Urology and nephrology

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Urology & Urology & NephrologyNephrology

SectionsSections

Anatomy and Physiology General Mechanisms of

Nontraumatic Tissue Problems General Pathophysiology,

Assessment, and Management Renal and Urologic Emergencies

Anatomy & Anatomy & PhysiologyPhysiology The Urinary

System Female Male

Urology & Nephrology

The Kidneys

The Urinary System Female Male

Urology & Nephrology

The Kidneys

Anatomy & Anatomy & PhysiologyPhysiology The

Kidneys Hilum Medulla Pyramids Papilla Renal Pelvis

The Kidneys Hilum Medulla Pyramids Papilla Renal Pelvis

Anatomy & Anatomy & PhysiologyPhysiology Nephrons

Glomerulus Bowman’s

capsule Proximal Tubule Loop of Henle Distal Tubule Collecting Duct

Nephrons Glomerulus Bowman’s

capsule Proximal Tubule Loop of Henle Distal Tubule Collecting Duct

Anatomy & Anatomy & PhysiologyPhysiology Functions of the Kidneys

Forming and Eliminating Urine Maintaining blood volume with proper balance of

water, electrolytes, and pH. Retaining key compounds such as glucose, while

excreting wastes such as urea.

Controlling Arterial Blood Pressure Regulating Erythrocyte Development

Functions of the Kidneys Forming and Eliminating Urine

Maintaining blood volume with proper balance of water, electrolytes, and pH.

Retaining key compounds such as glucose, while excreting wastes such as urea.

Controlling Arterial Blood Pressure Regulating Erythrocyte Development

Anatomy & Anatomy & PhysiologyPhysiology Formation of Urine

Glomerular Filtration GFR

Reabsorption & Secretion Simple diffusion and osmosis Facilitated diffusion

• Active transport

Formation of Urine Glomerular Filtration

Reabsorption & Secretion Simple diffusion and osmosis Facilitated diffusion

• Active transport

Anatomy & Anatomy & PhysiologyPhysiology Tubular Handling of Water and

Electrolytes Diuresis and Antidiuresis

Tubular Handling of Glucose and Urea BUN and Creatinine

Control of Arterial Blood Pressure The Renin-Angiotensin System

Control of Erythrocyte Production Erythropoietin

Tubular Handling of Water and Electrolytes Diuresis and Antidiuresis

Tubular Handling of Glucose and Urea BUN and Creatinine

Control of Arterial Blood Pressure The Renin-Angiotensin System

Control of Erythrocyte Production Erythropoietin

Anatomy & Anatomy & PhysiologyPhysiology Ureters

Urinary Bladder

Urethra Testes Epididymus

and Vas Deferens

Prostate Gland Penis

Ureters Urinary

Bladder Urethra Testes Epididymus

and Vas Deferens

Prostate Gland Penis

Inflammatory or Immune-Mediated Disease

Infectious Disease Physical Obstruction Hemorrhage

Inflammatory or Immune-Mediated Disease

Infectious Disease Physical Obstruction Hemorrhage

General Mechanisms of General Mechanisms of Nontraumatic Tissue Nontraumatic Tissue

ProblemsProblems

Differentiating GI and Urologic Complaints

Pathophysiologic Basis of Pain Causes of Pain Types of Pain

Visceral pain Referred pain

Differentiating GI and Urologic Complaints

Pathophysiologic Basis of Pain Causes of Pain Types of Pain

Visceral pain Referred pain

General General Pathophysiology, Pathophysiology, Assessment and Assessment and

ManagementManagement

Scene Size-up Initial Assessment Focused History

OPQRST History Prior History of Similar Event History of Nausea, Vomiting, and Weight Loss Change in Bowel Habits and Stool Last Oral Intake Presence of Chest Pain

Scene Size-up Initial Assessment Focused History

OPQRST History Prior History of Similar Event History of Nausea, Vomiting, and Weight Loss Change in Bowel Habits and Stool Last Oral Intake Presence of Chest Pain

Assessment and Assessment and ManagementManagement

Physical Exam Appearance

Uncomfortable appearance.

Posture Lying with knees drawn up. Relief with walking.

Level of Consciousness Determine if changes are acute or chronic.

Physical Exam Appearance

Uncomfortable appearance.

