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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 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
GFR
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.
Assessment and Assessment and ManagementManagement
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
Assessment and Assessment and ManagementManagement
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
Assessment and Assessment and ManagementManagement
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
Acute Renal FailureAcute Renal Failure
Acute Renal FailureAcute Renal Failure
Assessment Focused History
Change in urine output Swelling in face, hands, feet, or torso Presence of heart palpitations or irregularity Changes in mental function
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
Acute Renal FailureAcute Renal Failure
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
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
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
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
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
Anatomy and Physiology General Mechanisms of
Nontraumatic Tissue Problems General Pathophysiology,
Assessment, and Management Renal and Urologic Emergencies