Transcript The Urinary Bladder

Chapter 9
The Urinary
System
Related Combining Forms
Structure
Related Combining Forms
Kidneys
nephr/o, ren/o
Renal pelvis
pyel/o
Urine
ur/o, urin/o
Ureters
ureter/o
Urinary bladder
cyst/o
Urethra
urethr/o
Prostate
prostat/o
Functions of the Urinary System
• Maintaining homeostasis by:
– Proper balance of water, salts, and acids by
filtering of blood flowing through the kidneys
– Filtering blood to remove urea, creatinine, uric
acid, and other waste products
– Converting waste products and excess fluids
into urine in the kidneys, and excreting them
from the body
Structures of the Urinary System
•
•
•
•
Two kidneys
Two ureters
One bladder
One urethra
Structures of the Urinary System
The Kidneys
• Located in retroperitoneal space
• Filter blood to remove waste products and
excess water
• Assist with maintenance of fluid level,
production of hormones controlling blood
pressure, erythrocyte production, and
activation of Vitamin D
The Kidneys
• Renal cortex
– Outer region
– Contains nephrons
• Renal medulla
– Inner region
– Contains urine-collecting tubules
Nephrons
• Microscopic functional units
• Site of urine production using filtration,
reabsorption, and secretion
• Contains glomeruli (clusters of capillaries)
• Renal artery supplies blood from kidney to
nephrons
• Renal vein carries filtered blood from kidney
to bloodstream
Nephrons
• Urine is transported to renal pelvis and
collected in preparation for entry into ureters
The Renal Pelvis
• Funnel-shaped area surrounded by renal
cortex and renal medulla
• Site of urine collection before it flows into the
ureters
The Ureters
• Two narrow tubes transporting urine from
kidneys to bladder, through process of
peristalsis
• Ureteral orifices allow draining of urine from
ureters into the bladder
The Urinary Bladder
• Located in anterior portion of pelvic cavity
behind pubic symphysis
• Muscular reservoir for urine
• Lined with rugae allowing for expansion when
full, and contraction when empty
The Urethra
• Tube extending from bladder to exterior of
the body
• Urinary sphincters located at either end of
urethra controll flow of urine from bladder to
urethra, and from urethra to urethral meatus
(external opening of the urethra)
The Urethra
• Female urethra
– Approximately 1.5 inches long
– Meatus located between clitoris and vaginal
opening
– Transports only urine
The Urethra
• Male urethra
– Approximately 8 inches long
– Meatus located at tip of penis
– Transports urine and semen
– Surrounded by prostate gland
The Excretion of Urine
• Known as:
– Urination
– Voiding
– Micturition
• Requires coordinated contraction of bladder
muscles and relaxation of sphincters
Medical Specialties Related to the Urinary System
• Nephrologist
– Specializes in diagnosing/treating
diseases/disorders of kidneys
• (nephr: kidney; -ologist: specialist)
• Urologist
– Specializes in diagnosing/treating
diseases/disorders of urinary system of
females and genitourinary system of males
• (ur: urine; -ologist: specialist)
Pathology of the Urinary System
• Nephropathy
– Any disease of the kidney
• (nephr/o: kidney; -pathy: disease)
• Renal failure
– Improper function of one or both kidney(s)
– Destruction of nephrons
Renal Failure
• Azotemia
– Elevated BUN due to lack of blood flow to
kidneys
• Uremia
– Toxic condition resulting from renal failure
– Urea and other waste products are retained in
the blood
• (ur: urine; -emia: blood condition)
Renal Failure
• Acute renal failure
– Sudden onset of uremia
– Fatal if not reversed promptly
• Chronic kidney disease
– Progressive loss of renal function
– Can be life-threatening
Renal Failure
• End-stage renal disease
– Final stage of chronic kidney disease
– Fatal unless kidney function replaced by
dialysis or kidney transplant
Nephrotic Syndrome
• Nephrotic (nephr/o: kidney; -tic: pertaining to)
• Group of conditions when excessive amounts
of protein are lost through urine
