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Urinary System. CHAPTER 15. Urinary System Overview. Functions of urinary system Removes waste products from blood Produces and eliminates urine Kidneys produce hormone Erythropoietin (EPO) Stimulates production of red blood cells within bone marrow Kidneys produce enzyme Renin

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Urinary system

Urinary System

CHAPTER 15


Urinary system overview
Urinary System Overview

  • Functions of urinary system

    • Removes waste products from blood

    • Produces and eliminates urine

    • Kidneys produce hormone Erythropoietin (EPO)

      • Stimulates production of red blood cells within bone marrow

    • Kidneys produce enzyme Renin

      • Aids in raising blood pressure


Structures of the urinary system
Structures of the Urinary System

  • Kidneys

    • Reddish-brown, bean-shaped organs located on either side of the vertebral column at back of upper abdominal cavity

    • Cortex

      • Outer layer of kidney

      • Contains millions of microscopic units called nephrons

        • Functional units of kidneys


Structures of the urinary system1
Structures of the Urinary System

  • Kidneys: Components of Nephron

    • Glomerulus

      • Ball-shaped collection of very tiny, coiled, and intertwined capillaries

    • Bowman’s capsule (renal capsule)

      • Double-walled cup surrounding the glomerulus

    • Renal tubule

      • Proximal convoluted tubule

      • Loop of Henle

      • Distal convoluted tubule

    • Peritubular capillaries


Structures of the urinary system2
Structures of the Urinary System

  • Kidneys

    • Medulla

      • Inner layer of kidney

      • Consist of triangular tissues called renal pyramids- loops and collecting tubules of nephron

      • Pyramids extend into a cuplike urine collection cavity called minor calyx

      • Minor calyces merge to form major calyx

      • Major calyces merge to form renal pelvis


Structures of the urinary system3
Structures of the Urinary System

  • Ureters

    • Muscular tubes lined with mucous membrane

    • One leads from each kidney down to urinary bladder

    • Urine is propelled from renal pelvis through ureters by wavelike contractions known as peristalsis


Structures of the urinary system4
Structures of the Urinary System

  • Bladder

    • Hollow, muscular sac in pelvic cavity

      • Between pubic symphysis and rectum in men

      • Between pubic symphysis and uterus and vagina in women

      • Serves as a temporary reservoir for urine

      • Spherical shaped when full

      • Resembles inverted pyramid when empty


Structures of the urinary system5
Structures of the Urinary System

  • Urethra

    • Mucous membrane-lined tube that leads from bladder to exterior of body

      • Urine exits bladder through urethra

      • External opening of urethra is the urinary meatus

    • Female urethra carries only urine

    • Male urethra carries both urine and semen during ejaculation


Formation of urine
Formation of Urine

  • Formation of urine consists of three distinct processes: glomerular filtration, tubular reabsorption, and tubular secretion

    • Process begins as blood enters kidneys via left and right renal arteries

      • Renal arteries branch out into smaller vessels throughout kidney tissue, until these arteriolesreach cortex of kidney

      • Each arteriole leads to a glomerulus


Formation of urine1
Formation of Urine

  • Glomerular filtration

    • As blood passes through the glomeruli, blood pressure forces materials through glomerular walls into Bowman’s capsule

      • Glomerular Filtrate = water, sugar, salts, and nitrogenous waste products such as urea, creatinine, and uric acid that filter out of blood through thin walls of glomeruli


Formation of urine2
Formation of Urine

  • Tubular reabsorption

    • As glomerular filtrate passes through renal tubules, water, sugar, and salts are returned to bloodstream through network of capillaries that surround them

  • Tubular secretion

    • Materials are selectively transferred from blood into the filtrate to be excreted in the urine


Formation of urine3
Formation of Urine

  • Urine

    • Urine consists of water and other materials that were filtered or secreted into the tubules but not reabsorbed

      • Normally one percent of glomerular filtrate is excreted as urine


Characteristics of normal urine
Characteristics of Normal Urine

  • Color

    • From pale yellow to a deep golden color

    • Darker the urine, greater the concentration

  • Clarity

    • Normal urine is clear

    • Cloudy, turbid appearance to the urine may be due to presence of pus, bacteria, presence of bladder or kidney infection, or a specimen that has been standing for more than an hour


