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UROLOGY

UROLOGY. Dr.Ishara maduka. THE RENAL SYSTEM. STRUCTURES: KIDNEYS RETROPERITONEAL RENAL ARTERY & VEIN NEPHRON URETER URINARY BLADDER URETHRA. NORMAL ADULT KIDNEY –

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UROLOGY

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  1. UROLOGY Dr.Ishara maduka

  2. THE RENAL SYSTEM • STRUCTURES: • KIDNEYS • RETROPERITONEAL • RENAL ARTERY & VEIN • NEPHRON • URETER • URINARY BLADDER • URETHRA

  3. NORMAL ADULT KIDNEY – The capsule has been removed and a pattern of fetal lobulations still persists, as it sometimes does. The hilum at the mid left contains some adipose tissue. At the lower right is a smooth-surfaced, small, clear fluid-filled simple renal cyst. Such cysts occur either singly or scattered around the renal parenchyma and are not uncommon in adults.

  4. In cross section, this normal adult kidney demonstrates the lighter outer cortex and the darker medulla, with the renal pyramids into which the collecting ducts coalesce and drain into the calyces and central pelvis.

  5. THE RENAL SYSTEM • 4 MAIN FUNCTIONS OF THE KIDNEYS: • EXCRETION OF WASTE PRODUCTS • FILTRATION • TUBULAR REABSORPTION • TUBULAR SECRETION • REGULATION OF FLUID & ELECTROLYTES • BLOOD PRESSURE REGULATION • ERYTHROPOEITIN SECRETION

  6. THE RENAL SYSTEM PHYSIOLOGY: • RENIN-ANGIOTENSIN • ERYTHROPOEITIN • PROSTAGLANDIN RELEASED BY CELLS NEAR THE GLOMERULUS WHEN GFR IS LOW OR WHEN SYMPA-NS IS STIMULATED • RELEASED IN RESPONSE TO HYPOXEMIA • IS RELEASED BY RENAL MEDULLA; VASODILATOR; • REGULATE RENAL BLOOD FLOW

  7. THE RENAL SYSTEM PHYSIOLOGY: • METABOLISM OF VIT D – FOR CALCIUM METABOLISM • DEGRADATION OF INSULIN • URGE TO VOID : 200-300 ml OF URINE • BLADDER DISTENTION: 400 ml • PARASYMPA-NS : DESIRE TO VOID • SYMPA-NS: MUSCLE RELAXATION & ELIMINATION

  8. RENAL DISORDERS • RENAL FAILURE • GLOMERULONEPHRITIS • NEPHROTIC SYNDROME • NEPHROSCLEROSIS • HYDRONEPHROSIS • INFECTIONS • NEUROGENIC DISORDERS • BENIGN PROSTATIC HYPERTROPHY

  9. RENAL FAILURE (R. F.) INABILITY OF THE KIDNEY TO FUNCTION NORMALLY & EFFECTIVELY • ACUTE RENAL FAILRE • CHRONIC RENAL FAILURE

  10. ACUTE RENAL FAILURE SUDDEN DETERIORATION OF KIDNEY FUNCTION 3 PHASES: • OLIGURIC • ANURIC • POLYURIC / RECOVERY + WASTING OF Na, K, & base HCO3

  11. ACUTE RENAL FAILURE CAUSES: • PRERENAL • SHOCK • MISMATCHED BT • RENAL • NEPHRITIS • NEPHROTOXIC INFECTION • POST RENAL • RENAL CALCULI

  12. CAUSES: PRERENAL GOUT DM SUBACUTE BACTERIAL ENDOCARDITIS RENAL SLE GLOMEROLU-NEPHRITIS POSTRENAL PROSTATIC OBSTRUCTION CHRONIC RENAL FAILURE

  13. UO ALTERATIONS WEAK INCREASINGLY DROWSY RESTLESSNES INSOMIA DRY SKIN & MUCOUS MEMBRANES NAUSEA/ VOMITING CNS IRRITABILITY ANXIETY HALLUCINATION MUSCLE TWITCHING CONVULSIONS COMA HPN ANEMIA EDEMATOUS BRUISE EASILY R. F. - SIGNS & SYMPTOMS