• Edema
– Excessive fluid accumulation in body tissues
as symptom of nephrotic syndrome or other
kidney diseases
Nephrotic Syndrome
• Hyperproteinuria
– Abnormally high concentrations of protein in
urine
• (hyper-: excessive; protein: protein; -uria: urine)
Nephrotic Syndrome
• Hypoproteinemia
– Abnormally low concentration of protein in the
blood
– May be associated with hyperproteinuria
• (hypo-: deficient or decreased; protein; protein;
-emia: blood condition
Additional Kidney Conditions
• Hydronephrosis
– Dilation of one or both kidney(s) due to
obstruction resulting in reflux of urine
• (hydr/o: water; nephr: kidney; -osis: abnormal
condition or disease)
• Nephritis
– Inflammation of kidney(s)
• (nephr: kidney; -itis: inflammation)
Additional Kidney Conditions
• Glomerulonephritis
– Inflammation of glomeruli causing
erythrocytes and proteins to leak into urine
• (glomerul/o: glomeruli; nephr: kidney; -itis:
inflammation)
Additional Kidney Conditions
• Nephroptosis
– Prolapse of kidney into pelvic area when a
person stands
• (nephr/o: kidney; -ptosis: droop or sag)
• Nephropyosis
– Suppuration of kidney
• (nephr/o: kidney; py: pus; -osis: abnormal condition
or disease)
Additional Kidney Conditions
• Polycystic kidney disease
– Genetic disorder
– Growth of numerous fluid-filled cysts in kidney
which replace much of the mass of the kidney
– Leads to reduced kidney function and kidney
failure
• (poly-: many; cyst: cyst; -ic: pertaining to)
Additional Kidney Conditions
• Renal colic
– Acute pain in kidney area caused by blockage
during passage of kidney stone
• Wilms tumor
– Malignant tumor of kidney
– Occurs in young children
Stones
• A stone also known as calculus
• Abnormal mineral deposit formed within the
body
• Nephrolithiasis
– The presence of stones in the kidney
• (nephr/o: kidney; -lithiasis: the presence of stones)
Stones
• Nephrolith: located in kidney
– (nephr/o: kidney; -lith: stone)
• Ureterolith: located in ureter
– (ureter/o: ureter; -lith: stone)
• Cystolith: located in urinary bladder
– (cyst/o: bladder; -lith: stone)
Stones
The Ureters
• Hydroureter
– Distention of ureter with urine due to blockage
• (hydr/o: water; -ureter: ureter)
• Ureterectasis
– Distention of ureter due to hydroureter or
congenital abnormalities
• (ureter: ureter; -ectasis: enlargement)
The Ureters
• Ureterorrhagia
– Discharge of blood from the ureter
• (ureter/o: ureter; -rrhagia: bleeding)
The Urinary Bladder
• Cystalgia (cystodynia)
– Pain in the bladder
• (cyst: bladder; -algia: pain)
• Cystocele
– Hernia of bladder through vaginal wall
• (cyst/o: bladder; cele: hernia)
• Interstitial cystitis
– Chronic inflammation within bladder walls
The Urinary Bladder
• Vesicoureteral reflux
– Backward flow of urine into ureters from the
bladder
• (vesic/o: bladder; ureter: ureter; -al: pertaining to)
• Vesicovaginal fistula
– Abnormal opening from bladder to vagina
allowing constant involuntary flow of urine
from bladder to vagina
• (vesic/o: bladder; vagin: vagina; -al: pertaining to)
The Urinary Bladder
• Neurogenic bladder
– Caused by interference of normal nerve
pathways associated with urination
• (neur/o: nerve; -genic: created by)
– May cause urinary incontinence
– May cause inability to empty bladder
The Prostate Gland
• Benign prostatic hyperplasia
– Enlargement of prostate gland
– May cause difficulty in urination
• Prostatism
– Results from compression of urethra due to
benign prostatic hyperplasia
• (prostat: prostate gland; -ism: condition of)
The Prostate Gland
• Prostate cancer
– One of the most common cancers in men
– May be asymptomatic or aggressive
• Prostatitis
– Group of disorders characterized by
inflammation of prostate gland
The Urethra
• Urethrorrhagia
– Bleeding from the urethra
• (urethr/o: urethra; -rrhagia: bleeding)
• Urethrorrhea
– Abnormal discharge from urethra
• (urethr/o: urethra; -rrhea: flow or discharge)
The Urethra
• Urethrostenosis
– Narrowing of urethra
