Pathology Ii: Exam 2 , Electrolytes, Renal & Gi

Front 1

Describe 4 main roles of Ca+.

Back 1

1) Managing the coagulation cascade. It's a coagulation factor in a number of steps and is a co-enzyme in others still.

2) It's also important facilitating conduction between nerve and muscle; this becomes critical when talking about the heart muscle.

3) It's also an important means of communication in glands and their successful release of hormones.

4) Aids transmission between nervous impulses.

Front 2

What is the storage form of Ca+?

Back 2

Stored in bone marrow as Ca++. We are constantly turning over the calcium in bone.

This is also why exercise is so important to have strong bones and prevent osteoporosis and is important for conditions like hypothyroidism.

Front 3

How many minutes per day in the sunlight is needed for Vit D manufacturing?

Back 3

20 minutes

NOTE: UVA radiation does the bulk of the radiation damage. UVB in some ways protects the damage.

Front 4

Vitamin D is fat soluble, what role does that fact play when considering absorption?

Back 4

The trouble with modern life is that after we've been out in the sun, we wash off [soap] and you risk washing off a substantial portion of Vit D that you just made (go a couple of hours before you wash).

Front 5

What does the parathyroid hormone do?

Back 5

Parathyroid hormone liberates calcium from bone during remodeling, stimulating osteoclasts (cells that break down bone) and it also stimulates the reabsorption of Ca+ from the distal tubule.

The primary stimulus for parathyroid activity is HYPOcalcemia and adrenal hormones.

Front 6

What is Calcitonin?

Back 6

The complement to parathyroid. It promotes bone strength and bone growth (if you are still growing).

Front 7

If you have hyperparathroidism you are likely to experience...?

Back 7

Osteoporosis over time and in the short term causes hypercalcemia.

Front 8

What are the 5 causes of hypocalcemia?

Back 8

I. IMPAIRED ABILITY TO MOBILIZE CA++ FROM BONE

1) Hypoparathyroidism
2) Hypomagnesemia (b/c Mg def inhibits parathyroid hormone release), impairs the PTH on bone.

II. DECREASED INTAKE OR ABSORPTION OF CA++
3) Decreased dietary calcium intake (Vit D deficiency)...due to malabsorption or failure to convert Vit D into the active form in the LV and KI [this is unusual - maybe in severe anorexia]

NOTE: More common occurrence is damage to the parathyroid glands during thyroid surgery and these people become HYPOparathyroid and quickly develop HYPOcalcemia.

III. ABNORMAL RENAL LOSS - renal failure (pee out too much calcium)

IV. INCREASED CHELATION OR PROTEIN BINDING

V. SEQUESTRATION in the pancreas in acute pancreatitis.

Front 9

What are the manifestations of HYPOcalcemia?

Back 9

1) Increased neuromuscular excitability (you'd think it would decrease it but it's the opposite); Ca is a membrane stabilizer

2) Sensory and/or motor

3) Parasthesias (numbness and tingling, esp in mouth, hands and feet); what you can also get from extremely low levels of C02

4) Tetany (you can get from any muscle groups but most commonly affects facial muscles and fingers and toes); people may have distorted lips and thing they are having a stroke - Chvostek's Sign, Trouseau's Sign

5) Acute arrhythmias (may lead to VFIB or VTACH)

6) Chronic- skeletal, skin changes

Front 10

What are Chvostek's Sign?

Back 10

Indicative of hypoparathyroidism -> hypocalcemia - evoking muscles twitches by tapping in the buccal area just below the zygomatic area where the facial nerve exits.

They are at risk for cardiac arrhythmias if this is positive

Front 11

What are the causes of HYPERcalcemia?

Back 11

YOU NEED TO THINK MALIGNANCY

1) 90% due to increased resorption from bone due to HYPERparathyroidism or Malignancy

2) OTHER
a) Prolonged bedrest (if they are inactive),
b) excess Vit D
c) increased absorption
d) drugs like lithium, thiazide, diuretics (excretion of sodium and other minerals from the urine...by action of ADH in the distal tubule, massive amounts of Ca+ are reabsorbed in the distal tibule...diuretics triggers the release of calcium more than is excreted)

Front 12

What are the manifestations of HYPERcalcemia?