Posture Lying with knees drawn up. Relief with walking.

Level of Consciousness Determine if changes are acute or chronic.

Apparent State of Health Skin Color Examination of the Abdomen

Inspection for distention, ecchymosis, or scarring Pain associated with percussion of abdomen Palpation

• Normal or ectopic pregnancy• Masses

Assessment Tools Vital Signs

Apparent State of Health Skin Color Examination of the Abdomen

Inspection for distention, ecchymosis, or scarring Pain associated with percussion of abdomen Palpation

• Normal or ectopic pregnancy• Masses

Assessment Tools Vital Signs

Management Airway, Breathing Circulation Pharmacologic Interventions

IV access and analgesics. Nonpharmacological Interventions

Nothing by mouth (NPO). Maintain position of comfort. Reassess mental status and vital signs frequently.

Transport Considerations

Management Airway, Breathing Circulation Pharmacologic Interventions

IV access and analgesics. Nonpharmacological Interventions

Nothing by mouth (NPO). Maintain position of comfort. Reassess mental status and vital signs frequently.

Transport Considerations

Risk Factors Older Patients History of Diabetes History of Hypertension Multiple Risk Factors

Renal and Urologic Emergencies Acute Renal Failure Chronic Renal Failure Renal Calculi Urinary Tract Infection

Risk Factors Older Patients History of Diabetes History of Hypertension Multiple Risk Factors

Renal and Urologic Emergencies Acute Renal Failure Chronic Renal Failure Renal Calculi Urinary Tract Infection

Renal and Urologic Renal and Urologic EmergenciesEmergencies

Acute Renal FailureAcute Renal Failure

Pathophysiology Prerenal Acute Renal Failure

Dysfunction before the level of kidneys• Most common and most easily reversible

Renal Acute Renal Failure Dysfunction within the kidneys themselves

Postrenal Acute Renal Failure Dysfunction distal to the kidneys

Pathophysiology Prerenal Acute Renal Failure

Dysfunction before the level of kidneys• Most common and most easily reversible

Renal Acute Renal Failure Dysfunction within the kidneys themselves

Postrenal Acute Renal Failure Dysfunction distal to the kidneys

Assessment Focused History

Change in urine output Swelling in face, hands, feet, or torso Presence of heart palpitations or irregularity Changes in mental function

Acute Renal FailureAcute Renal Failure Physical Assessment

Altered mental status Hypertension Tachycardia ECG indicative of hyperkalemia Pale, cool, moist skin

Physical Assessment Altered mental status Hypertension Tachycardia ECG indicative of hyperkalemia Pale, cool, moist skin

Acute Renal FailureAcute Renal Failure Physical

Assessment Edema of face,

hands, or feet Abdominal

findings dependent on the cause of ARF

Physical Assessment Edema of face,

hands, or feet Abdominal

findings dependent on the cause of ARF

Management Airway, Breathing, Circulation IV Access

Protect fluid volume.

Positioning and Transport

Management Airway, Breathing, Circulation IV Access

Protect fluid volume.

Positioning and Transport

Chronic Renal Chronic Renal FailureFailure Chronic Renal Failure

Permanent Loss of Nephrons End-Stage Renal Failure (ESRF)

Pathophysiology Similar to Renal ARF

Microangiopathy, glomerular injury Tubular cell injury Insterstitial injury

Chronic Renal Failure Permanent Loss of Nephrons End-Stage Renal Failure (ESRF)

Pathophysiology Similar to Renal ARF

Microangiopathy, glomerular injury Tubular cell injury Insterstitial injury

Chronic Renal Chronic Renal FailureFailure

Chronic Renal Chronic Renal FailureFailure Impairment of Kidney Functions

Maintenance of blood volume with proper balance of water, electrolytes, and pH• Increased sodium, water, and potassium retention

Retention of key compounds such as glucose with excretion of wastes such as urea• Loss of glucose and buildup of urea within the blood

Control of arterial blood pressure• Disruption of the renin-angiotensin loop resulting in HTN

Regulation of erythrocyte development• Development of chronic anemia

Impairment of Kidney Functions Maintenance of blood volume with proper balance

of water, electrolytes, and pH• Increased sodium, water, and potassium retention

Retention of key compounds such as glucose with excretion of wastes such as urea• Loss of glucose and buildup of urea within the blood

Control of arterial blood pressure• Disruption of the renin-angiotensin loop resulting in HTN

Regulation of erythrocyte development• Development of chronic anemia

Chronic Renal Chronic Renal FailureFailure Assessment

Differentiate chronic and acute problems. Focused history and physical exam.

