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Questions and Answers
Obstruction can lead to dilation of structures proximal to the obstruction.
Obstruction can lead to dilation of structures proximal to the obstruction.
True
Polyuria refers to low urine output.
Polyuria refers to low urine output.
False
Cystoscopy involves looking inside the bladder with a scope.
Cystoscopy involves looking inside the bladder with a scope.
True
Anuria is the term used for excessive urine output.
Anuria is the term used for excessive urine output.
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An indwelling catheter is less likely to lead to infection compared to an external catheter.
An indwelling catheter is less likely to lead to infection compared to an external catheter.
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Prostate cancer typically has noticeable symptoms before it metastasizes.
Prostate cancer typically has noticeable symptoms before it metastasizes.
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Altered motility in the urinary system can lead to stasis of filtrate in the tubules.
Altered motility in the urinary system can lead to stasis of filtrate in the tubules.
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The presence of red blood cells in urine is termed hematuria.
The presence of red blood cells in urine is termed hematuria.
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Alpha-blockers like Flomax are used to relax bladder muscles for treating prostate cancer.
Alpha-blockers like Flomax are used to relax bladder muscles for treating prostate cancer.
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Neurogenic bladder is primarily caused by issues with kidney function.
Neurogenic bladder is primarily caused by issues with kidney function.
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A urine dipstick can detect nitrites and leukocyte esterase.
A urine dipstick can detect nitrites and leukocyte esterase.
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A biopsy is the definitive test for diagnosing prostate cancer.
A biopsy is the definitive test for diagnosing prostate cancer.
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Transurethral Resection of the Prostate (TURP) involves removing prostate tissue that is obstructing the bladder.
Transurethral Resection of the Prostate (TURP) involves removing prostate tissue that is obstructing the bladder.
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Acute kidney failure is one of the conditions classified under altered urinary elimination.
Acute kidney failure is one of the conditions classified under altered urinary elimination.
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Renal ultrasound is one of the diagnostic tests for kidney function.
Renal ultrasound is one of the diagnostic tests for kidney function.
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Urolithiasis refers to a condition involving bladder muscles dysfunction.
Urolithiasis refers to a condition involving bladder muscles dysfunction.
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Prostate cancer is the leading cause of cancer-related deaths among males under 50.
Prostate cancer is the leading cause of cancer-related deaths among males under 50.
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Reduced blood supply to the kidneys can lead to ischemia and renal failure.
Reduced blood supply to the kidneys can lead to ischemia and renal failure.
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Incontinence is the inability to fully empty the bladder.
Incontinence is the inability to fully empty the bladder.
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Polycystic kidney disease is unrelated to altered urinary elimination.
Polycystic kidney disease is unrelated to altered urinary elimination.
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Benign prostatic hypertrophy can contribute to urinary incontinence.
Benign prostatic hypertrophy can contribute to urinary incontinence.
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Dialysis typically begins when kidney function is reduced to 50% or less.
Dialysis typically begins when kidney function is reduced to 50% or less.
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Polycystic Kidney Disease (PKD) is a genetic condition that leads to the growth of fluid-filled cysts in the kidneys.
Polycystic Kidney Disease (PKD) is a genetic condition that leads to the growth of fluid-filled cysts in the kidneys.
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Hemodialysis is a form of treatment that cleanses the blood of waste products and is done at home.
Hemodialysis is a form of treatment that cleanses the blood of waste products and is done at home.
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Anemia is a potential symptom indicating a significant deterioration in kidney function.
Anemia is a potential symptom indicating a significant deterioration in kidney function.
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Urinary incontinence can affect both older individuals and pregnant women.
Urinary incontinence can affect both older individuals and pregnant women.
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Acidosis is not associated with kidney function deterioration.
Acidosis is not associated with kidney function deterioration.
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An AV graft is preferred over an AV fistula for vascular access in dialysis.
An AV graft is preferred over an AV fistula for vascular access in dialysis.
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Bleeding can be a symptom of kidney failure.
Bleeding can be a symptom of kidney failure.
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Enuresis is a term primarily used for daytime bedwetting.
Enuresis is a term primarily used for daytime bedwetting.
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Diuretics are commonly used to treat urinary incontinence.
Diuretics are commonly used to treat urinary incontinence.
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Overflow incontinence occurs when there is a strong urge to urinate but the bladder cannot hold the volume.