Back 12

1) Decreased neuromuscular excitability (weakness, **fatigue**, CNS/behavior changes, deorientation, confusion, delerium)

2) Cardiac function - ventricular dysrrhythmias. Premature ventricular contractions - the slowed conduction system of the heart as a result from HYPERcalcemia is overridden. Remember the more PVC's you get the more likely you are able to get VTACH. So bother HYPER and HYPOcalcemia can result in VTACH.

3) GI - constipation, N/V, pancreatitis from deoposi

4) ) GI- constipation, N/V, pancreatitis from deposition of Ca++ stones in the ducts.

5) RENAL- stones, interference w/ ADH, polyuria, polydipsia.

NOTE: Dr. Stewart has never seen HYPERcalcemia in an otherwise healthy person (esp not from taking supplements).

Front 13

HYPO and HYPERcalcemia can share what manifestation?

LIKELY TEST QUESTION

Back 13

Both lead to cardiac arrhythmias

Front 14

What is the best way to prevent osteoporosis?

LIKELY TEST QUESTION

Back 14

Encourage exercise and everyone can exercise (weight bearing).

Front 15

What is the 2nd most common intracellular cation behind K+?

Back 15

Magnesium

Front 16

T/F Mg is calcium's right hand man and is important in membrane stabalization?

Back 16

True

Front 17

PHOSPHATEMIA

Back 17

Listen to the tape again. This appears to be skipped over.

Front 18

What are the 2 causes of HYPO-Mg?

Back 18

1) Decreased intake (we lose a lot of Mg from food sources that used to contain it - it is very easily depleted from top soil)

2) excess renal excretion (mostly as diuretic use, hyperaldosteronism...mg is also excreted with potassium, nephrotoxic drugs)

Front 19

HYPOmagnesemia manifests similar to HYPOcalcemia, what is one main difference?

Back 19

Hypomagnesia also causes Htn.

REMEMBER: HypoMg is a muscle relaxant. Can be used to treat Htn and asthma (intravenous). Theoretically, Mg should help with menstrual cramps. If you go into premature labor, a prudent OB will put you on Mg. Ca can also help with menstrual cramping.

Dr. Stewart doesn't see a reason to go above 2g/day (start with a pt off at 500mg/day tablets and build up to 1500mg/day...it's not the elemental weight but the weight of the pill - diarrhea is a common side effect of too much). Magnesium aspartate or orotate (hard to find) or citrate. Mg picalinate (sp) is favored b/c its very easily absorbed.

Front 20

What is Nystagmus?

Back 20

It's a manifestation of hypomagnesemia and is a neurological manifestation.

Twitching of the eyeballs during extreme lateral gaze. This is what cops are testing for when they pull you over to check for alcohol intoxication. Chronic alcoholic abuse can lead to hypomagnesemia.

Front 21

What are the Manifestations of Hypomagnesemia?

NOT on the boards to distinguish but it's good to know.

Back 21

1) Cardiovascular:
-Tachycardia
-Hypertension
-Dysrhythmias

2) Neuromuscular:
-Depression
-Weakness, fatigability
-Tetany
-Nystagmus

[Dr. steward doesn't know the diff readily]

Front 22

What are the causes of HYPERmagnesemia?

Back 22

1) Renal insufficiency
2) Mg-containing medication (unlikely); lots of Mg absorbed at once, causes diarrhea so a loss all at once

NOTE: Elderly are the most susceptible due to age-related decrease in renal function and increased use of Mg-containing meds.

Front 23

HYPERmagnesemia and HYPERcalcemia share what manifestations?

Back 23

Causes weakness and fatigue and hyporeflexia. If very severe can cause paralysis.

NOTE: When tx asthma pt, if Dr. Stewart gives them too much Mg, he also intubates them, so he can breathe for them.

Front 24

What's the most common difference between HYPERMg and HYPERCa?

Back 24

Calcium doesn't affect BP like Mg does. So HYPERMg, causes HYPOtension.

Front 25

T/F Polycystic KI Dz is fairly common?

Back 25

TRUE - 600k Americans; one of the most common inherited Ds. You'll probably see it.

Front 26

How does Polycystic KI Dz often present?