Characteristics of normal urine1
Characteristics of Normal Urine

  • Odor

    • Normal urine is aromatic

    • Has a strong but agreeable odor

  • Specific gravity

    • Normal urine has specific gravity of 1.003 – 1.030

    • Specific gravity = measurement of the amount of solids in the urine


Characteristics of normal urine2
Characteristics of Normal Urine

  • pH

    • Normal urine is slightly acid, pH of 6.0

      • pH range is 4.5 – 8.0

    • pH represents relative acidity or alkalinity of a solution

      • pH of 7.0 is neutral

      • pH below 7.0 is acid

      • pH above 7.0 is alkaline (base)


Characteristics of normal urine3
Characteristics of Normal Urine

  • Protein

    • Normal urine may have small amounts of protein present

    • Only in insignificant amounts, too small to be detected by reagent strip

  • Glucose

    • Normal urine does not contain glucose


Characteristics of normal urine4
Characteristics of Normal Urine

  • Ketones

    • Normal urine does not contain ketone bodies

    • Ketones result from the breakdown of fats


Common signs and symptoms
Common Signs and Symptoms

  • Albuminuria

    • Presence in urine of abnormally large quantities of protein, usually albumin

    • Also known as proteinuria

  • Anuria

    • Cessation (stopping) of urine production, or a urinary output of less than 100 ml per day


Common signs and symptoms1
Common Signs and Symptoms

  • Bacteriuria

    • Presence of bacteria in urine

  • Dysuria

    • Painful urination

  • Enuresis

    • Condition of urinary incontinence, especially at night in bed

    • Bedwetting


Common signs and symptoms2
Common Signs and Symptoms

  • Fatigue

    • State of exhaustion or loss of strength or endurance

    • May follow strenuous physical activity

  • Frequency

    • In case of urinary frequency = urination at short intervals (frequently) without increase in the daily volume of urinary output due to reduced bladder capacity


Common signs and symptoms3
Common Signs and Symptoms

  • Glycosuria

    • Abnormal presence of sugar, especially glucose, in urine

  • Hematuria

    • Abnormal presence of blood in urine


Common signs and symptoms4
Common Signs and Symptoms

  • Ketonuria

    • Presence of excessive amounts of ketone bodies in urine

  • Lethargy

    • State or quality of being indifferent, apathetic (without emotion), or sluggish


Common signs and symptoms5
Common Signs and Symptoms

  • Malaise

    • Vague feeling of bodily weakness or discomfort, often marking the onset of disease of infection

  • Nocturia

    • Urination, especially excessive, at night

    • Also called nycturia


Common signs and symptoms6
Common Signs and Symptoms

  • Oliguria

    • Secretion of a diminished amount of urine in relation to fluid intake

    • Scanty urine output

  • Polydipsia

    • Excessive thirst


Common signs and symptoms7
Common Signs and Symptoms

  • Polyuria

    • Excretion of abnormally large amounts of urine

  • Pyuria

    • Pus in urine, usually a sign of an infection of urinary tract

  • Urgency

    • Feeling to void urine immediately


Pathological conditions

PATHOLOGICAL CONDITIONS

Urinary System


Cystitis
Cystitis

  • Pronounced

    • (siss-TYE-tis)

  • Defined

    • Inflammation of urinary bladder

      • Characterized by urgency and frequency of urination, and by hematuria


Glomerulonephritis acute
Glomerulonephritis (Acute)

  • Pronounced

    • (gloh-mair-yoo-loh-neh-FRYE-tis)

  • Defined

    • Inflammation of glomerulus of kidneys

      • Condition characterized by proteinuria, hematuria, and decreased urine production


Hydronephrosis
Hydronephrosis

  • Pronounced

    • (high-droh-neh-FROH-sis)

  • Defined

    • Distension of pelvis and calyces of the kidney caused by urine that cannot flow past an obstruction in a ureter



Nephrotic syndrome
Nephrotic Syndrome

  • Pronounced

    • (neh-FROT-ic SIN-drohm)

  • Defined

    • Clinical symptoms occurring when damage to glomerulus of the kidney is present and large quantities of protein are lost through the glomerular membrane into urine

      • Results in severe proteinuria

      • Also called nephrosis


Polycystic kidney disease
Polycystic Kidney Disease

  • Pronounced

    • (pol-ee-SISS-tic kidney dih-ZEEZ)

  • Defined

    • Hereditary disorder of kidneys in which grapelike, fluid-filled sacs or cysts, replace normal kidney tissue


Pyelonephritis acute
Pyelonephritis (Acute)

  • Pronounced

    • (pye-eh-loh-neh-FRY-tis)