Overflow incontinence occurs when there is a strong urge to urinate but the bladder cannot hold the volume.
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Kegel exercises are designed to strengthen the pelvic floor muscles.
Kegel exercises are designed to strengthen the pelvic floor muscles.
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Interstitial cystitis is often characterized as a bacterial infection of the bladder.
Interstitial cystitis is often characterized as a bacterial infection of the bladder.
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Benign prostatic hyperplasia occurs in 50% of males over the age of 50.
Benign prostatic hyperplasia occurs in 50% of males over the age of 50.
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Behavioral techniques for treating urinary incontinence may include bladder training and double voiding.
Behavioral techniques for treating urinary incontinence may include bladder training and double voiding.
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Post-void residual tests are performed to examine how much urine the bladder holds before urination.
Post-void residual tests are performed to examine how much urine the bladder holds before urination.
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The Purewick catheter is designed to remain in the urinary tract permanently.
The Purewick catheter is designed to remain in the urinary tract permanently.
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Urolithiasis is characterized by the presence of renal calculi, which are solid masses formed from filtrate.
Urolithiasis is characterized by the presence of renal calculi, which are solid masses formed from filtrate.
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Renal colic pain is a constant dull ache associated with kidney stones.
Renal colic pain is a constant dull ache associated with kidney stones.
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CT scans and intravenous pyelograms are examples of imaging studies used to diagnose urolithiasis.
CT scans and intravenous pyelograms are examples of imaging studies used to diagnose urolithiasis.
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Increased fluid intake is part of the supportive treatment for passing kidney stones.
Increased fluid intake is part of the supportive treatment for passing kidney stones.
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Renal failure can only occur as a chronic condition, with no possibility of recovery.
Renal failure can only occur as a chronic condition, with no possibility of recovery.
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Symptoms of renal failure may include fluid retention and shortness of breath.
Symptoms of renal failure may include fluid retention and shortness of breath.
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Foods high in calcium oxalate are recommended for preventing the recurrence of kidney stones.
Foods high in calcium oxalate are recommended for preventing the recurrence of kidney stones.
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Study Notes
Altered Elimination-Urinary System
- Altered urine elimination has four types
- Clinical manifestations and diagnostic tools are reviewed.
- Infections (UTIs, pyelonephritis) (Review Chapter 5)
- Urolithiasis (kidney stones)
- Acute kidney failure
- Chronic renal (kidney) disease
- Kidney failure
- Polycystic kidney disease
- Urinary incontinence
- Benign prostatic hypertrophy
- Miscellaneous cancers of the urinary system and other urinary tract conditions
General Causes of Altered Elimination
- Altered motility
- Altered neuromuscular function
- Altered perfusion
- Altered patency
- Altered volume of excretion
- Altered body fluid balance
Altered Urinary Elimination #1
- Altered motility: Reduction in contraction of renal tubules and ureters
- Etiology: cancer, stones, congenital
- Complications of decreased motility: Stasis of filtrate in tubules and urine in the bladder leading to casts (collection of renal cells) potentially leading to obstruction.
- This leads to altered reabsorption and secretion
Altered Urinary Elimination #2
- Altered Neuromuscular Function: Dysfunction in the bladder
- Etiology: Nervous system injury
- Risk factors: Spinal cord injuries
- Symptoms: Decreased need to void (incontinence), Inability to fully empty the bladder (retention)
- Treatment goals: Preventing UTIs and controlling incontinence.
- Treatment: Catheterization
Altered Urinary Elimination #3
- Altered perfusion: Inadequate blood supply to the kidneys
- Etiology: DIC, Shock, drop in BP
- Complications: Ischemia and/or infarction (dead tissue), pain, altered reabsorption and excretion, renal failure
Altered Urinary Elimination #4
- Altered patency of ureters, urinary pelvis, etc.
