Chapter 7 Urinary System

Introduction Nitrogenous wastes urea creatinine uric acid https://www.youtube.com/watch?v=l128tW1H5a8 Nitrogenous wastes urea creatinine uric acid BUN: Blood Urine Nitrogen BUN levels tend to increase when the kidneys or liver are damaged. Having too much urea nitrogen in the blood or having high BUN levels can be a sign of kidney or liver problems.

Uremia Increased levels of urea in the blood, as noted by an increase in BUN, also called Azotemia

Introduction filter nitrogenous waste to form urine, about 200 quarts of blood are filtered every day to form 2 quarts of urine maintain proper balance of water, electrolytes (sodium, potassium) and acids release hormones (renin: enzyme hormone important in adjusting blood pressure; erythropoietin (epo): hormone that stimulates red blood cell production in the bone marrow; calciferol: active form of vitamin D necessary for the absorption of calcium from the intestine) degrade and eliminate hormone from the bloodstream

erythropoietin (epogen)

Review ___________________: enzymatic hormone important in adjusting blood pressure ___________________: hormone that stimulates the red blood cell production in bone marrow

Kidneys also adjust amount of water and electrolytes for proper muscle and nerve function. Other functions –Produce urine –Secrete an active form of Vitamin D so intestines can absorb calcium

Basic Anatomy of the Kidney The kidneys are covered by a thin, fibrous membrane called the renal capsule. However, the outermost functional region of the kidney is the renal cortex. Ureters – Muscular tubes that transport urine from each kidney to the bladder. Urinary Bladder – A sac that collects and holds urine that comes from the ureters. Urethra – a narrow passageway where urine passes from the bladder to the outside of the body, called urination.

Basic Anatomy of the Kidney Renal Pelvis – basin-like area that collects urine from the nephrons, it narrows into the upper end of the ureter Calyx – extension of the renal pelvis; they channel urine from the pyramids to the renal pelvis Cortex – the outer region of the kidney; extensions of the cortical tissue, contains about one million blood filtering nephrons Nephron – these are the filtration units in the kidneys

Basic Anatomy of the Kidney Medulla – inner region of the kidney contains 8-12 renal pyramids. The pyramids empty into the calyx. Ureter – collects filtrate and urine from renal pelvis and takes it to the bladder for urination Renal Artery – branches off of the aorta bringing waste-filled blood into the kidney for filtering in the nephrons; the renal artery is further subdivided into several branches inside the kidney. Each minute, the kidneys receive 20% of the blood pumped by the heart. Some arteries nourish the kidney cells themselves. Renal Vein – removes the filtered blood from the kidneys to the inferior vena cava

Renal Artery Branches into smaller and smaller arteries, eventually leading to microscopic filtering units called nephrons.

Nephron Microscopic functional unit of the kidney Forms urine in renal corpuscles and tubules by process of filtration, reabsorption, and secretion

Anatomy of the Major Organs Organs of the Urinary System in a Male

Anatomy of the Major Organs Organs of the Urinary System in a Female

How Kidneys Produce Urine – p. 220 • Blood enters kidneys through right and left renal arteries • Arterioles carry blood to capillaries • Glomeruli filter blood

Three steps in the formation of urine 1. Glomerular filtration 2. Tubular reabsorption 3. Tubular secretion

1.Name four organs of the urinary system. Kidneys, ureters, bladder, and urethra 2. What is the name of the structure that stores urine until it is voided? Urinary bladder 3. What is the main function of the kidneys? Remove toxic products from blood by forming urine

Combining Forms – p. 280 Cyst/o Meaning urinary bladder (ex: Cystocele, Cystoscopy) Vesic/o Meaning "bladder or blister“ (ex: vesicourethral) Glomerul/o Meat/o Meaning meatus

Combining Forms Nephr/o (meaning kidney, ex: nephrologist) Ren/o (meaning kidney) Pyel/o meaning  renal pelvis (ex: pyeloplasty) Ur/o menaing urine Urino/o meaning urine

Urinoma A urinoma is a mass formed by encapsulated extravasated urine.

Combining Forms Ureter/o ureter Urethr/o urethra

Building Terms Cyst/o/scopy Cyst/o/cele Nephr/oma Ur/emia • Ureter/o/stenosis

Suffixes -emia -iasis (indicating a diseased condition: psoriasis, cholelithiasis) -lysis (ex: dialysis) -pathy (ex: uropathy) -pexy (fixation, usually surgical; ex: urethropexy,  surgical procedure where support is provided to the urethra)

Suffixes - ptosis ("falling, dropping, or prolapse of an organ“, ex: Nephroptosis) -tripsy ("to crush, break, or pulverize“ ex:  lithotripsy) -uris

Building Terms Azot/emia Lith/iasis Dia/lysis

Kidney Stone

Building Terms Nephr/o/pathy Nephr/o/ptosis Lith/o/tripsy Poly/uria An/uria Hemat/uria Noct/uria

BPH: Benign Prostate Hypertophy

Pathology of the renal system ESRD: End State Renal Disease Signs and Symptoms Irreversible stage with gradual, progressive deterioration of kidney function. Kidneys lose ability to excrete nitrogenous end products of metabolism. Progressive weakness, anorexia, diarrhea, pruritus, and polyuria.

