Chapter 27: Disorders of the bladder and lower urinary tract

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What causes increased risk of UTI?

Obstruction and reflux Neruogenic disorders with impaired emptying Women who are sexually active Postmenopausal women, prostate disease, elderly, Foleys

What type of incontinence results from the overfilling of the bladder with escape of urine?

Overflow incontinence

What type of calculi has dull, aching flank PAIN?

Renal calculi

What calculi causes an acute, severe, intermittent pain of flank and upper at outer abdomen on affected side?

Renal colic

Describe the third stage of CRF...

Renal failure GFR is <20 %. SHARP INCREASES IN BUN/CR; OLIGURIA, UREMIA, METABOLIC ACIDOSIS

What is a failure to store urine when talking about the neurogenic bladder?

Spastic bladder dysfunction

What type of reflex do stretch receptors cause?

Spinal Reflux

Is urine in the kidneys and bladder sterile or nonsterile?

Sterile

How is bacteria in the lower (distal) portion of the urethera normaly controlled?

Through the "Washout phenomena"

What are the lower UTIs?

Urethritis Prestatitis Cystitis

What is the importance of "frequency" when talking about compensation?

Waiting a few minutes allows voiding to be initiated again

When may decompensation of the urinary system occur?

When mechanisms fail

What are risk factors for UTI?

Female Geriatric clients Strictures Impaired bladder innervation Chronic disease such as diabetes Prostatic hypertrophy Prostatitis Impaired immune response

What is the failure to empty when talking about the neurogenic bladder?

Flaccid bladder dysfunction

What are S/S of polycystic kidney disease?

Flank pain Hematuria Proteinuria Polyuria Nocturia UTI and Calculi are common HTN (develops as cysts obstruct renal blood flow and renin released)

What might occur with hematuria?

Frequency Urgency Dysuria

What is the primary cause of polycystic kidney disease?

Genetics

Describe nephrotic syndrone...

Glomerular membrane derangement causes increase permeability to plasma proteins Decreased plasma protein, decreased colloidal pressure (edema) MASSIVE LOSS OF PLASMA PROTEIN

What is defined as an inflammation of capillry loops of the glomeruli?

Glomerulonephritis

What is the 2nd leading cause of kidney failure worldwide and the 3rd cause of chronic kidney disease in the US and Canada?

Glomerulonephritis

What does the parasympathetic nervous system do during urination?

Produces contraction of smooth muscle of the bladder wall and relaxation of the internal sphincter.

What is inflammation of the kidney and renal pelvis?

Pyelonephritis

What is the upper UTI?

Pyelonephritis

What might UTIs lead to in children?

Pylonephritis

What is excess mucous and WBCs in urine?

Pyuria (foul odor of urine or cloudy appearance)

What does the sympathetic nervous system do during urination?

Relaxes smooth muscle of the bladder wall and contraction of the internal sphincter

Describe second stage CRF...

Renal insufficiency (25-50 % of functional renal tissue is destroyed) MAY HAVE OLIGURIA, POLYURIA, HTN, AND AZOTEMIA OR NO S/S

What is urine stasis?

Retention of urine

What are the effects of acquired obstruction and stasis?

STI's may cause uretheral strictures

Describe polycystic kidney disease...

Slow, progressive disease that destroys the kidney. Cysts may develop elsewhere in the body : liver, spleen, and pancreas

What is the function of the bladder?

Storing and emptying urine

What is the decreased ability of the vesicourethral sphincter to prevent the escape of urine during activities (coughing, lifting, exercise)?

Stress incontinence

What are the 3 types of incontinence?

Stress incontinence Urge incontinence Overflow incontinence

What types of receptors are in the bladder?

Stretch Receptors

What is voluntary control of urination controlled by?

Striated muscles in the external sphincter and pelvic floor

Relaxation and storage of bladder is controlled by what?

Sympathetic nervous system

What promotes bladder filling?

Sympathetic nervous system

What are the symptoms of kidney caner?

