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8/6/2019 Vista Group

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URINARY SYSTEM

By Vista Clinical Group


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KIDNEY

The kidney is a reddish brown in color, shaped

like a kidney bean.

4inch long 2wide

Weight: less than a lbAbout the size of a human fist.

The upper lobe is called the superior lobe

The lower lobe is called the inferior lobe


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KIDNEY

Renal Capsule, a layer of fibrous connectivetissue, surrounds the kidney.

Renal Cortex a thin layer of tissue just below therenal capsule.

Renal Medulla is the rest of the tissue beneaththe cortex.

y contains the triangular shaped renal pyramids

Minor calix: tip of each renal pyramid; ductthat drains urine

Major calix: minor calix drains into themajor calix; drains into renal pelvis.

Renal Pelvis is a large funnel shaped cavity onthe medial side of the kidney. The inferior part ofthe renal pelvis narrows and becomes the ureter.


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URETERS

Ureters: 12in tube that extends from the renal

pelvis of the kidney to the bladder.

Ureteral orifice: the openings where the ureter

joins the bladder. Peristalsis: process where the smooth walls of the

ureters contract every 30 seconds to propel urine

into the bladder.


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BLADDER

A reservoir for storing urine, located in the pelvic cavity.

Fundus (dome): rounded top of the bladder.

Mucosa: mucous membrane that lines the bladder.

Rugae: folds when mucosa collapses when the bladder is

empty.

Trigone: triangular area between the two ureteral orifices

and the bladder opening.

Bladder Neck: base of the bladder that connects to the

urethra.

Sphincter: muscular ring located at the base of the bladder

that allows urine to flow into the urethra; involuntary

reflex.


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URETHRA

Urethra: tube that carries urine from bladder to outside of

the body.

ExternalUrethral Sphincter: ring of voluntary muscles

located at the end of the urethra; ability to consciously

control the release or holding back urine. Prostate Gland: spherical gland at the base of the bladder.

PenileUrethra: urethra that travels the length of the penis

until it reaches the external surface of the body.

Urethral Meatus: where the urethra opens to the outside

of the body.

In women the urethra is much shorter, traveling only 1 to 2

inches from the bladder to the external surface of the body.


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FUNCTIONS OF THE URINARY SYSTEM

Kidneys

y Regulates blood volume, blood pressure, pH balancein the blood, production of red blood cells, synthesisof Vitamin D, and excretes waste products and

foreign substances. Ureters

y They transport urine from the renal pelvis to thebladder

Bladder

y Provides a storage place for uriney Expels urine into the urethra by micturition(also

known as urination)

Urethra

y Passageway in which urine is expelled from the body


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FUNCTIONS OF THE URINARY SYSTEM

Nephron

y Functional part of the kidneys that include 3 main

parts

1. Filtration

2. Re-absorption

3. Excretion


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RENAL DIET

Limit Fluid Intake

y Renal failure surrenders the body unable to rid itselfof fluid, resulting in Edema, SOB, and Elevated BP

Limit Potassium Intake

y Kidneys help correct potassium levels in the body.Failure may cause increased levels resulting inirregular heart beat and other cardiac problems candevelop

Limit Protein and Sodium

y Renal failure doesnt allow the kidneys to filterprotein causing a buildup of protein in the blood.Sodium the kidneys arent able to excrete sodiumleading to water retention

The amount is chosen for specific patient needs

and specified by the MD


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URINARY INCONTINENCE

Is any involuntary leakage of urine

Some causes include polyuria, uncontrolled

diabetes mellitus, excessive drinking, caffeine or

cola beverages can stimulate the bladder There are 5 types of incontinence(stress, urge,

overflow, reflex, and functional


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STRESS INCONTINENCE

Is the loss of urine when there is pressure or

stress on the bladder. Some examples are

coughing, sneezing, laughing, and etcs

It occurs due to the sphincter muscle of thebladder is weakened.

Treatment includes Kegel exercises, avoiding

bladder irritants such as caffeine or cola, and also

surgery


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OVERFLOW INCONTINENCE

Inability to empty your bladder completely. This

usually occurs in people with a damaged bladder,

blocked urethra or even prostate gland problems

in men

Treatment would be use of catheterization due to

the patient not being able to fully empty the

bladder


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REFLEX INCONTINENCE

Is the inability to control the release of urine.

This occurs when a persons bladder contracts

without the person being able to stop it

Treatment includes catheterization, having aschedule time to urinate, and having pads

underneath or adult diapers.


