Renal System: Upper and Lower Urinary Tract Functions
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Questions and Answers

What is the characteristic of Nitrofurantoin in treating uncomplicated UTIs?

  • It is used to treat urinary calculi
  • It is bacteriostatic and must be used for 5 to 7 days (correct)
  • It is bacteriocidal and only needs to be used for 3 days
  • It is used to treat complicated UTIs
  • What is the effect of obstruction of the ureter on the renal pelvicalyceal system?

  • Dilation of the ureter (correct)
  • Hypertrophy of the bladder wall
  • Dilation of the bladder
  • Constriction of the ureter
  • What is the most common type of urinary calculi?

  • Oxalate
  • Phosphate
  • Struvite and calcium carbonate apatite
  • Calcium oxalate or phosphate (correct)
  • What is the underlying cause of pelvicalyceal calculi?

    <p>All of the above</p> Signup and view all the answers

    What is the characteristic of Staghorn calculi?

    <p>They are made up of struvite and calcium carbonate apatite</p> Signup and view all the answers

    What is the treatment for larger bladder stones?

    <p>All of the above</p> Signup and view all the answers

    What is the function of the bladder in the lower urinary tract?

    <p>To act as a reservoir</p> Signup and view all the answers

    What type of bacteria often causes urinary tract infections?

    <p>Both A and B</p> Signup and view all the answers

    What is a symptom of acute bacterial urethritis and cystitis?

    <p>All of the above</p> Signup and view all the answers

    What is the purpose of culturing a urine sample in the diagnosis of urinary tract infections?

    <p>To test antibiotic resistance</p> Signup and view all the answers

    What is a predisposing factor for urinary tract infections?

    <p>Diabetes mellitus</p> Signup and view all the answers

    What is a potential complication of untreated urinary tract infections?

    <p>Kidney inflammation</p> Signup and view all the answers

    Study Notes

    Upper Urinary Tract: Elimination

    • Functions to eliminate urine from the kidney to the exterior
    • Extends from calyces to urethra

    Lower Urinary Tract: Excretion

    • Extends from calyces to urethra
    • Transits urine from kidney to exterior
    • Bladder acts as a reservoir
    • Lined by urothelium (transitional cell epithelium)
    • Resists osmotic stresses of contact with urine

    Disorders of the Lower Urinary Tract

    • Infection
      • Often secondary to stasis
      • Usually due to gram-negative bacteria (E. coli) or gram-positive bacteria (Staphylococcus)
      • Commensals in the large bowel
      • Women are particularly prone
      • Diabetes mellitus also predisposes to infection
      • Symptoms:
        • Pain when urinating or burning sensation
        • Urinating small amounts frequently
        • Cloudy or foul-smelling urine
        • Blood in urine
      • Diagnosis:
        • Urine sample
        • Dipstick
        • Microscopic analysis
        • Culture (not routine, but useful to test antibiotic resistance)
      • Treatment:
        • Some can clear without treatment
        • Cranberry juice/sodium citrate sachets can relieve symptoms
        • Antibiotic treatment is usually fast and effective
        • Antimicrobial resistance varies in different areas of the country
        • Trimethoprim/Sulfamethoxazole for three days is good mini-dose therapy, but resistance rates are high in many areas
        • Nitrofurantoin is a good choice for uncomplicated UTIs, but it is bacteriostatic, not bactericidal, and must be used for 5-7 days
    • Obstruction
      • Intrinsic (e.g., stone formation)
      • Extrinsic (e.g., tumor, pregnancy)
      • Obstruction of ureter:
        • Dilation of the ureter
        • Dilation of the renal pelvicalyceal system
        • Reabsorption of fluid by kidneys
      • Obstruction of urethra:
        • Bladder dilation
        • Hypertrophy of bladder wall
        • Predisposition to outpouching

    Urinary Calculi

    • Most commonly form in pelvicalyceal system and bladder
    • Calculus is a "pebble" in Latin
    • Solid aggregates of dietary minerals
    • Calcium oxalate or phosphate are most common types of calculi
    • Calculi are classified by their location
    • Predisposing factors:
      • Increased solute concentration in the urine
      • Reduced solubility of solute in the urine
    • Underlying causes:
      • Low fluid intake
      • Urine stasis
      • Persistent urinary tract infections
      • Primary metabolic disturbances

    Types of Calculi

    • Pelvicalyceal calculi:
      • Appearance depends on where calculi are formed
      • Calculi are often multiple and small (gravel-like)
      • Calculi in pelvicalyceal system predisposes to:
        • Infection
        • Squamous cell metaplasia
        • Carcinoma in metaplastic areas
    • Staghorn calculi:
      • Most common, made up of struvite and calcium carbonate apatite
      • Caused by organisms that produce enzyme urease, which promotes the generation of ammonia and hydroxide from urea
    • Ureter calculi:
      • Mostly develop in renal pelvis
      • Pass down urinary tract
      • Associated with loin pain
      • Treatment:
        • Small stones can pass naturally
        • Larger stones require surgical removal: shockwave lithotripsy, ureteroscopy, or percutaneous nephrolithotomy
    • Bladder stones:
      • Spherical and laminated
      • Often large
      • Stasis and chronic infection
      • Can cause squamous metaplasia in urinary bladder

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    Description

    This quiz covers the functions of the upper and lower urinary tract, including elimination and excretion processes, as well as disorders and infections that can occur in the lower urinary tract.

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