- Etiology: Obstruction (e.g., kidney stones)
- Complications: Backup of urine flow, dilation of structures proximal to obstruction, stasis of urine, leading to infection, injury to renal anatomy, damage to structure
General Clinical Manifestations of Altered Urinary Elimination
- Altered volume of excretion: Anorexia, nausea, vomiting, and fever
- Polyuria: Excessive urine output
- Oliguria: Low urine output
- Anuria: No urine output
- Frequency: Increased frequency of urination
- Urgency: Urgent need to urinate
- Dysuria: Painful urination
- Altered excretion characteristics: Hematuria (blood in urine), pyuria (pus in urine), proteinuria (protein in urine)
General Diagnostic Tests for Kidney Function
- Intravenous pyelogram (IVP)
- Cystogram
- Cystoscopy
- Bladder and kidney biopsy
- Renal ultrasound, CT scan
- Urine tests (urinalysis)
- Blood tests: GFR, BUN, and serum creatinine
General Urinary Tests
- Macroscopic urine inspection (color, clarity, smell)
- Urine dipstick (pH, specific gravity, protein, glucose, ketones, nitrite, leukocyte esterase, blood)
- Microscopic urine evaluation (crystals, casts, squamous cells, white and red blood cells, bacteria)
Urinary Catheterization
- Use of a flexible tube to drain or collect urine
- Types: indwelling, in-and-out, external
- When to use catheterization? Draining and Collecting Urine
- Which is most at risk for infection? Indwelling catheters.
Clinical Example: Urolithiasis (Kidney Stones)
- Development of renal calculi (kidney stones): Solid masses precipitated from filtrate.
- Causes: Urinary stasis, elevated urinary levels of salts (e.g., calcium, uric acid), organic or inorganic acids
- Risk of renal tubule obstruction
Urolithiasis Clinical Manifestations
- Pain: Renal colic pain (acute, intermittent, radiating) worse than childbirth; non-colic pain; distention of renal calices or pelvis; dull, deep pain with varying intensity
- Other symptoms: nausea, vomiting, hematuria, pain radiates in flank area
Urolithiasis Diagnostic Criteria
- Subjective findings: History of pain, pain radiating to groin, pain with urination/urgency/fever/chills/nausea/vomiting/hematuria
- Imaging studies: CT scan, IVP, KUB.
- Laboratory analyses: Urinalysis, lab analysis of calculi (stone) composition
Urolithiasis Treatment
- Supportive treatment: Pain control, increased fluid intake, strain urine to catch stones for analysis, lithotripsy (ultrasound waves to break up stones), surgical removal of calculi
Clinical Example: Renal Failure
- Kidneys fail to cleanse blood of waste products like urea, which is converted to ammonia and can be toxic to the brain.
- Can be acute or chronic
- Symptoms: Decreased urine output, fluid retention (edema), shortness of breath, fatigue, confusion, nausea, weakness, irregular heartbeat.
Acute Renal Injury/Failure
- Caused by sudden decreased blood supply or perfusion (compromised/insufficient blood flow to the kidneys.
- Etiology: hemorrhagic shock, surgical shock, embolism, CHF, severe dehydration and certain medications, sepsis, sudden drop in blood pressure
- Reversible in some cases
- Complications: Accumulation of urea, fluid imbalance (hypervolemia), electrolyte imbalance (hyperkalemia), acid-base imbalance
Chronic Kidney Disease
- Slow onset, progressive disease
- GFR used to categorize disease stages
- Causes: Often part of a chronic kidney disease process like diabetes, hypertension, or glomerulonephritis..
- Pathophysiology: Thickening of blood vessels to glomerulus decreases lumen size; decreased blood and oxygen to the kidney.
- Video https://www.youtube.com/watch?v=fv53QZRk4hs
Chronic Kidney Disease (CKD) - Progressive Disease: 5 Stages
- Stage 1-5 characterized by decreasing eGFR and worsening kidney function
- The disease classification is based on the estimated GFR and other kidney markers (BUN/creatinine)
- Dialysis starts when the kidney function is 15 or less
Chronic Kidney Disease - Pathophysiology Summary
- Kidney function decline leads to various complications such as hypertension, hyperkalemia, edema, anemia, skeletal issues, and other problems.
Clinical Manifestations of Kidney Failure - Related to Kidney Functions
- Not significant until 75% of kidney function is destroyed
- Symptoms: Edema, infertility/impotence, bone weakness/fractures, anemia, hypertension, bleeding, acidosis
- Diagnosis: Blood tests (GFR, creatinine, and BUN levels)
- Treatment: various methods, discussed in another slide.
Long-Term Treatment of Kidney Failure
- Dialysis: Procedure that cleanses the blood of waste products. Types include peritoneal dialysis (done at home) and hemodialysis (done in a clinic).