  • Defined

    • Bacterial infection of the renal pelvis of the kidney

      • Infection begins in the bladder and travels up the ureters to the renal pelvis


Renal calculi
Renal Calculi

  • Pronounced

    • (REE-nal KAL-kew-lye)

  • Defined

    • Stone formations in kidney


Renal cell carcinoma
Renal Cell Carcinoma

  • Pronounced

    • (REE-nal SELL car-sin-OH-mah)

  • Defined

    • Malignant tumor of kidney occurring in adulthood

      • Patient is asymptomatic (symptom free) until latter stages of disease


Renal failure chronic
Renal Failure, Chronic

  • Pronounced

    • (REE-nal FAIL-yoor, KRON-ik)

  • Defined

    • Progressively slow development of kidney failure occurring over a period of years

      • Late stages of chronic renal failure known as end-stage renal disease (ESRD)


Vesicoureteral reflux
Vesicoureteral Reflux

  • Pronounced

    • (vess-ih-koh-yoo-REE-ter-al REE-fluks)

  • Defined

    • Abnormal backflow (reflux) of urine from the bladder to the ureter


Wilm s tumor
Wilm’s Tumor

  • Pronounced

    • (VILMZ TOO-mor)

  • Defined

    • Malignant tumor of the kidney occurring predominately in childhood

      • Most frequent finding is palpable mass in the abdomen


Treatment of renal failure
Treatment of Renal Failure

  • Peritoneal Dialysis

    • Mechanical filtering process

    • Used to cleanse blood of waste products, draw off excess fluids, and regulate body chemistry when kidneys fail to function properly

      • Peritoneal membrane is used as filter


Treatment of renal failure1
Treatment of Renal Failure

  • Continuous Ambulatory Peritoneal Dialysis (CAPD)

    • Requires transfer set, connected to bag of dialysate solution

    • Dialysate solution remains in abdomen for approximately four hours after exchange

      • Process is repeated 3 to 5 times daily

    • Advantage: No machine, convenient for travel


Treatment of renal failure2
Treatment of Renal Failure

Continuous Ambulatory Peritoneal Dialysis


Treatment of renal failure3
Treatment of Renal Failure

  • Continuous Cycling Peritoneal Dialysis (CCPD)

    • Uses a machine that warms the solution and cycles it in and out of the peritoneal cavity at evenly spaced intervals at night while the patient sleeps

      • Process takes 8 to10 hours

      • Last exchange remains in abdomen during the day for approximately 12 to15 hours


Treatment of renal failure4
Treatment of Renal Failure

Continuous Cycling

Peritoneal

Dialysis


Treatment of renal failure5
Treatment of Renal Failure

  • Hemodialysis

    • Process of removing excess fluids and toxins from blood by continually shunting patient’s blood from body into a dialysis machine for filtering, and returning clean blood to patient’s bloodstream

      • Usually three treatments a week, 3 – 4 hours at a time

      • May be performed at dialysis center or at home



Treatment of renal failure7
Treatment of Renal Failure

  • Arteriovenous fistula

    • Access vessel created for use with hemodialysis

    • Opening or fistula is created between an artery and a vein in the forearm

      • Flow of arterial blood into venous system at point of fistula causes vein to become distended

      • Provides a large enough vessel with a strong blood flow for the hemodialysis connection


Treatment of renal failure8
Treatment of Renal Failure

Arteriovenous fistula for hemodialysis


Treatment of renal failure9
Treatment of Renal Failure

  • Kidney transplantation

    • Surgical implantation of a healthy, human donor kidney into the body of a patient with irreversible renal failure

      • Kidney function is restored with a successful transplant and the patient is no longer dependent on dialysis

      • Donor kidney may come from living donor (usually blood relatives) or cadaver donors (nonliving matches)


Treatment of renal failure10
Treatment of Renal Failure

  • Kidney transplantation

    • Donor kidney surgically placed in iliac fossa

    • Donor renal artery connected to recipient’s iliac artery

    • Donor renal vein connected to recipient’s iliac vein

    • Donor ureter connected to recipient’s bladder

      • Donor kidney usually functions once it is in place


Diagnostic techniques treatments and procedures

DIAGNOSTIC TECHNIQUES, TREATMENTS AND PROCEDURES

Urinary System


Diagnostic techniques treatments and procedures1
Diagnostic Techniques, Treatments, and Procedures

  • Blood Urea Nitrogen (BUN)

