Emergency Care In The Streets: Chapter 32 Renal And Urologic Emergencies

Front 1

What are the two main functions of the urinary system?

Back 1

Keeping track of electrolytes, water content and acids of the blood.
Removes metabolic wastes, drug metabolites, and excess fluid.

Hint 1

32.3

Front 2

What are the main parts of the uriniary system and their functions?

Back 2

Kidneys, which filter the blood and produce the urine.
Urinary bladder, which stores the urine until it is released from the body.
Ureters, which transport the urine from the kidney to the bladder.
Urethra, which transports the urine from the bladder out of the blody.

Hint 2

32.3

Front 3

The kidneys are found in the...

Back 3

retoperitoneal (behind the peritoneum), which extends from the 12th thoracic vertebra to the third lumbar vertebra.

Hint 3

32.3

Front 4

What is the hilus of the kidneys?

Back 4

A cleft where the ureters, renal blood vessels, lymphatic vessels, and nerves enter and leave the kidney.

Hint 4

32.21

Front 5

What is the renal fascia?

Back 5

Dense, fibrous connective tissue that anchors the kidney to the abdominal wall.

Hint 5

32.21

Front 6

What are the three distinct regions of the internal anatomy of the kidney?

Back 6

The cortex, which is the lighter-colored outer region closes to the capsule.
The medulla (middle layer), which includes the renal pyramids (parallel bundles of urine-collecting tubules), and inward extensions of cortical tissue that surround the pyramids, called renal columns.
Renal Pelvis, which is flat, funnel shaped tuge that fills the sinus at the level of the hilus. Which contains the calcyes, large urinary tubes that branch off of the renal pelvis and connect with the renal pyramids to collect the urine draining from the collecting tubules..

Hint 6

32.4 & 21

Front 7

Blood flow throught the kidney:

Back 7

The blood flows from the abdominal aorta into the kidney by way of the renal artery. Once it enters at the kidney at the hilus, the artery branches into several afferent arteriole. From there the arterioloe branches into a tuft of capillaries called a blomerulus, which is the main filter for the blood in the kidney. From there the blood enters the efferent arteriole, which branches into the peritubular capillaries where tubular resorption occurs.

Hint 7

32.4

Front 8

What are nephrons?

Back 8

The stuctural and functional unit of the kidney that forms urine. Each nephron is compolsed of the glomerulus; the glomerular (Bowman's) capsules, which surrounds the glomerulus; the proximal convolted tubule; the loop of Henle; and the distal convoluted tubule, which connects the kidney's collecting tubules. Each kidney contains approximately 1.25 million nephrons.

Hint 8

32.4

Front 9

Glomerular filtration rate (GFR)

Back 9

The rate at which blood is filtered throught the glomerula. Should be 125 mL/min in a healthy adult.

Hint 9

32.21 & 5

Front 10

Who are the BP monitors of the kidney and how do they act?

Back 10

At the site of where the efferent arteriole comes in contact with the distal convoluted tubule (after the Loop of Henle), a stucture called the juxtaglomerular apparatus is fomed. The cells in the efferent arteriole, called juxtaglomerular cells, are pressure-sensitive, and monitor the BP. The cells of the DCT monitor chemicals. When triggered by BP changes the juxtaglomerular cells release renin. This enzyme initiates a cascade of reactions by converting the plasma protein angiotension into angiotensin I which causes the other enzymes in the blood to convert it into angiotension II. Angiotension II is a potent vasoconstrictor which promotes smooth muscle contraction in the arterioles throughtout the body and also increases resorption of sodium from the proximal convoluted tubule. Water follows sodium thus BP increases.

Hint 10

32.5

Front 11

Antidiuretic hormone (ADH)

Back 11

Produced by the hypothalamus and stored in the posterior lobe of the pituitary. Neurons in the hypothalmus monitor solute concentration. When the solute concentration of the blood increases (often due to sweating or decreased fluid intake), ADH is released into the bloodstream. The hormone travels to the distal convoluted tubule and collecting ducts of the kidney, increasing the permeability to water. Water thereforem leaves the DCT and collecting ducts, and reenters the bloodstream.

Hint 11

32.6

Front 12

Aldosterone

Back 12

A hormone produced in the adrenal glands that increases the rate of active resorption of the sodium and chloride ions into the blood; a corresponding increase occurs in water resorption. This hormone also decreases the resoption of potassium ion, resulting in excess potassium being secreted into the urine.