Back 26

High BP in an otherwise healthy person. If it remains unaddressed they can loose KI completely from cyst formation (in the renal tubule and obstruct the tubule). The KI tries to fix the problem by increasing the flow rate through renin-angiotension system (->fluid retention and elevated BP).

Whenever you see a young person with essential Htn., think about this! It's most likely due to secondary Htn - it's due to renal Dz!

Front 27

How can polycystic KI Dz manifest?

Back 27

1) Htn (most common)
2) Abdominal, flank pain
3) Hematuria (stone formation, can be painless); in a younger person it almost always mean KI Dz, in an older person it usu means bladder Dz, usu cancer
4) palpable abdominal mass (rare)

Front 28

What are the causes of urinary obstruction?

TEST: NAME 2-3 causes

Back 28

1) congenital malformation
2) renal calculi (KI stones)
3) tumors, pregnancy, strictures (narrowing of a passageway and usu a result of trauma)
4) benign prostatic hypertrophy (BPH), if prostate is enlarged it can block flow of urine through the urethra
5) surgical

Front 29

Urinary obstruction results in what?

Back 29

In addition to pain...
1) hydronephrosis (uni or bilateral massive expansion of the KI causing fairly high intrarenal hydrostatic pressures and the pressure itself can cause necrosis due to cessation of blood flow)
2) Static urine -> infection -> stone formation
3) If not relieved within days to a week or 2 results in renal failure from back pressure interfering with blood flow

NOTE: Normal urine output per hour is about 50cc's. If the KI don't output at least 15cc KI will die.

Front 30

What are the manifestations of urinary obstructions?

TEST: M/C question

Back 30

1) Fever
2) Flank Pain
3) Ileus (disruption in GI motility; no bowel noises)

NOT KI Infection - b/c KI infection doesn't usually cause ilieus

Front 31

What is the 3rd most common urinary tract Ds?

Back 31

KI stones [a.k.a. nephrolithiasis]

[behind UTI and prostate Ds]

Front 32

What are the most common KI stones?

Back 32

1) Ca+ oxalate, calcim phosphate
2) Mg
3) Magnesium ammonium
4) phosphate.
5) Uric acid.
6) Cystine

Front 33

Why do stones form?

Back 33

1) Saturation theory (high uric acid levels, typically)
2) Matrix theory (matrix of the lining of the tubules in the KI that encourages stone formation)
3) Inhibitor theory (we have chemical inhibitors of stone formation and some people might be deficient in these inhibitors)

p. 542 in the paperback

Front 34

What are the etiology of KI stones?

Back 34

If people are forming KI stones, they will continue to form them. If we can figure out what kind of stone they are forming, we might be able to interrupt that process.

p. 543 in the paperback

Front 35

Which KI stones are easiest to treat?

Back 35

Struvite or uric acid

If uric acid, low purine diet. People with gout often form these stones. The pathway is the same.

p. 543

Front 36

If you have a pt that has Mg ammonium phos. stones, what do you need to check for?

[This was on Dr. Stewart's board exam.]

Back 36

Urea splitting bacteria (UTI); treat their UTI.

Best way to reduce calcium phosphate - substitute water for their diet coke. Sodas use phosphoric acid to make carbonation last longer or be more intense.

Front 37

What is a difficult KI type to treat?

Back 37

CaOxalate/Phosphate

Make sure they are not hypercalcemic or hypercalcuric. Many form stones b/c of diminished flow through the KI.

ONCE A STONE FORMER, ALWAYS A STONE FORMER.

HAVE THEM DRINK IT.

IF SOMEONE COMES IN WITH FLANK PAIN - DON'T THINK THEY BROKE THEIR BACK!

NOTE: Spinach is a high oxalate containing food. Beet greens, chard...

Front 38

What's the main reason we form urine?

Back 38

To get rid of urea. Urea is a main byproduct of metabolism.

Front 39

What is colicky pain?

Back 39

Pain that is really intense, then eases up but doesn't go away and then gets really intense again. It may wax and wane but it's never completely absent. Usually this wax/wane cycle is measured in minutes (versus hours or days). "Stabbing, squeezing" pain has been used - but it's intense. KI stones, gallstones or GI obstruction [smooth muscle cramping and trying to pass something that is not moving]

It's not intermittent pain (this means that the pain comes and goes).

Front 40

What are the manifestations of colicky pain?