TRIAD OF SYMPTOMS: GROSS HEMATURIA FLANK PAIN AND PALPABLE ABDOMINAL MASS FEVER FATIGUE WEIGHT LOSS ANEMIA OR POLYCYTHEMIA MAY BE PRESENT

What occurs with progressive decompensation of the bladder that causes it to become severely overstretched with a residual urine volume of 1000-3000 mL?

The bladder loses its power of contraction and overflow incontinence

What are S/S of Renal calculi?

These vary with their location and size Renal calculi Bladder calculi Renal colic

What connects the kidneys and the bladder?

Ureters

What is the inflammation of the urethera?

Urethritis

What is sudden, compelling need to urinate?

Urinary frequency and urgency

Bladder structure changes can cause what?

Urinary obstruction Urinary incontinence-overflow incontinence

WHat are stones in the urinary tract?

Urolithiasis

What are the types of urinary calculi?

Urolithiasis Nephrolithiasis

What are the most uncomplicated lower UTIs caused by?

Escherichia coli

What does the external sphincter do during urination?

Relaxes

What does the internal sphincter do during urination?

Relaxes

What are the UTI pathophysiologies?

Descending Ascending

What UTI pathophysiology is hemaogenously from blood (glomerulus)? (It is rare and associated with previous damage or scarring of urinary tract)

Descending UTI

What is the most common cause of glomerular injury?

Immunologic

What are stones formed in the kidney?

Nephrolithiasis

What are the glomerular injury pathogenesis?

Immunologic Nonimmunologic Hereditary

What happens when decompensation occurs in the urinary system due to mechanisms failing?

Muscle fatigue may cause one to not be able to overcome obstruction and leaves residual urine in the bladder HESITANCY, need to strain, weak, small stream, and incomplete emptying

WHat is the primary cause of ARF leading to ATN?

Ischemia

During compensation, what type of stimuli causes hypersensitivity?

Afferent stimuli (stretch receptors)

What is the end stage of glomerular disorders?

Chronic glomerulonephritis

Describe the early stage of CRF...

Decreased renal reserve (COMPENSATION working). Normal BUN/Creatinine, no S/S

What is the inflammation of the prostate?

Prostatitis

What is defined as an inflammatory disorder affecting the renal pelvis and functional portion of kidney tissue?

Pyelonephritis

What is the 2nd layer of the bladder?

Detrusor Muscle

What muscle contracts during urination to push out urine?

Detrusor muscle Abdominal muscles may also be used

What is painful or difficult urination?

Dysuria

What are S/S of UTI?

Dysuria Urinary frequency and urgency Nocturia Pyuria Hematuria Elderly may present w/ behavior change or confusion

Describe renal colic...

Pain my radiate 2 suprapubic region, groin, and the external genetalia May be associated with vomiting, pallor, and cooled/clammy skin

What type of incontinence is described as hyperactive bladder contraction?

Urge incontinence (overactive bladder)

What is defined as "masses of crystals composed of minerals" in the urinary system?

Urinary calculi

Relaxation of the pelvic support structures, such as cystocele and rectocele may occur in who?

Women

Does pregnancy increase UTI risk?

Yes

Define kidney cancer...

A tumor of the kidney

What calculi may cause a dull suprapubic pain?

Bladder calculi

What is defined as a tumor of bladder; arises from epithelial tissue and mosts common site is urinary bladder?

Bladder cancer

What structures are involved with obstruction and urinary stasis?

Bladder neck Urethera External urethral meatus

How are UTIs classified?

By region and primary site affected

What are the two ways obstruction and stasis can be obtained?

Congenital Acquired

Describe male urethra...

16.5-18.5 cm long Passes through prostate

Describe female urethra...

2.5-3.5 cm long Allows urine to pass more freely Increased risk of UTI

How many layers is the bladder?

4 layers

What occurs after there is hypersensitivity to the afferent stimuli (stretch receptors)?

Ability to suppress urination is diminished Bladder contraction can become so strong that it produces bladder spasm URGENCY, sometimes incontinence

What are the classification of pyelonephritis?

Acute Chronic

What are the classifications of glomerulonephritis?

Acute Rapidly progressive Chronic

What is defined as a rapid decrease in renal function?