Hint 12

32.6

Front 13

Mechanism of action with diuretics

Back 13

Often work by decreasing the the reabsorbtion of filtration and increasing the amount of water retiained in the urine. Diabetes mellitus has an osmotic effect. Alcohol encourages diuresis by inhibiting the production of antidiuretic hormone. Other diuretic, including caffine and diuretic medications, inhibit the sodium importers in the DCT and the collecting ducts(within the kidney).

Hint 13

32.6

Front 14

Urethra of man vs female

Back 14

The urethra of a man is about 5 times longer than that of a female. 4 cm vs 20 cm.

Hint 14

32.6

Front 15

How may a UTI become serious?

Back 15

Often when a lower UTI is not treated it leads to an upper UTI. Upper UTIs can lead to pyelonephritis and abscess, which eventually reduce kidney fuction. In severe cases, untreated UTIs can lead to sepsis.

Hint 15

32.7

Front 16

Common syptoms of a lower UTI

Back 16

Painful urniation, frequent urges to urinate, difficulty in urination, and foul odor and cloudy urine.

Hint 16

32.7

Front 17

Kidney stone pain

Back 17

The pain usually starts as vague discomfort in the flank, but becomes very intense within 30 to 60 minutes. It may migrate forward toward the groin as the stone passes through the system.

Hint 17

32.7

Front 18

Acute renal failure (ARF)

Back 18

Sudden (possibly over a period of days) decrease in filtration through the glomeruli. Toxins accumlate within the blood.

Hint 18

32.7

Front 19

oliguria

Back 19

Decrease urine output, <500 mL/day.

Hint 19

32.7

Front 20

anuria

Back 20

When urine output stops completely.

Hint 20

32.7

Front 21

Chronic renal failure

Back 21

A progressive and irreversible inadequate kidney function due to permanent loss of nephrons. Develops over months or years. More than half of all cases are caused by systemic diseases such as diabetes or hypertension.

Hint 21

32.8

Front 22

uremic frost

Back 22

Powdery accumulation of uric acid, especially around the face. Sign of kidney failure.

Hint 22

32.9

Front 23

What is renal dialysis?

Back 23

A technique for "filtering" toxic wastes from the blood, removing excess fluid, and restoring the normal balance of electrolytes.

Hint 23

32.9

Front 24

What are the types of dialysis?

Back 24

There are two types, peritoneal, and hemodialysis.

Periotoneal dialysis uses a large amount of specialize fluid which is infused into abdominal cavity, where it stays for an hour or two. High chance of infection.

Hemodialysis, the patient's blood circulates through a dialysis machine that functions in much the same way as the normal kidneys. It uses the patient's shunt, connection created between a vein and an artery. Treatment is usually needed every 3 to 4 days for 3 to 5 hours.

Hint 24

32.9

Front 25

Potssuim Imbalance in CRF patients

Back 25

One consequence of renal impairment is the inability to excrete ingested potassium. Thus they are very prone to hyperkalemia. Syptoms include profound muscular weakness, peak T waves on an EKG, prolong QRS complex, and sometimes disappearance of the P wae. Complete heart blocks and asystole may occur.

Hypokalemia may occur as a consequence of overagressive dialysis. Patient my be hypotensive, and have cardiac dysrhythmias often bradycardias.

Hint 25

32.10-11

Front 26

Disequilibrium Syndrome

Back 26

During dialysis, the Concentration of Urea in the blood is lowered rapidly, while the solute concentration of the CSF remains hign. Water, moves by osmosis causing an initial shift of water from the bloodstream into the CSF, thereby increasing intracranial pressure. S/s are N/V, headache, and confusion. After a few hours the fluid will re-equilibriate on its own. However this cannot be distinguish from subdural hematoma (which dialysis patients are very prone to) in the field.

Hint 26

32.11

Front 27

Risk of air embolism in dialysis patients

Back 27

If any part of the dialysis is loose, air may enter the system creating an embolism. Symptoms include sudden dyspnea, hypotension, and cyanosis. If you have reason to suspect this disconnect the patient from the machine, place them in left lateral recombent position with 10 degress of head tilt down, and transport immediately .

Hint 27

32.11

Front 28

What are the most frequent presentation of blunt renal trauma?

Back 28

Pain and hematuria (blood in the urine)

Hint 28

32.12

Front 29

Visceral pain

Back 29

The type of pain mostly associated with urologic problems, usually occurs when receptors in the hollow structures such as the ureters, urinary bladder, and urethra become stimulated. It is described as cramping, aching pain, deeping within the body.

Hint 29

32.15

Front 30

Effects of Acute Renal Failure

Back 30

Causes hyperkalema, causing tachycardia, increased PR and QT intervals.

Hint 30

32.18

Front 31

ARF appear

Back 31

pale, cool, moist, and edema will apear on the extremities and face.

Hint 31

32.18