Back 40

1) Due to dilation of the ureter or collecting system due to obstruction.
2) Assoc w/ stones 1-5 mm that pass.
3) Pain is acute, intermittent, severe, in the flank and upper-outer quadrant abdominal pain, radiating to the abdomen, bladder area, perineum, and scrotum.
4) Cool, clammy skin, N / V.

THESE people don't develop a fever. Fever indicates infection.

Front 41

What is hematuria?

Back 41

Blood in urine.

Dull aching pain in their flank and they usually always have hematuria. If you do a urinalysis you will see occult blood (microscopic blood)

Front 42

T/F People who are passing a stone often have gross hematuria.

Back 42

True

Front 43

How can you Dx KI stones?

Back 43

90% of KI stones are radiopaque. Can order a KUB (radiology tech gets KI, ureters and bladder all in the same view). *Could be the 10% that can't be seen. But you could rule them in but not rule KI stones out through this test.

Most of the time, 95% - will pass. Most med's to tx pain will relax the muscles. Sometimes the test using the die - will actually help the stone pass and push it out.

Front 44

Why is the type of stone a factor like the size is in terms of determining complications of passing?

Back 44

Caoxalate are smoother and easier to pass even if large.

Struvite stones (Mg/P) are not smooth and often have stalagtites and often get stuck are are painful when they do. These also get stuck at the smaller size.

Uric acid are easily passed.

Cystine stones are spiky and are the worst for getting stuck.

Front 45

Which KI stones are easiest to treat?

Back 45

Struvite or uric acid

If uric acid, low purine diet. People with gout often form these stones. The pathway is the same.

p. 543

Front 46

If you have a pt that has Mg ammonium phos. stones, what do you need to check for?

[This was on Dr. Stewart's board exam.]

Back 46

Urea splitting bacteria (UTI); treat their UTI.

Best way to reduce calcium phosphate - substitute water for their diet coke. Sodas use phosphoric acid to make carbonation last longer or be more intense.

Front 47

What is a difficult type of KI stone to treat?

Back 47

CaOxalate/Phosphate

Make sure they are not hypercalcemic or hypercalcuric. Many form stones b/c of diminished flow through the KI.

ONCE A STONE FORMER, ALWAYS A STONE FORMER.

HAVE THEM DRINK IT.

IF SOMEONE COMES IN WITH FLANK PAIN - DON'T THINK THEY BROKE THEIR BACK!

NOTE: Spinach is a high oxalate containing food. Beet greens, chard...

Front 48

What's the main reason we form urine?

Back 48

To get rid of urea. Urea is a main byproduct of metabolism.

Front 49

What is colicky pain?

Back 49

Pain that is really intense, then eases up but doesn't go away and then gets really intense again. It may wax and wane but it's never completely absent. Usually this wax/wane cycle is measured in minutes (versus hours or days). "Stabbing, squeezing" pain has been used - but it's intense. KI stones, gallstones or GI obstruction [smooth muscle cramping and trying to pass something that is not moving]

It's not intermittent pain (this means that the pain comes and goes).

Front 50

What are the manifestations of colicky pain?

Back 50

1) Due to dilation of the ureter or collecting system due to obstruction.
2) Assoc w/ stones 1-5 mm that pass.
3) Pain is acute, intermittent, severe, in the flank and upper-outer quadrant abdominal pain, radiating to the abdomen, bladder area, perineum, and scrotum.
4) Cool, clammy skin, N / V.

THESE people don't develop a fever. Fever indicates infection.

Front 51

What is hematuria?

Back 51

Blood in urine.

Dull aching pain in their flank and they usually always have hematuria. If you do a urinalysis you will see occult blood (microscopic blood)

Front 52

T/F People who are passing a stone often have gross hematuria.

Back 52

True

Front 53

How can you Dx KI stones?

Back 53

90% of KI stones are radiopaque. Can order a KUB (radiology tech gets KI, ureters and bladder all in the same view). *Could be the 10% that can't be seen. But you could rule them in but not rule KI stones out through this test.

Most of the time, 95% - will pass. Most med's to tx pain will relax the muscles. Sometimes the test using the die - will actually help the stone pass and push it out.

Front 54

Why is the type of stone a factor like the size is in terms of determining complications of passing?