Acute renal faliure

What is a rare, progressive loss of renal function and can be transmitted to future generations when talking about glomerular injury?

Alport Syndrome (Hereditary pathogenesis)

What UTI pathophysiology is from perineal area to lower urinary tract? (associated with females and E. coli)

Ascending UTI

What are the causes of pyelonephritis?

Ascending bladder infection Blood-borne infections Frequent calculi Other obstructions

Describe the patho of pyelonephritis,,,

Ascending infection spreads and kidney becomes edematous with localized abscesses, scar tissue replaces infected/inflamed areas. S/S ONSET IS RAPID WITH CHILLS AND FEVER, MALAISE, AND VOMITING, FLANK PAIN, COSTOVERTEGRAL TENDERNESS, URINARY FREQUENCY, AND DYSURIA

What is chronic pyelonephritis?

Associated with nonbacterial infections that may be METABOLIC, CHEMICAL, OR IMMUNOLOGICAL

What are most upper and lower UTIs caused by?

Bacteria that enter via the urethera

What is acute pyelonephritis?

Bacterial infection of the kidney

What stores urine in the body?

Bladder

What do UTIs infect?

Bladder Urethera Prostate Ureters *Kidneys

What are the causes of bladder cancer?

CIGARETTE SMOKE EXPOSURE TO CHEMICALS AND DYES CHRONIC USE OF PHENACETIN-CONTAINING ANALGESIC AGENTS S/S PAINLESS HEMATURIA, SYMPTOMS OF UTI, AND COLICKY PAIN.

What are urinary calculi composed mostly of?

Calcium

Describe glomerular function...

Capillary network supported by basement membrane Glomerular membrane is selectively permeable Glomerulonephritis (inflammatory process)

What are the high risk factors for renal cell cancer?

Carcinogens excreted in the urine and stored in the bladder Heavy smoking (30-50% of all bladder cancers associated) Chronic infections Some toxins from manufacture of rubber, textiles, paint, chemicals, and proteoleum

What might bladder tumors do?

Cause obstruction

What is defined as a progressive inability (over months to years) of kidneys to respond to changes in body fluids and electrolyte composition?

Chronic renal failure (inability to produce sufficient urine) (GRF< 20 % of normal) (Serum creatinine > 5 mg/dl)

What is hypertrophy to help overcome obstruction?

Compensation

What are urinary calculi risk factors?

Dehydration (loop diuretics*) Males White people Young-middle adult Personal/family history Calcium containing antacids Co-morbid disease Frequent cola ingestion

What might cause hesitancy, need to strain, weak, small stream, and incomplete emptying?

Decompensation

What is inflammation of the urinary bladder?

Cystitis

What is the most common form of UTI?

Cystitis

Describe nephritis syndrome...

DECREASED GLOMERULAR PERMEABILITY decreased GFR *fluid retention and nitrogenous waste accumulation

What are the nonimmunologic glomerular injuries?

DM HTN Toxic (drugs, chemicals)

DESCRIBE THE FOURTH STAGE OF CRF...

END STAGE RENAL DISEASE (ESRD) GFR IS < THAN 5%. EXTREME UREMIA, DIALYSIS OR TRANSPLANT REQUIRED

What are the stages of renal failure?

Early Second Third Fourth

Who often have the most problems with incontinence?

Elderly

What are the 2 ways neurogenic bladder may be manifested?

Failure to store urine Failure to empty

What are co-morbid diseases?

Gout Hyperparathyroidism Urinary stasis Repeated infections

What are the S/S of glomerulonephritis?

HEMATURIA PROTEINURIA SALT & H2O RETENTION htn AZOTEMIA fatigue anorexia n/v and headache May have flu like symptoms, oliguria, abdominal or flank pain. Chronic develops insidiously and is often unreconized until renal failure is evident

What is the most common sign of bladder cancer (it may be painless)?

Hematuria

What is bloody urine?

Hematuria (usually from bleeding or inflamed bladder wall)

What are the causes of rapidly progressive glomerulonephritis?

