Exam (elaborations)
Exam 4 adv patho 2024/2025
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Exam 4 adv pathoKidney stone - ANS Are also called renal calculus or urolithiasis
Masses of crystals, proteins or mineral salts form in the urinary tract and obstruct it
Risk factors for kidney stones - ANS -Male
- LESS THAN 50 years old will most likely develop
-Inadequate fluid intake
-Geographic location (TEMP, HUMIDITY, RAIN, FALL, FLUID, AND DIETARY PATTERNS)
Composition of mineral salts - ANS Calcium oxalate and calcium phosphate: 70% to 80%
Struvite (magnesium, ammonium, phosphate): 1-5%
Uric acid: 5-10%
Staghorn calculi vs nonstaghorn - ANS Stag is large and fill the minor and major calyces
Non stag is variable in size, located in calyces, renal pelvis, different sites of ureter
Kidney stone formation - ANS Supersaturation of one or more salts
-Presence of a salt in a higher concentration than the volume able to dissolve the salt
Precipitation of a salt from liquid to solid state
-Temperature and pH
Growth into a stone via crystallization or aggregation
-process by which crystals grow from a small industrial or nucleus to a larger stones
-embedded in matrix
,Presence of absence of stone inhibators
-alkaline urinary PH - increases the risk of calcium phosphate stone formation
-acidic urine - increases the risk of Uris acid stone
-potassium citrate, uromodulin, pyrophophate, magnesium
Treatment for kidney stones - ANS -Managing pain
-Reducing the concentration of stone-forming substances
-Adjusting pH of urine
-Decreasing amount of stone-forming substances
-Removing stones using percutaneous nephrolithotomy, ureteroscopy, or ultrasonic or laser lithotripsy
to fragment stones for excretion
Neurogenic bladder - ANS bladder dysfunction caused by neurologic disorders problems w urine storage
or voiding
Upper motor neurons neurogenic bladder - ANS Dyssynergia - overactive or hyperreflexive bladder
function
Detrusor hyperreflexia - uninhibited or reflex bladder
Detrusor hyperreflexia with vesicosphincter (Detrusor sphincter) dyssynergia - both the bladder and the
sphincter are contracting at the same time, causing functional obstruction of the bladder outlet
Lower motor neurons neurogenic bladder - ANS Detrusor areflexia - underactive, hypotonic, or atonic
bladder
Clinical manifestations of neurogenic bladder - ANS Frequent daytime voiding - more often than every 2
hours while awake
,Nocturia - night time voiding
Urgency - often combined with hesitancy
Dysuria
Poor force of stream, intermittency of urinary stream
Feelings of incomplete bladder emptying, despite micturition
treatment of detrusor sphincter dyssynergia - ANS A-adrenergic blocking (antimuscarinic) meds or
botulinum toxin
Intermittent cath in combination with higher dose antimuscarinic drugs
Condom catheter containment, supplemented by a-adrenergic blocking drug or transuretheral
sphincterotomy (surgical incision of the striated sphincter)
UTI - ANS inflammation of the urinary epithelium caused by bacteria from gut flora
Retrograde movement of bacteria into urethra, bladder, ureter, kidney
UTI: Protective Urinary Mechanisms - ANS Washed out of the urethra during micturition
Low PH and high osmolality of urea
Presence of tamm-horsfall protein
Secretions from the uroepithelium - bactericidal effect
Ureterovesical junction - closes to prevent reflex of urine to the ureters and kidneys
, Women - mucus - secreting glands
Men - length of the male urethra
Lewis blood group
Cystitis - ANS inflammation of the bladder
Acute or chronic
Frequency, dysuria, urgency, low back and or suprapubic pain
Eval by urine culture of specific microorganism with counts of 10k ml or more
Antimicrobial therapy
Acute pyelonephritis - ANS Acute pyelonephritis - acute infection of the ureter, renal pelvis, and/or
kidney interstitium
Clinical manifestions - flank/groin pain, fever, chills, CVA tenderness, UTI symptoms
Evaluation - white blood casts indicating pyelonephritis
Treat with antibiotics
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