• (urethr/o: urethra; -stenosis: tightening or
narrowing)
Abnormal Urethral Openings
• Epispadias
– Congenital abnormality
– Male: urethral opening located on upper
surface of penis
– Female: urethral opening located in region of
clitoris
Abnormal Urethral Openings
• Hypospadias
– Congenital abnormality
– Male: urethral opening is on ventral surface of
penis
– Female: urethra opens into the vagina
Urinary Tract Infections
• Cystitis
– Inflammation of bladder
• (cyst: bladder; -itis: inflammation)
• Polynephritis
– Inflammation of renal pelvis and kidney
• (pyel/o: renal pelvis; nephr: kidney)
• Urethritis
– Inflammation of urethra
• (urethr: urethra)
Urination
• Anuria
– Absence of urine formation
• (an-: without; -uria: urine)
• Diuresis
– Increased output of urine
• (di-: through; -uresis: urination)
Urination
• Dysuria
– Difficult, painful urination
• (dys-: painful; -uria: urination)
• Enuresis
– Involuntary discharge of urine
• (en-: into; -uresis: urination)
Urination
• Nocturnal enuresis
– Urinary incontinence during sleep
• Nocturia
– Frequent, excessive urination during the night
• (noct: night: -uria: urination)
• Oliguria
– Scant urination
• (olig: scanty; -uria: urination)
Urination
• Polyuria
– Excessive urination
• (poly-: many; -uria: urination)
• Urinary hesitancy
– Difficulty in starting urinary stream
• Urinary retention
– Inability to completely empty the bladder
Incontinence
• Inability to control excretion of urine, feces, or
both
• Urinary incontinence
– Inability to control voiding
• Overflow incontinence
– Continuous leaking from bladder
Incontinence
• Stress incontinence
– Inability to control voiding under physical
stress (running, sneezing, laughing, etc.)
– More common in women
• Overactive bladder
– Bladder muscles contract involuntarily when
bladder is not full enough to indicate need to
urinate
Diagnostic Procedures of the Urinary System
• Urinalysis
– Determines presence of abnormal elements
• (urin: urine; -alysis: a study of the parts)
• Bladder ultrasound
– Assists with visualization of stones, elevation
of bladder by enlarged prostate, or measuring
of residual urine
Diagnostic Procedures of the Urinary System
• Urinary catheterization
– Insertion of a tube into bladder to procure a sterile
specimen for diagnostic purposes
– Procedure must be performed under sterile conditions
• Obtaining sterile specimen, draining urine from bladder,
placement of medication into bladder
• Cystoscopy
– Use of endoscope for visual examination of
urinary bladder
• (cyst/o: bladder; -scopy: visual examination)
Diagnostic Procedures of the Urinary System
• Voiding cystourethrography
– Use of fluoroscope to determine flow of urine
from bladder and through the urethra
• Computed tomography
– For evaluation of urinary system
• Glomerular filtration rate
– Blood test for determination of filtering of
blood by the kidneys
Radiographic Examinations of the Urinary System
• Cystography
– X-ray examination of bladder
– Requires contrast medium
• (cyst/o: bladder; -graphy: the process of creating a
picture or record)
• Intravenous pyelography
– Provides image of kidneys and ureters
– Requires contrast medium
• (pyel/o: renal pelvis)
Radiographic Examination of the Urinary System
• KUB (kidneys, ureters, bladder)
– Assists with detection of bowel obstructions
and nephroliths
– Does not require contrast medium
• Retrograde urography
– Observes upward flow of urine
– Requires contrast medium
• (ur/o: urine: -graphy: the process of creating a
picture or record)
Diagnostic Procedures of the Prostate Gland
• Digital rectal examination
– Lubricated, gloved finger placed in rectum to
palpate prostate gland
• Prostate-specific antigen blood test
– Screens for prostate cancer
Treatment Procedures of the Urinary System
• Medications
– Diuretics
• Increase urine secretion, primarily to rid body of
excess water and salt
– Antibiotics
• Treatment of urinary tract infections