Back 54

Caoxalate are smoother and easier to pass even if large.

Struvite stones (Mg/P) are not smooth and often have stalagtites and often get stuck are are painful when they do. These also get stuck at the smaller size.

Uric acid are easily passed.

Cystine stones are spiky and are the worst for getting stuck.

Front 55

What's wrong with the term UTI?

Back 55

Don't know if it's the bladder or ureter or....

Front 56

When a UTI is Dx in a male, what should you consider?

Back 56

Underlying genitourinary pathology, malformations of the urinary tract, obstruction, retention, STD (indication of immunocompromise, including diabetes - bacteria feeding of the sugar or immunocomprising effects of diabetes), diabetes

Front 57

What is the most common organism in UTI?

TEST: Know 3 common bugs involved in UTI

Back 57

E-coli

Others: Staph, saprophyticus, Klebsiella, proteus, enterobacter, pseudomonas, serratia

Front 58

Why do women more often get UTI's over men?

Back 58

They are ascending infections. While the bacteria is colonizing in the urethra the male is likely to pass urine several times. Short run in women.

The inner lining of the bladder is characterized by rugae (folds) but to a bacteria - this is like a dream landscape and it can hide out from urine.

Front 59

T/F The urethra is normally colonized by bacteria.

Back 59

TRUE - it's most commonly symptomatic when there is trauma - like sex.

Referred to as "Honeymoon cystitis and it's not really cystitis it's urethitis". It does NOT need to be tx with antibiotics. DRINK LOTS of WATER.

Front 60

What mechanisms protect against UTI?

Back 60

1) The "wash out" phenomenon - peeing a lot
2) Protective layer of mucin in the bladder, protective barrier, prevents attachment of bacteria, colonization of the bladder mucosa
3) Host immune response - secratory IgA, phagocytes
4) Normal periurethral and vagical flora-lactobacillus-fend off urinary pathogens

Front 61

What factors predispose people to UTI?

Back 61

1) Obstruction- urinary stasis (like in benign prostatic hypertrophy- can commonly close the urethra)

STATIC URINE WILL BECOME INFECTED

2) Reflux...[more later]

3) Loss of normal flora - estrogen def states

4) Immunocompromise

5) Instrumentation, catheterization.

Front 62

What is pyelonephritis?

Back 62

Infection of the KI that involves the renal pelvis comes from the lower urinary tract.

BEWARE if someone has a history of pyelonephritis - if within 72 hours, go ahead and try to treat naturally.

COMMON bladder infections clear up quickly if they are going to clear up. Get it early before it ascends to the kidneys.

THEY WILL HAVE A FEVER.

Front 63

When should you refer a dysuria patient to get on antibiotics?

Back 63

As you approach 72 hours, if they are at risk for a KI infection.

NOTE: If they are at risk due to immunocompromised, you might want to refer them within 24 hours.

Front 64

What is reflux?

Back 64

[listen to tape, when to the rest room]

Front 65

T/F UTI's in children should warrant investigation.

TEST QUESTION

Back 65

TRUE:

In general UTI's in kids don't just happen, there is SOMETHING else going on.

1) Uncircumcised males - keep it clean

NON-BENIGN
2) Vesicoureteral reflux.
3) Urinary tract anomalies.
4) Immunologic disease.

NOTEWORTHY: Maybe a child (female) is fondling herself. Recurrent UTI in kids - suspect child abuse. Yeast is not alarming in this same way.

IF KIDS AREN'T PEEING, suspect infection. Kids tend TO pee when they are stressed.

Front 66

UTI's in the eldery

Not on the test but good to know

Back 66

1) Incomplete emptying- prostatic enlargement, immobility.
2) Stones.
3) Estrogen deficiency.
4) Instrumentation, catheterizations.
Especially prevalent in nursing homes

Front 67

T/F Elderly (40 +) people often have symptomatic.

Vaginal drying, Prostate issues

Back 67

TRUE -

1st step to take is DRINK MORE WATER

Front 68

Why are UTI's dangerous in the elderly?

Back 68

They can develop pyeloneprhitis that only presents when advanced.

KI infections CAN BE LETHAL, it warrants 2 weeks in the hospital with antibiotics (now our antibiotics are improved but it is still serious). If they are untreated they are still as lethal as they used to be.

