Chapter 27: Disorders of the bladder and lower urinary tract
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.