    • Blood test performed to determine amount of urea and nitrogen (waste products normally excreted by the kidney) present in blood

  • Catheterization

    • Introduction of a catheter into a body cavity or organ to instill a substance or remove a fluid


Diagnostic techniques treatments and procedures2
Diagnostic Techniques, Treatments, and Procedures

  • Creatinine clearance test

    • Diagnostic test for kidney function that measures filtration rate of creatinine, a waste product (of muscle metabolism), which is normally removed by kidney

  • Cystometrography

    • Examination performed to evaluate bladder tone; measuring bladder pressure during filling and voiding


Diagnostic techniques treatments and procedures3
Diagnostic Techniques, Treatments, and Procedures

  • Cystoscopy

    • Process of viewing interior of bladder using a cystoscope

  • Extracorporeal lithotripsy

    • Non-invasive mechanical procedure for breaking up renal calculi so they can pass through ureters

      • Also known as extracorporeal shock-wave lithotripsy


Diagnostic techniques treatments and procedures4
Diagnostic Techniques,Treatments, and Procedures

  • Intravenous pyelogram

    • Radiographic procedure that provides visualization of the entire urinary tract: kidneys, ureters, bladder, and urethra

      • Contrast dye is injected intravenously

      • Multiple x-ray films are taken as medium is cleared from blood


Diagnostic techniques treatments and procedures5
Diagnostic Techniques,Treatments, and Procedures

  • KUB (Kidneys, Ureters, Bladder)

    • X-ray of lower abdomen that defines size, shape, and location of the kidneys, ureters, and bladder

      • Contrast medium is not used with this x-ray

  • Renal angiography

    • X-ray visualization of internal anatomy of renal blood vessels after injection of a contrast medium


Diagnostic techniques treatments and procedures6
Diagnostic Techniques, Treatments, and Procedures

  • Renal scan

    • Radioactive isotope (tracer) is injected intravenously

    • Radioactivity over each kidney is measured as tracer passes through kidney


Diagnostic techniques treatments and procedures7
Diagnostic Techniques,Treatments, and Procedures

  • Retrograde Pyelogram (RP)

    • Radiographic procedure in which small-caliber catheters are passed through a cystoscope into ureters to visualize ureters and renal pelvis


Diagnostic techniques treatments and procedures8
Diagnostic Techniques, Treatments and Procedures

  • Ultrasonography

    • Procedure in which sound waves are transmitted into body structures as a small transducer is passed over patient’s skin

    • Also called ultrasound

  • Urinalysis

    • Physical, chemical, or microscopic examination of urine


Diagnostic techniques treatments and procedures9
Diagnostic Techniques, Treatments, and Procedures

  • Urine culture

    • Procedure used to cultivate the growth of bacteria present in a urine specimen, for proper microscopic identification of the specific pathogen

      • Sample of urine specimen swabbed onto a culture medium plate and placed into an incubator for 24 to 72 hours

      • Plate is then examined for growth on culture medium


Diagnostic techniques treatments and procedures10
Diagnostic Techniques, Treatments, and Procedures

  • 24-Hour urine specimen

    • Collection of urine excreted by the individual over a 24-hour period

      • Urine collected in one large container

      • Also called a composite urine specimen

  • Voiding cystourethrography

    • X-ray visualization of bladder and urethra during voiding process after bladder has been filled with a contrast material


Urine specimen collections
Urine Specimen Collections

  • Catheterized specimen

    • Also known as a sterile specimen

    • Using aseptic techniques, a very small, straight catheter is inserted into the bladder via the urethra to withdraw a urine specimen

      • Urine flows through catheter into a sterile specimen container


Urine specimen collections1
Urine Specimen Collections

  • Clean-catch specimen

    • Also known as midstream specimen

    • Collection method used to avoid contamination of the urine specimen from the microorganisms normally present on the external genitalia

      • Patient cleanses external genitalia with antiseptic wipe

      • Expels small amount of urine into toilet, then collects specimen in sterile container


Urine specimen collections2
Urine Specimen Collections

  • First-voided specimen

    • Also known as an early-morning specimen

    • Patient instructed to collect first voided specimen of the morning

      • Specimen should be refrigerated until it can be taken to the medical office or laboratory


Urine specimen collections3
Urine Specimen Collections

  • Random specimen

    • Urine specimen that is collected at any time

  • Residual urine specimen

    • Specimen obtained by catheterization after the patient empties the bladder by voiding

      • Amount of urine remaining in the bladder after voiding is noted as the residual amount


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