They can get SEPSIS, bacteria in the blood, Hypotension, shock and death.

Often signs of pyelo such as fever, chills, flank pain may be absent until the infection is advance and SEPTIC.

Front 69

What is the presentation of cystitis?

Back 69

1) Urinary frequency
2) Dysuria
3) Abdominal pain (the most common presentation in children)
4) Fever (usu absent in adults)
5) Urine may be cloudy - WBC and mucous in the urinary tract when it's inflammed

NOTE: Odor is not a reliable factor. Cystitis Sx are similar to urethritis can be confused with vaginitis.

Front 70

More trouble initiating urinary stream presents more towards which Dz?

Back 70

Cystitis; if burns more later might be more likely vaginitis.

Front 71

What are the manifestations of pyelonephritis (upper tract)?

Back 71

1) Fever, chills, flank pain. N/V. Looks ill.
* Lower tract Sx’s may be present or absent.
2 EXCITING FLAVORS
1) ACUTE PYELO.
2) CHRONIC PYELO- refers to recurring episodes of pyelo, or a continuous infection; can be asymptomatic, and result in scarring and loss of kidney function. Often found only during work-up for hypertension.

Front 72

Why is there drug related nephropathy with NSAIDs?

TEST

Back 72

They are good at treating pain and inflammation is they inhibit prostaglandin and it important in regulation of renal blood flow and it might shut down the blood supply to the KI but not it's filtration.

This is why long-term use of NSAIDS can cause renal failure. The longer these people take these normal daily doses the more likely the are to develop a nephropathy.

Front 73

What is the leading cause of chronic renal failure?

Back 73

Glomerulonephritis

Front 74

Describe which types of contents pass through the urine.

Back 74

PASS THRU
- electrolytes
- urea
- creatinine

DON'T
- albumin
- fibrinogen

Front 75

T/F A number of autoimmune Dz can cause glomerulonephritis.

Back 75

TRUE - they can cause diminished glomerular function (secondary glomerulonephritis), proteinuria (globulins, antibodies can spill in), hematura, oliguria and hypertension

Front 76

T/F Diabetes can lead to glomerulonephritis.

Back 76

TRUE - Diabetes can cause microvascular Dz in the glomerulus so the walls in the tiny capillaries where the filtration via diffusion become fragile and instead of filtering they rupture and bleed and this process breakdown.

It's the same kind of capillary fragility that can cause diabetic retinopathy.

IF YOU ARE DIABETIC AND YOU DO NOT GET KI DZ YOU HAVE WON THE BATTLE

Front 77

T/F Most KI cancers in adults are renal cell carcinomas

TEST: On BENCHMARK

Back 77

TRUE - 85% and they often have metastisies before it's every know they have cancer.

The rest are squamous cell carcinomas. These usually cause hematuria sooner.

Front 78

List 3 causes of pre-renal failure

TEST QUESTION

Back 78

SEE SLIDES
1) Hemmoragic shock
2) Septic shock
3) Anaphalactic shock
4) Cardiogenic shock

Front 79

What causes postrenal failure?

Back 79

1) Urinary obstruction.
* The most common are ureteral stones and people can develop ureteral-strictures which can also obstruct the flow enough to cause this.
2) Bladder tumors, neurogenic bladder
3) Urethra- prostatic enlargement

Reversible if obstruction is reversed before damage to nephrons occur.

Front 80

Intrinsic renal failure results from a damage to which structures?

Back 80

1) Glomeruli, [most common]
2) Tubules,
3) Interstitial tissue

Front 81

What are the causes of intrinsic renal failure?

Back 81

1) Ischemia from pre-renal failure,
2) Toxic insult to the tubules*
3) Intratubular obstruction
4) Acute glomerulonephritis,
5) Acute pyelonephritis (KI infection)

*People who drink antifreeze die of acute renal necrosis.

Front 82

Acute Tubular Necrosis (ATN)

Back 82

It's a devistating Dz process that has to be recognized quickly. If they go to dialisis immediately, they can be saved after surgery.

Front 83

What is sometimes an unfortunate accident of IVP contrast agent?

Back 83

This test and radiocontrast agent can cause the pt KI to die.