Gastrointestinal complaints Changes in mental status Marked abnormalities during physical exam Uremic frost

Assessment Differentiate chronic and acute problems. Focused history and physical exam.

Gastrointestinal complaints Changes in mental status Marked abnormalities during physical exam Uremic frost

Chronic Renal FailureChronic Renal Failure

Chronic Renal Chronic Renal FailureFailure Immediate Management

Monitor and support ABCs. Establish IV access.

Regulate fluid volume.

Monitor vital signs and cardiac rhythm. Expedite transport to an appropriate facility.

Immediate Management Monitor and support ABCs. Establish IV access.

Regulate fluid volume.

Monitor vital signs and cardiac rhythm. Expedite transport to an appropriate facility.

Chronic Renal Chronic Renal FailureFailure Long-Term

Management Renal Dialysis

Hemodialysis Common

complications

Long-Term Management Renal Dialysis

Hemodialysis Common

complications

Chronic Renal Chronic Renal FailureFailure Long-Term

Management Renal Dialysis

Peritoneal dialysis Common

complications

Long-Term Management Renal Dialysis

Peritoneal dialysis Common

complications

Renal CalculiRenal Calculi Pathophysiology

Results when “too much insoluble stuff” accumulates in the kidneys.

Stone types Calcium salts Struvite stones Uric acid Cystine

Pathophysiology Results when “too

much insoluble stuff” accumulates in the kidneys.

Stone types Calcium salts Struvite stones Uric acid Cystine

Renal CalculiRenal Calculi Assessment

Focused History Severe pain in one flank that increases in intensity

and migrates from the flank to the groin Painful, frequent urination with visible hematuria Prior history of calculi

Physical Exam Difficult due to patient discomfort Tachycardia with pale, cool, and moist skin

Severe pain in one flank that increases in intensity and migrates from the flank to the groin

Painful, frequent urination with visible hematuria Prior history of calculi

Physical Exam Difficult due to patient discomfort Tachycardia with pale, cool, and moist skin

Renal CalculiRenal Calculi

Management Maintain ABCs. Maintain position of comfort. Establish IV access.

Fluid bolus may promote stone movement and urine formation.

Consider medication administration. Parenteral narcotic analgesics may be indicated.

Management Maintain ABCs. Maintain position of comfort. Establish IV access.

Fluid bolus may promote stone movement and urine formation.

Consider medication administration. Parenteral narcotic analgesics may be indicated.

Urinary Tract Urinary Tract InfectionInfection Pathophysiology

Risk Factors Increased risk in female or catheterized patients Sexual activity

Lower and Upper UTIs Urethritis Cystitis Prostatitis Pyelonephritis Community-acquired vs. nosocomial infections

Pathophysiology Risk Factors

Increased risk in female or catheterized patients Sexual activity

Lower and Upper UTIs Urethritis Cystitis Prostatitis Pyelonephritis Community-acquired vs. nosocomial infections

Urinary Tract Urinary Tract InfectionInfection Assessment

Focused History Abdominal pain Frequent, painful urination A “burning sensation” associated with urination Difficulty beginning and continuing to void Strong or foul-smelling urine Similar past episodes

Abdominal pain Frequent, painful urination A “burning sensation” associated with urination Difficulty beginning and continuing to void Strong or foul-smelling urine Similar past episodes

Urinary Tract Urinary Tract InfectionInfection Physical Exam

Restless, uncomfortable appearance. Presence of a fever. Vital signs vary with degree of pain.

Management Maintain ABCs. Establish IV access. Consider analgesics. Transport to appropriate facility.

Physical Exam Restless, uncomfortable appearance. Presence of a fever. Vital signs vary with degree of pain.

Management Maintain ABCs. Establish IV access. Consider analgesics. Transport to appropriate facility.

Urology and Urology and NephrologyNephrology Anatomy and Physiology

General Mechanisms of Nontraumatic Tissue Problems

General Pathophysiology, Assessment, and Management

Renal and Urologic Emergencies

Urology and nephrology

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