  14. R. F. - MANAGEMENT MODALTIES: • CONSERVATIVE TREATMENT 2. AGGRESSIVE TREATMENT

  15. CONSERVATIVE TREATMENT • DIET • K+, & Na+ RESTRICTED • TREATMENT OF INFECTION • ANTIBIOTICS • TREATMENT OF ALTERATIONS OF BODY CHEMISTRY

  16. ALTERATIONS IN BODY CHEMISTRY I. SUBSTANCES FROM PROTEIN METABOLISM: • UREA • CREATININE • URIC ACID MGT: • PROTEIN RESTRICTION • PREVENTION OF INFECTION • ANABOLIC HORMONES – CAUSE TISSUE BUILD UP & REVERSE BREAKDOWN

  17. ALTERATIONS IN BODY CHEMISTRY • ELECTROLYTES: • HYPERKALEMIA • HYPOKALEMIA • HYPERNATREMIA • HYPONATREMIA • HYPOCALCEMIA, HYPERPHOSPHATEMIA, & BONE DSE • ACIDOSIS

  18. AGGRESSIVE TREATMENT • HEMOFILTRATION • PERITONEAL DIALYSIS • HEMODIALYSIS

  19. HEMOFILTRATION • CONTINUOUS ARTERIOVENOUS HEMOFILTRATION (CAVH) INDICATION: • FLUID OVERLOAD FROM OLIGURIA • RENAL FAILURE A-V SHUNT ULTRAFILTRATION

  20. HEMOFILTRATION ADVANTAGE: • DOES NOT REQUIRE DIALYSIS MACHINE OR DIALYSIS PERSONNEL DISADVANTAGE: • 36-48 HRS

  21. DIALYSIS INDICATION: • GFR FALLS BELOW 3ml/min PURPOSE: • REMOVING WASTE PRODUCTS FROM THE BODY TYPES: • PERITONEAL DIALYSIS • HEMODIALYSIS

  22. RENAL TRANSPLANTATION • AUTOGRAFT • ALLOGRAFT/ HOMOGRAFT • XENOGRAFT

  23. HYDRONEPHROSIS OBSTRUCTION OF URINARY FLOW DISTENTION OF PELVIS & CALYCES THINNING OF RENAL PARENCHYMA GRADUAL DESTRUCTION OF THE KIDNEY COMPENSATORY HYPERTROPHY OF THE CONTRALATERAL KIDNEY IMPAIRMENT OF RENAL FUNCTION

  24. HYDRONEPHROSIS CLIN MANIFESTATIONS: • Asymptomatic • Flank & back pain • Hematuria

  25. HYDRONEPHROSIS MANAGEMENT • Urinary diversion: Nephrostomy • Antimicrobials

  26. INFECTIONS OF THE URINARY TRACT PREDISPOSING FACTORS: • FEMALE : PROXIMITY OF THE URETHRA TO THE VAGINAL-RECTAL ORIFICES • INFANTS AFFECTED MORE OFTEN THAN OLDER CHILDREN • ELDERLY

  27. INFECTIONS OF THE URINARY TRACT CAUSE: • ORGANISMS FROM THE BOWEL • E. coli • Pseudominas • Enterococci

  28. INFECTIONS OF THE URINARY TRACT • Ascending infection & Vesico - Ureteral reflux • Sexual activity • Instrumentation

  29. - KIDNEY- URETER URETERO-VESICAL JUNCTION BLADDER VESICO- URETERAL REFLUX

  30. U.T.I. S/SX CYSTITIS: • FREQUENCY • URGENCY • DYSURIA • BLADDER SPASM • WALLS MAY BLEED WITH SEVERE INFLAMMATION

  31. This is an opened urinary bladder. The mucosa shows many petechial hemorrhages and is swollen and congested. This is hemorrhagic cystitis. It is frequently seen with lower urinary tract infections and is particularly common in the presence of an indwelling urinary catheter.

  32. U.T.I. S/SX PYELONEPHRITIS • PRIMARY LOWER UTI • FLANK PAIN • MUSCLE SPASM • CHILLS • FEVER • DYSURIA

  33. This is another section of a kidney with acute suppurative pyelonephritis. Notice the parenchyma is congested and swollen. There is a calculus in the calyx.