- Transplants: Kidney transplant is another long term treatment option
Hemodialysis during End-Stage Renal Disease
- Procedure for cleaning blood during end-stage renal disease
- Involves blood flow through a dialysis machine
- Components include dialysis inflow pressure monitor, heparin pump, dialyzer, etc
Vascular Access for Dialysis
- AV fistula (artery-vein connection), preferred due to longer life of the access site, less prone to infection
- AV graft (synthetic material connecting artery and vein), alternative if AV fistula isn't possible
- Central venous catheter access: An alternative to AV fistula or graft
Clinical Example: Polycystic Kidney Disease (PKD)
- Genetic condition (autosomal dominant or recessive)
- Pathophysiology: Growth of fluid-filled cysts in the kidneys. Functional tissue replacement. Reduced perfusion, tubule obstruction
- How PKD affects kidney function and GFR: Discussion of affected function and GFR.
- Treatment: Treating complications (infections, pain, meds), hypertension, possible dialysis (depending on severity)
Clinical Example: Urinary Incontinence
- Inability to prevent urine discharge voluntarily
- Risk factors: Older adults, pregnant women, neurological conditions, paralysis, some medications
- Types: Overflow, stress, urge, and functional
- Enuresis: Bedwetting, primarily in children in nighttime
Urinary Incontinence Diagnosis
- Urodynamic studies (e.g., cystometry), tests that study filling and emptying of the bladder
- Post-void residual tests: Checks how much urine is left after voiding, done with ultrasound.
Urinary Incontinence Treatment
- Behavioral techniques (e.g., double voiding, scheduling, bladder training)
- Other treatments: estrogen creams, collagen injections to strengthen sphincter, medications to calm overactive bladder, many surgical options
Clinical Example: Interstitial Cystitis
- Nonbacterial inflammation of the bladder's inner lining
- Potential autoimmune etiology
- Symptoms: Pelvic pain (feels like UTI) and urinary frequency
- Affects mostly young women
- Treatment: Medications (pain relievers, antidepressants, bladder protecting meds), pelvic floor PT, bladder training, nutrition changes (low acid diet)
Clinical Example: Benign Prostatic Hyperplasia (BPH)
- Benign enlargement of prostate gland due to normal cell overgrowth in older men (>50).
- Diagnosis: Digital rectal exam (DRE), prostate-specific antigen (PSA) blood test, biopsy (possible)
- Symptoms: Nocturia (frequent urination at night), hesitancy (difficulty starting urination), weak urinary stream, inability to empty bladder, possible excess urine in ureters (hydroureter, hydronephrosis) and UTIs
Treatment for BPH
- Medications (alpha-blockers) to relax bladder muscles and improve urinary flow.
- Surgery (transurethral resection of the prostate (TURP)) to remove excess prostate tissue
- Surgical method like TURP to alleviate pressure causing the symptoms.
Prostate Cancer
- Slow-growing neoplasm of the prostate gland, common in older men
- Symptoms: Often asymptomatic until metastasis, symptoms similar to BPH (if symptomatic)
- Diagnosis: Digital rectal examination (DRE), Prostate-specific antigen (PSA) monitoring, biopsy (if necessary).
- Treatment: Surgery (prostatectomy), radiation, hormone therapy to reduce growth.
Kidney Cancer: Adenocarcinoma
- Risk factor: Cigarette smoking
- Frequently metastasizes to other organs before symptoms appear (liver, brain, bone)
- Symptoms: Painless hematuria, flank pain, fever
- Diagnosis: KUB, IVP, CT scan, biopsy
- Treatment: Nephrectomy (kidney removal)
Bladder Cancer
- Carcinoma of the bladder lining
- Often metastasizes before symptoms appear
- Risk factors: smoking, chemical exposure, chronic cystitis. More common in men over 60.
- Symptoms: hematuria, dysuria, nocturia
- Diagnosis: cystoscopy and biopsy
- Treatment: Transurethral resection (TUR), Radical cystectomy, Radiation therapy, chemotherapy (if metastasis)
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Description
This quiz covers altered urine elimination and its various types, including urinary tract infections, kidney stones, and chronic renal disease. Clinical manifestations and diagnostic tools are reviewed, along with the general causes of altered elimination. Test your knowledge of these crucial components of the urinary system.