Pathology of the renal system ESRD: •Usually result of chronic renal failure (CRF), the gradual, progressive deterioration of kidney function to the point that the kidneys cannot sustain their necessary day-to-day activity. Treatment • Dietary restriction of protein, sodium, and potassium intake • Antiemetics for nausea • Control of hypertension Dialysis?

Renal Calculi Signs and Symptoms Concentration of mineral salts in the renal pelvis, in the calices of the kidney, or in the urinary tract. Renal calculi patients may remain asymptomatic for long periods

Cystitis Bacterial infection often cause acute or chronic cystitis. In acute cystitis the bladder contains blood as a result of mucosal hemorrhage

Hydronephrosis

Polycystic Kidney Disease (PKD) The kidneys contain masses of cysts. Typically polycystic kidneys weigh 20 times more than their usual weight

Urinalysis (UA) Used to detect and manage a wide range of disorders, such as urinary tract infections, kidney disease and diabetes. A urinalysis involves checking the appearance, concentration and content of urine Tests include: Protein Glucose Specific Gravity (amount of wastes, minerals, ans solids) Alcohol/drugs Infection

Urinalysis (UA) Ketone Bodies: Occur when the body breaks down fats instead of sugar for fuel Ketones make the blood acidic and lead to Ketoacidosis which can lead to coma and death DKA

Urinalysis (UA) Sediment: Presence of abnormal particles, blood cells, bacteria… Phenylketonuria (PKU): can accumulate in the urine of infants who lack an enzyme called phenylalnine hydroxylase and leads to retardation

Pathologic Terminology Glomerulonephritis Interstitial nephritis Nephrolithiasis Nephrotic syndrome Polycystic kidneys (PKD)

Hypernephroma Renal cell carinoma Cancerous tumor of the kidney in adulthood

Pathologic terms Pyelonephritis Renal cell carcinoma Renal failure Renal hypertension Wilms Tumor: Malignant tumor of the kidney occurring childhood usually before the age of 5 (usually unilateral)

Urinary Bladder Bladder Cancer

Associated Conditions: Diabetes Insipidus: Lack of ADH prevents H2O from being reabsorbed Diabetes Mellitus (DM): Inadequate secretion of use of insulin. Sugar can not leave the bloodstream and be available to cells for energy Type I and II

Quick Quiz A term that means frequent (voluntary) urination at night: A. Anuria B. Nocturia C. Diuresis D. Hematuria

Diagnostic Procedures BUN: Normally low, accumulates in the blood when kidney is disease. Can lead to death Creatinine Clearance test: The creatinine clearance test helps provide information about how well the kidneys are working. The test compares the creatinine level in urine with the creatinine level in blood. When BUN and Creatinine levels are both elevated it may represent acute renal failure

X-Ray Studies CT scan Kidneys, Ureters and Bladder (KUB) Renal Angiography Retrograde pyelogram (RP), KUB after contrast Voiding cystourethrogram (VCUG):  technique for visualizing a person's urethra and urinary bladder while the person urinates (voids).

CT Scan

Voiding cystourethrogram (VCUG)

Clinical Procedures Ultrasonography: Imaging urinary tract structures using high frequency sound waves Radioisotope Scan: Image of kidney after injecting radioisotope (that concentrates in the kidney) into the bloodstream Magnetic resonance imaging (MRI): Using magnetic field and radio waves to produce images in all three planes of the body

Other Clinical Procedures Cystoscopy: Visual exam with an endoscope Dialysis: Separating wastes from blood Lithotripsy: Removal of stones Exracorpeal shock wave lithrotripsy (ESWL): Powerful sound wave vibrations break up calculi in urinary tract of gallbladder

Clinical Procedures Renal angioplasty: Dilation of narrow arteries Renal Biopsy Renal transplantation Urinary catheterization (foley cath, condom cath…)

Cystoscopy direct visual examination of urinary bladder with an endoscope.

Continuous ambulatory peritoneal dialysis (CAPD)

Abbreviations pg 305 ADH ARF CRF BUN UA UTI VCUG

Which combining form means pus? A. Pyel/o B. Lith/o C. Ogli/o D. Py/o

A term that means no urine production A. Anuria B. Nocturia C. Diuresis D. Hematuria

Pharmacology Treat bacterial infection of urinary tract. Act on the bacterial membrane or one of its metabolic processes. Type of antibiotic prescribed depends on the infecting organism and the type and extent of infection.

Pharmacology Antispasmodics: –Suppress spasms in ureter, bladder, and urethra by relaxing smooth muscles lining their walls. Allow normal emptying of the bladder Diuretics: –Promote and increase excretion of urine. (Lasix)

A chest x-ray reveals an accumulation of fluid in the lungs A chest x-ray reveals an accumulation of fluid in the lungs. The doctor prescribes a drug to stimulate production and flow of urine. The drug is a/an (antispasmodic, antidiuretic, diuretic). Mr. Q was catheterized for surgery and now experiences spasms in the urethra and bladder. To decrease the spasms and allow normal emptying of the bladder, the doctor prescribes a/an (antispasmodic, antidiuretic, diuretic).

Mrs. T is diagnosed with a urinary tract infection Mrs. T is diagnosed with a urinary tract infection. To treat the bacterial infection, the physician prescribes an (analgesic, antibiotic, antispasmodic). To relieve the patient’s nephralgia, the physician prescribes an (analgesic, antibiotic, antispasmodic).

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