– Antispasmodics
• Block signals that cause urinary incontinence
Treatment Procedures of the Urinary System
• Nutritional Interventions
– Monitoring of sodium, potassium, protein, and
phosphorus in diet
Treatment Procedures of the Urinary System
• Dialysis
• (dia-: complete or through; -lysis: separation)
– Removes waste products, and excess water
from blood when kidneys do not function
properly
• Hemodialysis (waste products filtered directly from
patient's blood; cleansed blood returned to body
through a vein)
• Peritoneal dialysis (lining of peritoneal cavity acts
as filter to remove waste from the blood)
The Kidneys
• Nephrolysis
– Surgical freeing of a kidney from adhesions
• (nephr/o: kidney; -lysis: setting free)
• Nephropexy
– Surgical fixation of floating kidney
• (nephr/o: kidney; -pexy: surgical fixation)
The Kidneys
• Nephrostomy
– Placement of catheter to maintain opening
from pelvis of one or both kidneys to exterior
of the body
• (nephr: kidney; -ostomy (creating an opening)
The Kidneys
• Pyelotomy
– Surgical incision into renal pelvis
• (pyel: renal pelvis; -otomy: surgical incision)
• Renal transplantation
– Grafting of donor kidney to replace recipient's
failed kidney
Treatment of Nephroliths
• Extracorporeal shockwave lithotripsy
– Breaking of stones into fragments, which are
then excreted in urine
• (lith/o: stone; -tripsy: to crush)
• Percutaneous nephrolithotomy
– Surgical removal of nephrolith through small
opening in the back
• (nephr/o: kidney; lith: stone; -otomy: surgical
incision)
The Ureters
• Ureterectomy
– Surgical removal of a ureter
• Ureterorrhaphy
– Surgical suturing of a ureter
• Ureteroscopy
– Treatment for nephrolith lodged in the ureter
The Urinary Bladder
• Cystectomy
– Surgical removal of all or part of the urinary
bladder
• Ileal conduit
– Use of small piece of intestine to convey urine
to ureters and then to abdominal stoma
• Cystopexy
– Surgical fixation of bladder to abdominal wall
The Urinary Bladder
• Cystorrhaphy
– Surgical suturing of wound/defect in bladder
• Lithotomy
– Surgical incision for removal of nephrolith
from bladder
– Surgical procedure is rarely performed; term
now refers to physical examination position
for procedures involving pelvis and lower
abdomen
Urinary Catheterization
• Sterile Procedure
• Indwelling catheter
– Catheter remains inside body for prolonged
time
– Most common type is Foley catheter
• Urethral catheterization
– Insertion of catheter through urethra and into
the bladder
Urinary Catheterization
• Suprapubic catheterization
– Placement of catheter into bladder through
small incision in abdominal wall just above the
pubic bone
• Intermittent catheter
– Inserted as needed several times per day to
drain urine from bladder
The Urethra
• Meatotomy
– Surgical incision in urethral meatus to enlarge
opening
• (meat: meatus; -otomy: surgical incision)
• Urethroplasty
– Surgical repair of damage/defect in walls of
urethra
• (urethr/o: urethra; -plasty: surgical repair)
The Urethra
• Urethrotomy
– Surgical incision into urethra to relieve
stricture
• (urethr: urethra; -otomy: surgical incision)
Prostate Treatment
• Ablation
– Removal of a body part, or destruction of its
function
• Prostatectomy
– Surgical removal of part or all of the prostate
gland
• (prostat: prostate; -ectomy: surgical removal)
Prostate Treatment
• Transurethral prostatectomy
– Use of resectoscope to remove excess tissue
from enlarged prostate gland
• Radiation therapy and hormone therapy
– Additional treatment for prostate cancer
• Watchful waiting
– May be prescribed approach due to slow
progression of prostate cancer
Urinary Incontinence Training
• Kegel exercises
– Exercises to strengthen muscles of pelvic floor
• Bladder retraining
– Behavioral therapy
– Teaches the patient to urinate at a scheduled
time and at longer intervals as bladder capacity
increases
– Assists with reestablishing voluntary bladder
control