi?calcium stones (most common) struvite stones uric acid stonesWhat are calcium stones found in the kidney composed of?calcium oxalate and phosphateWhat are struvite stones found in the kidney composed of?magnesium ammonium phosphateWhy do struvite stones form in the kidney? What are their characteristics?in response to an infection, they grow rapidly, and form staghorn calculiWhat puts someone at risk for developing uric acid stones?those who do not hydrate adequately, do not replace lost fluid, have a high protein diet, have goutWhat are signs and symptoms of kidney stones?intense pain in that radiates from the kidney to the groin area, hematuria, nausea, vomiting, and diarrheaWhat are the treatment methods for kidney stones?depends on size and shape medication that partially dissolves stones lithotripsy (sonic vibrations are applied externally crushing the stones)What is chronic renal failure?progressive loss of kidney function over timeWhat are the manifestations of renal failure throughout the body?Respiratory system: deep sighing, urine smell to breath Digestive system: ammonia taste in mouth, nausea, vomiting, diarrhea Urinary system: pyuria, hematuria, albuminuria, casts nervous system: drowsiness, dim vision, mental cloudiness, convulsions, comaWhat are risk factors for chronic renal failure?diabetes, glomerulonephritis, other chronic kidney diseasesWhat situations can cause chronic renal failure?ischemia, hemorrhage, shock, toxins, large kidney stones, tumorsWhat is the cause of the systemic manifestations of chronic renal failure in the body?the kidneys are unable to process and clear the blood of urea and creatinine which are waste products that can cause sepsisWhat is uremia and what is it a result of?an accumulation of urea in the bloodWhat is the clinical manifestation of renal failure in the body?uremiaWhat are the signs a patient is suffering from uremia?progressive weakness, fatigue, loss of appetite, nausea and vomiting, muscle atrophyWhat can uremia progress to if not treated with dialysis or kidney transplant?stupor, coma, and deathWhat are the chronic diseases and disorders of the kidney?diabetic nephropathy, hypertensive kidney disease, nephrotic syndrome, hyWhdronephrosis, hydroureters, chronic glomerulonephritis, urinary incontinenceWhat are the common treatments for chronic kidney diseases?hemodialysis, peritoneal dialysis, kidney transplantWhat is nephrosclerosis?complication of severe hypertensionWhat is the pathological manifestation of nephrosclerosis?small arterioles become damaged by high blood pressure, these arterioles then undergo degenerative changes that consist of thickening of the walls and decreased luminal diameter, which increases blood pressureWhat effect does a decrease in luminal diameter have on the kidneys?decreased blood flow through the kidney which can cause the kidney to shrink and renal insufficiencyWhat is nephrotic syndrome?chronic disease with proteinuria, hypoalbuminemia (low plasma albumin), hyperlipidemia (high plasma lipids), edemaWhat is the hallmark sign of nephrotic syndrome?protein spilling into the urineWhat does nephrotic syndrome result from?glomerular damage that can be caused by diabetes, lupus, and many other diseasesWhat are the signs and symptoms of nephrotic syndrome?edema of the ankles and around the eyes, pleural and genital edema, low blood pressure, lethargy, anorexiaHow do you diagnose nephrotic syndrome?urinalysis that shows high protein levels and casts, blood test that shows high lipids and low albumin, possibly kidney biopsyWhat are the treatment options for nephrotic syndrome?antihypertensive medications diuretics cholesterol-reducing medications anticoagulants to help decrease the risk of thrombus formation corticosteroids to decrease inflammationWhat is End Stage Renal Disease?complete failure of kidney functionWhat things can reduce the risk of for ESRD?1. control blood pressure and blood sugar levels 2. if diabetic or hypertensive, monitor total urine protein levels 3. if at high risk for ESRD, reduce dietary protein 4. Do not smokeWhat are treatments, palliative treatments for ESRD?dialysis, kidney transplantWhat are common malignancies of the urinary tract?Renal cell carcinoma Wilm's tumor Carcinoma of the bladderWhat are the major risks for renal cell carcinoma?smoking, obesity, heredityWhat are the signs and symptoms of renal cell carcinoma?painless hematuria, palpable mass, loss of appetite, weight loss, anemia, elevated leukocyte countHow is renal carcinoma treated?surgical removalWhat is Wilm's tumor?a fast growing malignant tumor of the kidney pelvis that develops in children between the ages of 2 and 5What are the symptoms of Wilm's tumor?hematuria, pain, vomiting, hypertensionWhat is the genetic factor associated with Wilm's disease?1 in 10,000 individuals are affected Wilm's tumor gene 1 (WT-1)What is carcinoma of the bladder?a malignant tumor originating in the urinary bladderWhat are symptoms of carcinoma of the bladder?bleeding, burning pain, cramping, inability to urinateHow do you diagnose carcinoma of the bladder?physical exam, urinalysis procedures, biopsy, blood analysis, cytoscope, removed surgicallyWhat are common congenital disorders?polycystic kidney disease medullary sponge kidney disorders of the ureters, urinary bladder, and urethraWhat type of genetic disease is polycystic kidney disease?autosomal dominant (only one parent has to have it)What is polycystic kidney disease (PKD)?the development of numerous fluid-filled pockets of tissue within the kidneyWhat are the signs and symptoms of PKD?pain, hypertension, and hematuria.How do you diagnose PKD?combination of physical exam and renal ultrasoundHow do you treat PKD?controlling high blood pressure, pain, and infections that tend to arise in cysts.What are common congenital ureter disorders?duplication, abnormal position, abnormal location of openings, abnormal dilation, constrictionsWhat are common congenital urinary bladder abnormalities?malformed walls or pouchesWhat are common congenital urethra abnormalities?epispadias (opening develops on the dorsal side of the penis), hypospadias (opening develops on the ventral side of the penis)What is medullary sponge syndrome?named for the appearance of the medulla in the kidneyWhat are signs and symptoms of medullary sponge syndrome?recurrent kidney stones, sometimes accompanied with pain and hematuriaWhat is benign prostate hyperplasia (BPH)?enlargement of the inner ring of the glandular tissue that surrounds the urethraWhat urinary symptoms does BPH cause?frequency dysuria nocturia diminished urinary stream incomplete emptying of the bladderWhat is BPH caused by?the hormone dihydrotestosteronHow is BPH treated?medical treatments that attempt to shrink the prostate by blocking the conversion of testosterone into dihydrotestosteroneWhat is the surgical treatment for BPH?TURP (transurethral resection of the prostate)Which ring in the prostate develops BPH?the inner ring which compresses the urethraWhich ring in the prostate develops prostate cancer?outer ring which is palpable upon digital rectal examWhat are common urinary tract developmental abnormalities?bilateral renal agenesis unilateral renal agenesis horseshoe kidney pelvic kidney ureteropelvic junction obstruction posterior urethral valves uteral duplicationWhat are the characteristics of prostate cancer?grows in the outer ring of the prostate grows slowly and typically remains confined to the prostate glandWhat are risk factors for prostate cancer?age, race, family history, obesityWhat are the treatment options for prostate cancer?active surveillance radiation brachytherapy hormone therapy used to stop the production of testosterone surgery to remove prostate chemotherapyWhat is the average age of testicular cancer?33Is testicular cancer common?no, dying risk is very low (1 in 5,000)