  34. U.T.I. TREATMENT: • ANTIBIOTICS • INCREASE FLUIDS – 3-4L /DAY • EARLY TREATMENT TO PREVENT COMPLICATIONS

  35. U.T.I. COMPLICATIONS: • SEPTICEMIA • RENAL FAILURE

  36. NEUROGENIC DISORDERS • PARASYMPATHETIC NERVOUS SYSTEM – SACRAL CORD 2,3,4 • PERCEPTION TO URINATE: 300-500 ML OF URINE • MAXIMUM BLADDER CAPACITY: 1L OF URINE

  37. NEUROGENIC DISORDERS TYPES: • LESION ABOVE THE SACRAL MICTURITION CENTER (SMC) • SPASTIC, NEUROPATHIC BLADDER • LESION BELOW THE SMC • FLACCID, NEUROPATHIC BLADDER

  38. SPASTIC BLADDER • REDUCED CAPACITY • INVOLUNTARY DETRURSOR CONTRACTIONS • HYPERTROPHY OF THE BLADDER • SPASTICITY OF PELVIC MUSCLES • AUTONOMIC DYSREFLEXIA S/SX: • INVOLUNTARY URINATION • VOIDING CAN BE TRIGGERED BY STIMULATION OF GENETALIA OR ABDOMEN, WITH SPASM OF EXTREMITIES

  39. FLACCID (ATONIC) BLADDER TYPES: • SENSORY • MOTOR • LARGE CAPACITY • LACK OF VOLUNTARY DETRURSOR MUSCLES • MILD WALL HYPERTROPHY (TRABECULATIONS) • DECREASED TONE OF EXTERNAL SPHINCTER

  40. FLACCID (ATONIC) BLADDER • LOSS OF SENSORY / MOTOR SUPPLY TO THE BLADDER • SHOCK PHASE OF SCI • BLADDER : • FLACCID & DISTENDED • RETENTION WITH OVERFLOW INCONTENENCE • SMOOTH MUSCLE STILL ACTIVE + WEAK STRIATED SPHINCTER MUSCLES = TRABECULATIONS • GENITAL PROBLEMS : LOSS OF ERECTION

  41. NEUROGENIC BLADDER DIAGNOSIS: • HISTORY • NEUROLOGICAL EXAM & STUDIES (EMG) • RADIOLOGIC EXAM (VOIDING CYSTOURETHROGRAM) • UROLOGIC STUDIES (UTZ)

  42. NEUROGENIC BLADDER INTERVENTIONS: • INTERMITTENT CATHETER DRAINAGE • CREDE’S METHOD • ALCOHOL, TEA & COFFEE AS DIURETICS • ELECTRONIC STIMULATION OF THE BLADDER

  43. UROLITHIASIS CAUSE: • URINARY STASIS • UREA- SPLITTING ORGANISMS • E. coli • Proteus • Staph, Strep

  44. UROLITHIASIS Types of Stones: • ACID STONES • URIC ACID • CYSTINE • ALKALINE STONES • PHOSPHATE • CALCIUM OXALATE

  45. Alkaline Stone formation UREA-SPLITTING ORGANISMS IN THE URINE URINE BECOMES ALKALINE CALCIUM PHOSPHATE BECOMES INSOLUBE UROLITHIASIS

  46. There was a large renal calculus (stone) that obstructed the calyces of the lower pole of this kidney, leading to a focal hydronephrosis (dilation of the collecting system). The stasis from the obstruction and dilation led to infection. The infection with inflammation is characterized by the pale yellowish-tan areas next to the dilated calyces with hyperemic mucosal surfaces. The upper pole is normal and shows good corticomedullary demarcations.

  47. Sometimes a very large calculus nearly fills the calyceal system, with extensions into calyces that give the appearance of a stag's (deer) horns. Hence, the name "staghorn calculus". Seen here is a horn-like stone extending into a dilated calyx, with nearly unrecognizable overlying renal cortex from severe hydronephrosis and pyelonephritis. Nephrectomy may be performed because the kidney is non-functional and serves only as a source for infection.

  48. UROLITHIASIS S/SX: • CVA PAIN • COLICKY & EXCRUCIATING • RADIATES TO THE LABIA OR SCROTUM • ASHEN FACE • DIAPHORESIS • FREQUENCY • HEMATURIA • FEVER - INFECTION

  49. UROLITHIASIS MEDICAL TREATMENT: • ACID STONES - ALKALINE ASH DIET: • FRUITS • VEGETABLES • MILK • ALKALINE STONES - ACID ASH DIET : • MEAT • FISH • EGGS • CEREALS

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