Chapter 11 The Urinary System Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 1 Lesson 11.1 Learning Goals 1. State the function of the urinary system, and analyze associated 2. 3. 4. 5. 6. 7. terms. Write the meanings of the word parts associated with the urinary system, and use them to build and analyze terms. Write the names of the structures of the urinary system, define the terms associated with these structures, and label the structures. Sequence the formation and excretion of urine. Write the names of the diagnostic tests and procedures for assessment of the urinary system when given their descriptions, or match them with their descriptions. Distinguish between normal and abnormal components of urine. Identify the major structures of the nephron and their functions. Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 2 Functions of the Kidneys Filter the blood by removing urea (the byproduct of protein metabolism) and other wastes Maintain proper balance of water, salts, and other substances Eliminate wastes as urine Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 3 Additional Kidney Functions Produce renin (hormone that controls blood pressure) Produce erythropoietin (hormone that stimulates red blood cell production) Metabolize vitamin D to its active form Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 4 Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 5 Quick Quiz! What term means between the kidneys? A. B. C. D. adrenal interrenal infrarenal nephrotoxic Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 6 Terminology: Word Parts ur(o) urine, urinary tract -uria urine or urination Major urinary structures: cyst(o) bladder, cyst, fluid-filled sac nephr(o), ren(o) kidney ureter(o) ureter urethr(o) urethra vesic(o) bladder or blister Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 7 Terminology vesicoureteral, vesicovaginal, urethrovaginal extracystic, abdominocystic, abdominovesical rectourethral, urethrorectal genitourinary, urogenital Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 8 Kidney Cross Section Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 9 Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 10 Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 11 Terminology: Word Parts Internal structures of the kidneys: glomerul(o) pyel(o) Review: dist(o) proxim(o) glomerulus renal pelvis distant near Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 12 Functions of the Nephron Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 13 Formation and Excretion of Urine (cont.) Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 14 Diagnostic Tests and Procedures laboratory tests urinary catheterization urinary radiography endoscopy Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 15 Laboratory Tests urinalysis: physical, chemical, and microscopic examination pH abnormal substances in urine: ketones, sugar, protein, red blood cells, and white blood cells specific gravity, urinometer, or chemical dipstick intake and output (I&O) Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 16 A From Zakus S: Mosby’s clinical skills for medical assistants, 2001, Mosby. B From Bonewit-West K: Clinical procedures for medical assistants, ed 6, Philadelphia, 2004, Saunders. Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 17 From Brunzel NA: Fundamentals of urine & body fluid analysis, ed 2, St Louis, 2004, Saunders. Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 18 Terminology: Word Parts urin(o) Urine Abnormal substances in urine: albumin(o) albumin glyc(o), glycos(o) sugar hemat(o) blood ket(o), keton(o) ketone bodies prote(o), protein(o) protein py(o) pus Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 19 Laboratory Tests (cont.) urine specimen types: voided clean-catch catheterized urine culture, antibiotic sensitivity test creatinine clearance test, renal clearance test blood studies: serum creatinine blood urea nitrogen Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 20 Urinalysis Appearance color: usually pale straw odor: aromatic; similar to ammonia turbidity: should be clear specific gravity: 1.005-1.030 Chemical pH: 6 (possible range 4.6 – 8) glucose, ketones, protein, bilirubin (urobilinogen), leukoesterase and nitrites should all be none. Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 21 Urinalysis (cont.) Microscopic crystals: none RBCs: 0-2 per high-power field (HPF) WBCs: females 0-5/HPF; males 0-3/HPF bacteria: none or few/ HPF = less than 1000 colonies/mL parasites: none casts: few to none Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 22 Indwelling Catheter From Harkreader H, Hogan MA, Thobaben M: Fundamentals of nursing, ed 3, St Louis, 2007, Saunders. Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 23 Urinary Catheterization: Urethral Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 24 Urinary Catheterization (cont.) Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 25 Urinary Catheterization (cont.) Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 26 Diagnostic Tests and Procedures (cont.) urodynamic studies: cystometrography, electromyography urinary radiography nephrosonography nephrotomography, nephrotomogram intravenous urography, urogram intravenous pyelography, pyelogram cystography, cystourethrography voiding cystourethrogram renal angiography, renal arteriogram kidney scan, renography Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 27 From Bontrager KL, Lampignano J: Textbook of radiographic positioning and related anatomy, ed 6, St Louis, 2005, Mosby. Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 28 From Lewis S, Heitkemper MM, Dirksen SR: Medical-surgical nursing, assessment and management of clinical problems, ed 6, St Louis, 2004, Mosby. Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 29 From Price S, Wilson L: Pathophysiology: clinical concepts of disease processes, ed 6, St Louis, 2003, Mosby. Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 30 Diagnostic Tests and Procedures (cont.) endoscopy cystoscopy cystoureteroscopy urethroscopy ureteroscopy nephroscopy Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 31 Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 32 Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 33 Quick Quiz! Which of the following is normal to find in urine? A. B. C. D. blood albumin urea glucose Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 34 Lesson 11.2 Learning Goals 1. 2. 3. 4. 5. 6. 7. Match the terms for urinary system pathologies with their meanings, or write the names when given their descriptions. Describe the significance of genitourinary infections and their association with some sexually transmitted diseases. Match terms for surgical and therapeutic interventions for interventions for urinary pathologies with descriptions of the interventions, or write the names of the interventions when given their descriptions. Select the correct meanings of terms and write the meanings of abbreviations in a health care report pertaining to the urinary system. Spell the terms accurately. Pronounce the terms correctly. Write the meanings of the abbreviations. Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 35 Pathologies uropathy renovascular disorders disorders of urination: dysuria, polyuria, anuria (anuric), oliguria, polyuria, nocturia, nycturia, urgency, frequency, hesitancy, urinary reflux, incontinence, enuresis Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 36 Pathologies (cont.) kidney disorders: uremia, renal failure (acute and chronic), nephromegaly, nephrolysis, nephromalacia, polycystic kidney disease, nephrotic syndrome diabetes mellitus, diabetic nephropathy, nephrotic syndrome, diabetes insipidus renovascular diseases: renal artery stenosis, renal hypertension, nephrosclerosis, renal vein thrombosis Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 37 Courtesy Department of Pathology, Duke University Medical Center, Durham, North Carolina. Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 38 Pathologies (cont.) Uremia an accumulation of waste products in the blood, including urea caused by renal failure acute uremia can be characterized by oliguria and high blood urea nitrogen chronic uremia can require dialysis Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 39 Pathologies (cont.) obstructive nephropathies: hydronephrosis, hydroureter, urolithiasis, nephrolithiasis, ureterolithiasis, cystolithiasis growths: polyps (bladder polyp), bladder cancer, Wilms tumor structural alterations: uterine prolapse, ureterocele, urethrocele, cystocele, urethrostenosis, ureterostenosis Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 40 Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 41 Benign Prostatic Hyperplasia Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 42 Hydronephrosis v. Hydroureter Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 43 Renal Carcinoma From Kumar V, Abbas AK, Fauston N, Mitchell RN: Robbins’ basic pathology, ed 8, Philadelphia, 2007, Saunders. Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 44 Cystocele Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 45 Pathologies (cont.) septicemia, glomerulopathy, ureteropathy UTIs: cystitis, urethritis, pyelonephritis, urethrocystitis/cystourethritis, cystitis, ureteritis, ureteropyelonephritis, pyelitis, pyelonephritis, nephritis, glomerulonephritis, interstitial nephritis sexually transmitted diseases: gonorrhea, urethritis (See also Chapter 13) Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 46 Pathologies (cont.) association of GU infections with STDs gonorrhea can produce urethrorrhea in both genders may include urethritis, dysuria, and pyuria Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 47 Terminology: Word Parts noct(i), nyct(o) olig(o) gon(o) thromb(o) night few, scanty genitals or reproduction thrombus (internal blood clot) Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 48 Hypospadias v. Epispadias From Zitelli BJ, Davis HW: Atlas of pediatric physical diagnosis, ed 5, St Louis, 2007, Mosby. Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 49 Surgical and Therapeutic Interventions: Hemodialysis A, From Ignatavicius MS, Workman ML: Medical-surgical nursing: critical thinking for collaborative care, ed 5, 2006, Philadelphia, Saunders. B, From Lewis S, Heitkemper MM, Dirksen SR: Medical-surgical nursing, assessment and management of clinical problems, ed 6, St Louis, 2004, Mosby. Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 50 Surgical and Therapeutic Interventions (cont.) lithotripsy, lithotomy: nephrolithotomy, pyelolithotomy, ureterolithotomy, cystolithotomy, ESWL urinary diversion: nephrostomy, ureterostomy, cystostomy, transureteroureterostomy, ureterocystostomy, ureterocystoneostomy Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 51 Lithotripsy Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 52 Nephrostomy, Ureterostomy, Transureteroureterostomy Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 53 From Athanasoulis CA et al: Interventional radiology, Philadelphia, 1982, Saunders. Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 54 Surgical and Therapeutic Interventions (cont.) incision: suprapubic cystotomy, cystotomy, urethrotomy excision: nephrectomy, laparoscopic nephrectomy, nephroureterectomy, cystectomy, ureterectomy, renal transplant vascular therapy: percutaneous transluminal renal angioplasty reparative procedures: ureteroplasty, pyeloplasty, cystoplasty, nephropexy other therapies: antibiotics, analgesics, antispasmodics, diuretics Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 55 Transurethral Resection From Lewis S, Heitkemper MM, Dirksen SR, O’Brien PG, Bucher L: Medical-surgical nursing, assessment and management of clinical problems, ed 7, St Louis, 2007, Mosby. Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 56 Quick Quiz! Which term means an abnormal accumulation of waste products in the blood? A. B. C. D. uremia hematuria septicemia thrombolytics Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 57 Abbreviations ADH ARF BPH BUN C&S CRF EMG ESWL GFR GU I&O Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 58 Abbreviations (cont.) IVP KUB pH STD TUR TURP UA, U/A UTI VCUG VD Copyright © 2012, 2009, 2005, 2001, 1997, 1993, 1988, 1983 by Saunders, an imprint of Elsevier Inc. 59