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UTI

Urinary Tract Infection (UTI) is an infection that

can happen anywhere along the urinary tract

Symptoms include: Cloudy or bloddy urine, foul

or strong odor, polyuria, and pain in theU

rethra Cause is mostly due to bacteria

A urinalysis is done to diagnosis to look for

bacteria

Treatment would be to increase fluid intake ortake prescribed antibiotics


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PYELONEPHRITIS

Inflammation of the kidney leading to edema

Cause: E. coli organism (associated w/ diseases

such as DM and UTI

Outcome could be atrophy of kidney and nephrons


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PYELONEPHRITIS-SIGNS AND SYMPTOMS

Nausea, Vomiting

Diarrhea, Hypertension

Signs of Infection


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PYELONEPHRITIS-TREATMENT

Rest & Comfort

Intake & Output

Promote fluid & Nutrition

Medication: Antibiotics for infectiony Antispasmodics for discomfort


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UROLITHIASIS

Development of stones within the urinary tract

Most common cause of obstructed urine flow

Neprolithiasis indicates stone formation within the

kidney Stone (Calculus) can cause obstruction at any point

within the urinary tract

More common in males 4:1 ratio


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UROLITHIASIS- PATHOPHYSIOLOGY

Stone (calculi) crystals formed from materials

normally excreted in the urine.

Most are made of calcium

Phathophysiology


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UROLITHIASIS- RISKFACTORS

Personal of family history

Dehydration; excess calcium, oxalate, or protein

intake

Gout Hyperparathyroidism

Urinary stasis (bladder stones)

Immobility

Alkaline Urine


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UROLITHIASIS- SYMPTOMS

Urinary tract obstruction if develops slowly

y Pain in the flank region

y Pain in genitals

Urine production continues leading to an

increased pressure and distention

y Hydronephrosis- abnormal dilation of the renal pelvis & calyces)

y Hydroureter -distention of the ureter with urine


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UROLITHIASIS- DIAGNOSTIC TEST

Urinalysis

y to detect hematuria

KUB x-ray

y to identify the presence of calculi

IVP, Renal Ultrasound, CT Scan, MRI

y to locate calculi

y Identify hydroureter or hydronephrosis

Treatment

y Analgesicsy Pain relief

y Lithotripsy

y ESWL (extracorporeal shock-wave)

y Nephrectomy


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HYDRONEPHROSIS

Abnormal dilation of the renal pelvis & calyces

Vesicoureteral Reflux

y backflow or urine from the bladder to ureters

Pressure in the renal pelvis increases, and itdilates

Nephrons & collecting tubules may be damaged,

affecting renal function


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HYDRONEPHROSIS-TREATMENT

Ultrasound, CT scan, cystoscopy

Immediate treatment involves reestablishing

urine flow from affected kidney

Nephrostomy tube, ureteral stent, indwellingcatheter

y Stent may be temporary or used for longer periods for

ureteral obstruction

y Stent may be pigtail or J-shaped to keep it in place


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POLYCYSTIC

Treatment

Management of adult polycystic kidney disease is

supportive

Renal ultrasound done to diagnose Care is taken to avoid nephrotoxins, UTI,

obstruction & HTN

Fluid intake 2,000 to 2,500mL is encouraged

preventU

TI & lithiasisAce inhibitor to manage HTN

Hemodialysis or kidney transplantation


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GLOMERULONEPHRITIS

Glomerulonephritis is a type of kidney disease in

which the part of your kidneys that helps filter waste

and fluids from the blood is damaged.

Symptoms include: Fever, Edema, hematuria,

decreased urine output, lethargy, and anemia

Caused by specific problems with the body's immune

system. Often, the precise cause of glomerulonephritis

is unknown.

Test include:U

rine Specific Gravity Test,BU

N,Creatinine Clearnance Test, Urine Protein Screen,

and GFR

Treatment woud include: Dialysis, BP management,

fluid restriction with dietary restriction, or a kidney

transplant


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RENAL FAILURE

The kidneys fail to remove toxins and waste

products from the blood. There are two types of

Renal failure(Acute and Chronic)

Renal failure can be shown by a decrease in theGFR (Glomerular Filtration Rate) and by an

elevated Creatinine level

Renal failure is mostly seen in Patients with

Diabetes Mellitus and Hypertension

One way to differentiate acute renal failure and

chronic kidney failure includes anemia and

kidney size on an ultrasound. Chronic kidney

failure usually leads to anemia and a small

kidney size


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ACUTE RENAL FAILURE

Sudden loss of the ability of the kidneys toremove waste and concentrate urine withoutlosing electrolytes

Symptoms include bloody stools, breath odor,

change in mental status or mood, flank pain,high BP, metallic taste in mouth, decreased urineoutput, and nocturia

Diagnostic test include; BUN, Creatinineclearance, serum creatinine and potassium, and

an Urinalysis

Treatment would include staying in the hospitalfor treatment, high carb diet, and low protein,sodium, and potassium diet, and dialysis may beused depending on patients condition


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