Front 84

T/F Cancer pt can sometimes be throw into ATN by their chemotherapy.

Back 84

TRUE

Front 85

Compare/contrast Pre-renal, Post-renal, intrinsic and acute tubular necrosis.

Back 85

1) Pre-renal caused by types of shock, 2) Intrinsic...Most of the time intrinsic renal failure is caused by glomerulonephritis.

FIX ME

Front 86

At what percentage determines renal failure (vs. renal insufficiency...)?

Back 86

When the KI has lost 80% of it's filtration ability

*Dialysis is usually towards End Stage Renal Dz at 95% loss. Unfortunately, this is when it starts getting paid for by insurance.

Front 87

Why do we need to get better at predicting renal failure and renal insufficiency?

Back 87

Because Signs and Sx typically develop only when the Dz is far advanced.

Front 88

What is the most common presentation of earlier chronic renal failure?

TEST QUESTION

Back 88

Htn, cardiovascular function

Front 89

Chronic renal failure is a cause of what?

Back 89

Hypertension, so be sure that they the root cause is identified (not just called "essential htn")

Front 90

T/F When Dr.'s put pt on ACE-inhibitors it Tx the Htn and the cause of it (if renal related).

Back 90

TRUE

Front 91

T/F One of the early signs of chronic renal failure is the excessive production of angiotension II.

Back 91

TRUE

Front 92

When the renal arterioles get thicker and less selectably permiable (microvascular Dz), the glomerial filtration rate starts to decline, what is one of the KI's first response?

Back 92

KI produce more renin -> cascade of events that result in more angiotension II being produced. Angiotension II is a direct vasoCONSTRICTOR and raises BP by itself and stimulates the sympathetic nervous system to do the same and lastly it stimulates the adrenals to produce more aldosterone and aldosterone raises BP.

Aldosterone raises BP by telling the distal tubule in the KI to reabsorb sodium at the expense of potassium.

This then causes Htn and tendency toward fluid retention. The KI is just trying to maintain it's filtration rate. It doesn't know it's due to diabetes. It's responding to a decrease in the filtration rate, regardless of why.

If you are dehydrated, for example, your KI will trigger the same cascade of events, just as if you were in shock. SO PEOPLE can present with High BP just because they are not drinking enough water and they will have a mild case of swollen extremities.

Front 93

T/F A decrease in GFR will raise your BP.

Back 93

TRUE

Front 94

What are manifestations of Chronic Renal Failure?

TEST QUESTIONS - KNOW 3

Back 94

1) Accumulation of nitrogenous wastes** (measured with BUN, blood urea nitrogen)
2) Altered water and electrolyte balance
3) Altered acid-base balance
4) Mineral and bone Ds
5) Htn, cardiovascular Fx
6) GI, skin, hematologic Ds
7) Neurologic, immune Ds

Front 95

T/F Controlled bladder function involves voluntary and involuntary reflexes.

Back 95

TRUE -
1) Spinal cord
2) Mitruration center in the pons
3) Corticol and subcortical centers (voluntary control - BL is say time to empty...says no, no and can sometimes inhibit that impulse).

Front 96

What are the 4 types of incontinence?

TEST/BENCHMARKS

Back 96

1) Stress urinary incontinence (SUI- bust out laughing and can't control)
2) Urge incontinence....

SLIDE 50

Front 97

Define Stress Incontinence

Back 97

Increase in intra-abdominal pressure (enough to override the urethral pressure) with coughing, sneezing, lifting, laughing are normally transmitted to the uretha, so intrauerthral pressure....

SEE SLIDE 52

Front 98

Define Urge Incontinence

Back 98

Two categories (slide 53):
1) Neurogenic
2) The threshold for contraction and relaxation is lowered. It's detrusor instability.

SEE SLIDE

Front 99

Define Overflow Incontinence

Back 99

Incontinence that is caused by bladder getting so distended that the signal to micturate and the pressure inside ....

SLIDE 54
happens in prostatic enlargement

Front 100

What are the causes of bladder cancer?

TEST QUESTIONS

Back 100

Carcinogens secreted in the urine and stored in the bladder:
1) Breakdown products of aromatic amines....(see slide), common environmental toxins
2) Smoking, 80% of bladder cancers are associated with smoking
3) Chronic bladder infections, stones