IDIOPATHIC (unknown) SECONDARY TO AN ACUTE INFECTION (vasculitis, SLE, or acute glomerulonephritis)

What can one do after intercourse to help combat UTIs?

Increase fluid intake and void soon after intercourse

What are the 3 phases of the S/S of ARF?

Initiation phase (onset of event causing tubular necrosis. few or no S/S) Maintenance phase (lasts about 2 weeks characterized by persistent reduction in GFR and tubular necrosis) (OLIGURIA, AZOTEMIA, FLUID RETENTION, ELECTROLYTE IMBALANCE, METABOLIC ACIDOSIS, EDEMA, R/T CHF, IMPAIRED RENAL ELIMINATION LEAD TO HYPERKALEMIA, HYPOCALCEMIA, UREMIA) (THE END OF MAINTENANCE PHASE IS CHARAZTERIZED BY DIURESIS) Recovery phase (GFR and tubular function have recovered and no further elevation in BUN/Creatinine

What type of acute renal failure causes damage to structures within the kidney?

Intrinsic

What controls bladder function?

Involuntary and Voluntary control

What is incontinence?

Involuntary loss of urine

Where is urine produced in the body?

Kidneys

Describe kidney cancer...

May be primary or metastasis from a lung or breast cancer, melanoma, or malignant lymphoma.

What are the effects of congenital obstruction and stasis?

Meatal stenosis Spinal nerve damage (spinal bifida)

Who has a longer urethra men or women?

Men

What coordinates the bladder?

Micturition

What occurs when the bladder contains 150-250 Ml of urine?

Micturition Reflex

Describe the stretch receptors in the bladder...

Micturition center in pons is stimulated Stretch receptors Bladder fills w/ urine Stretch receptors Spinal reflex stimulated

What is 2 or more awakenings at night to urinate?

Nocturia

What are acute postinfectious glomerulonephritis S/S?

Oliguria (1st symptom) Cola colored Urine (from RBC degeneration in urine) PROTEINURIA and hematuria occur as the glomerular permeability increases Edema due to sodium and water retention

Where might the bladder pouch in diverticuli?

Outward

What promotes bladder emptying?

Parasympathetic nervous system

Where is the motor control that causes bladder emptying?

Parasympathetic nervous system

What are the 3 stages of acute renal failure?

Prerenal (hypovolemia, CV failure, altered vascular resistance) Intrarenal (vascular disease, glomerulonephritis, nephritis, and ATN (tubular necrosis) Postrenal (extrarenal obstruction; interrenal obstruction)

What is defined as a HEREDITARY DISEASE or genetic predisposition characterized by CYST FORMATION and massive kidney enlargement?

Polycystic kidney disease

Where is the micturition center located?

Pons

What causes acute glomerulonephritis?

Post streptococcal glomerulonephritis is most common form. SLE and staphylococcal or viral infections may cause

What type of acute renal failure causes obstruction of urine outflow from the kidney?

Postrenal

What are pyelonephritis risk factors?

Pregnancy Urinary tract obstruction Congenital malformation Urinary tract trauma Scarring, calculi, other kidney disorders Vericoureteral reflux (urine moves back towards kidney) Diabetes

What type of acute renal failure causes are marked decrease in renal blood flow?

Prerenal

What does the treatment or management of incontinence depend on?

The type of incontinence

What is a major factor that contributed to incontinence in the elderly?

The use of multiple medications

WHat are the causes of chronic glomerulonephritis?

UNKNOWN Lupus nephritis diabetic neruopathy rapid progressive glomerulonephritis

What are the renal and urinary health problems?

UTI Urinary calcui Polycystic kidney disease Pyelonephritis Glomerulonephritis Acute renal failure Chronic renal failure Bladder cancer Kidney cancer

Does sexual intercourse increase risk of UTI?

Yes

Describe the path of acute glomerulonephritis...

circulating antigen antibody immune complexes are formed in trapped glomerular membrane. INFLAMMATORY PROCESS occurs allowing leakage of plasma proteins and blood cells escape into urine. The RAA system is disrupted which could lead to HTN.


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