1. Unit 3 Lesson 1: Urinary and Endocrine Diseases

2. Chapter 13 Urinary System Diseases and Disorders Chapter 13 Urinary System Diseases and Disorders

3. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 3 Anatomy and Physiology Kidneys, ureters, bladder, and urethra Kidneys are responsible for removing waste products from the bloodstream

4. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 4 Anatomy and Physiology Ureters are tubules that run from kidney to bladder transporting urine Bladder is a muscular organ that holds urine Urethra carries urine to outside of body

5. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 5 Anatomy and Physiology Urine is normally –Clear –Slightly yellow to gold –Free from sediments –Distinct odor but not foul smelling

6. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 6 Anatomy and Physiology Urine is normally –Specific Gravity is 1.005 to 1.030 –pH is 6 –Changes in these values indicate disease

7. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 7 Common Signs and Symptoms Urinary Disease –Hematuria –Pyuria –Proteinuria –Dysuria

8. S’s & Sx’s urinary frequency, urgency maybe incontinence urine may be dark yellow with foul odor may have pain in pelvic area, lower back bladder spasms fever, chills

9. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 9 Diagnostic Tests Urinalysis Urine culture and sensitivity Blood tests including BUN and creatinine clearance IVPKUB

10. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 10 Diagnostic Tests CystogramCystoscopy Bladder and kidney biopsy Catheterization

11. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 11 Common Diseases of the Urinary Tract Urinary Tract Infections (UTIs) –Broad diagnosis covering infections of urinary tract including the urethra, bladder, and kidneys –Caused by virus and fungi but most often are bacterial –Most common bacteria is escherichia coli (E.coli)

12. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 12 Common Diseases of the Urinary Tract Affects females more frequently than males –Female urethra is shorter –Female urethral opening is closer to rectum –Improper female toilet habits

13. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 13 Common Diseases of the Urinary Tract Affects females more frequently than males –Vaginal secretions may harbor bacteria –Sexual intercourse may cause trauma to urethra and bladder leading to inflammation and infection

14. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 14 Common Diseases of the Urinary Tract Affects females more frequently than males –Pregnant females are more susceptible to infection due to pressure of uterus on urinary tract –Male prostatic secretions have antibacterial effect, reducing risk of UTI

15. Etiology - can be secondary to STD’s Diagnosis – –Is made by U/A clean catch urine → shows abnormal color, odor, RBCs, WBCs Urine culture & sensitivity Cystoscopy Treatment: –specific antibiotics, urinary analgesics –organism specific antibiotics, urinary analgesics

16. Patient Teaching ↑ water intake for females, proper wiping technique of perineum → front to back avoid sexual intercourse during UTI episodes Citrus juice like cranberry concentrate or lemon

17. Some specific UTI’s Urethritis –More common males due to STD (gonorrhea) –Females due to soap, lotion sex, STD –Inflammation of the urethra –Symptoms include swelling of the urethra, dysuria, and urethral discharge

18. Cystitis ~ bladder infection –Again diagnosis is a urinalysis –Most common UTU –Medication turns urine a DARK red –Treatment is antobiotics

19. same Pyelitis –Pelvis of the kidney inflammation –Ascending infection –Young female chhildren Pyelonephritis –Ascending infection –Obstruction of the urine –Tumor needs to be ruled out

20. Acute Glomerulonephritis: Inflammation of glomerulus or filtering unit of kidney Is usually caused by a delayed immune response to a streptococcal infection May lead to renal failure

21. Glomerulus Similar to rheumatic heart disease – autoimmune response causes end-organ damage (causes antigens to be released that attack the Glm., the whole complex can be stuck)

22. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 22 Glomerulonephritis Glomerulonephritis (Acute) –Symptoms Flank pain Fever Loss of appetite

23. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 23 Glomerulonephritis Glomerulonephritis (Acute) –Symptoms Flank pain Fever Loss of appetite

24. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 24 Glomerulonephritis Glomerulonephritis (Acute) –Symptoms Malaise Eyes and ankles are edematous OliguriaHematuria

25. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 25 Glomerulonephritis Glomerulonephritis (Acute) –Treatment AntipyreticDiuretic Salt restriction Protein restrictions Fluid restrictions

26. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 26 Glomerulonephritis Glomerulonephritis (chronic) –Repeated bouts lead to chronic condition –Symptoms include those of acute glomerulonephritis and hypertension –Uremia may occur during late stages –Treatment includes peritoneal or hemodialysis

27. Renal Failure: Failure of kidneys to cleanse waste from the blood Acute Renal Failure – an abrupt reduction in kidney function that is usually reversible. Chronic Renal Failure – slow, progressive loss of nephrons caused by a variety of underlying diseases.

28. Renal Failure Acute and chronic failure is diagnosed with: –Blood urea nitrogen, creatinine –Uremia –Ammonia

29. Acute Symptoms are not significant until 75 percent of kidney function is destroyed Decreased blood flow to kidneys Shock is a big cause, as are medications –Like Tylenol© Embolism, heart failure and dehydration also can cause it

30. Chronic Renal Failure: Presents as a slow, progressive condition resulting from the gradual loss of nephrons. Caused by many disease processes including infection, glomerulonephritis, tumors, auto-immune disorders, and obstruction of the urinary tract.

31. Renal failure Usually no sx until failure is 75% Chronic is much slower, Sx don’t show up until much further degeneration of the parenchyma has occurred. Sx include: –Oliguria, hematuria, albuminumemia, proteinuria

32. Stages of Chronic Renal Failure: 1. Stage One – some nephrons are lost but the remaining nephrons compensate and maintain urine output. 2. Stage Two – renal insufficiency. The progressive loss of nephrons becomes critical and the remaining nephrons can no longer compensate.

33. Stages of Chronic Renal Failure – Continued: 3.Stage Three – End Stage Renal Disease (ESRD) Urine is no longer being formed Urine is no longer being formed Toxins, waste, and fluid build up in the body. Toxins, waste, and fluid build up in the body. Renal Dialysis or kidney transplant becomes necessary – otherwise death occurs. Renal Dialysis or kidney transplant becomes necessary – otherwise death occurs.

34. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 34 Incontinence Urinary Incontinence - loss of urine flow control Types of incontinence –Stress –Urge –Overflow

35. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 35 Incontinence Treatment of Incontinence –Empty bladder –Kegel’s exercises to strengthen pelvic muscles –Collagen injections near external sphincter to narrow the urethra –Marshall-Marchetti-Krantz procedure

36. Chapter 14 Endocrine System Diseases and Disorders

37. Obiectives At the end of this lesson the student will: Be able to identify the anatomy and physiology of the endocrine system Identify the common signs and symptoms of endocrine disorders Describe the signs and symptoms, causes, treatments and prognosis of selected diseases in this systems

38. Thyroid disorders Releases T3, T4 and calcitonin in response to TSH from the anterior pituitary Thyroxine and triiodothyronine regulate metabolism Calcitonin regulates calcium and works in opposition to PTH

39. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 39 Anatomy and Physiology Consists of many glands –Hypothalamus –Pituitary –Pineal –Thymus –Thyroid

40. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 40 Anatomy and Physiology Consists of many glands –Parathyroids –Adrenals –Pancreatic islets –Ovaries and testes

41. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 41 Anatomy and Physiology Each gland is unique and delivers its secretion into the bloodstream Negative feedback system controls amount of hormones secreted

42. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 42 Diagnostic Tests Endocrine glands that can be physically examined are the thyroid and testes Tests: blood and urine testing for hormones CT and MRI check for tumors or alteration in organ size

43. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 43 Pituitary Gland Diseases Hyperpituitarism –Increase in activity of pituitary gland –Oversecretion especially affects growth hormone leading to excessive growth of bones and tissues

44. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 44 Pituitary Gland Diseases Hyperpituitarism –If occurs before puberty, giantism occurs –If occurs in adult, acromegaly occurs Affects small bones of hands, feet, and face by enlarging them

45. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 45 Pituitary Gland Diseases Hypopituitarism –Abnormal decrease in activity of pituitary gland –Effects: Dwarfism Abnormality of secondary sex characteristics Amenorrhea and infertility in adult woman

46. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 46 Pituitary Gland Diseases Hypopituitarism –Adult men may have decreased testosterone levels and libido –Decrease in ACTH and TSH may lead to metabolic disorder

47. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 47 Pituitary Gland Diseases Diagnosis of pituitary function: blood test Treatment of hypopituitarism: hormone replacement, monitoring, and adjustment

48. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 48 Thyroid Diseases Hyperthyroidism –Thyroid gland secretes excessive thyroxine –Caused by tumor of thyroid gland

49. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 49 Thyroid Diseases Hyperthyroidism –Symptoms TachycardiaNervousnessHyperactivity Excessive excitability

50. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 50 Thyroid Diseases Hyperthyroidism –Symptoms Tremendous appetite with weight loss Diarrhea High heat production Moist skin Extreme thirst

51. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 51 Thyroid Diseases Hyperthyroidism –Treatment to reduce thyroxine is often effective –Surgery may be necessary –Autoimmune condition: “Graves’ disease” –Exophthalmos is characteristic symptom –Treatment: medication, radiation, or surgery

52. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 52 Pancreatic Islets of Langerhans Disease Pancreas is exocrine and endocrine gland Islets of Langerhans secrete insulin and glucagon

53. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 53 Pancreatic Islets of Langerhans Disease Insulin lowers blood sugar and glucagon increases blood sugar Sugar or glucose is primary source of energy for all tissue cells

54. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 54 Pancreatic Islets of Langerhans Disease Without glucose, cells produce a waste product called ketones Diabetes Mellitus - affects carbohydrate and sugar utilization due to lack of insulin

55. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 55 Pancreatic Islets of Langrerhans Disease Symptoms –Polydipsia –Polyuria –Polyphagia

56. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 56 Pancreatic Islets of Langerhans Disease Two types: Type 1 and Type II Type 1- Diabetes Mellitus –Known as insulin-dependent diabetes mellitus –Most serious –Affects children and young adults before age 25

57. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 57 Pancreatic Islets of Langerhans Disease Two types: Type 1 and Type II Type 1 - Diabetes Mellitus –Requires daily injections of insulin –Thought to be an autoimmune disorder –Individuals do not usually secrete insulin, making control difficult

58. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 58 Pancreatic Islets of Langerhans Disease Type 1 - Diabetes Mellitus –Must follow strict diet –Monitor blood levels –Administer daily insulin –Exercise and stress can alter insulin needs

59. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 59 Pancreatic Islets of Langerhans Disease Type II: Formerly called non-insulin- dependent Diabetes Mellitus –Adult-onset diabetes –Gradual onset occurring most often in obese females over forty

60. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 60 Pancreatic Islets of Langerhans Disease Type II: Formerly called non-insulin- dependent Diabetes Mellitus –Thought to be caused by the wearing out of pancreatic islets of Langerhans –Usually controlled with diet, exercise, and oral medication to stimulate insulin secretion

61. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 61 Pancreatic Islets of Langerhans Disease Complications –Diabetic shock occurs rapidly –Result of taking too much insulin and not eating enough food

62. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 62 Pancreatic Islets of Langerhans Disease Complications –Symptoms DiaphoresisLight-headednessTrembling –Treatment is emergent with IV glucose to raise blood sugar

63. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 63 Pancreatic Islets of Langerhans Disease Diabetic Coma –Not enough insulin or too many carbohydrates in diet –Symptoms: Polyuria and Polydipsia DehydrationKetoacidosis

64. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 64 Pancreatic Islets of Langerhans Disease Diabetic Coma –Progresses slowly with the individual becoming lethargic and slipping into coma –Slow deep breathing pattern and “fruity or sweet” smelling breath

65. Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 65 Pancreatic Islets of Langerhans Disease Complications of diabetes include –Atherosclerosis –Diabetic retinopathy –Kidney damage –Diabetes cannot be cured Diagnosis: history and blood glucose testing