Acute renal disease What disorder is related to abrupt insult to the kidney that leads to rapid decrease in renal filtration and an accumulation of nitrogenous waste in the body? If not treated properly it can lead to ESRD. Gastroenteritis mixed incontinence Gigantism and Acromegaly

What disorder is related to abrupt insult to the kidney that leads to rapid decrease in renal filtration and an accumulation of nitrogenous waste in the body? If not treated properly it can lead to ESRD.

• Decreased glomerular filtration of the blood in AKI leads to azotemia, high serum creatinine, and fluid retention Causes of Nephrotic Syndrome Primary adrenal hyperfunction Pathophysiology of Acute Kidney Injury Motility diarrhea

Pathophysiology of Acute Kidney Injury

• Initial insult: condition that disrupts kidney function • Oliguria: low GFR, lack of urine output, fluid overload • Diuresis: large un-concentrated urine outflow • Recovery: healthy nephrons take over function of damaged nephrons; kidney function resumes What disorder is related to abrupt insult to the kidney that leads to rapid decrease in renal filtration and an accumulation of nitrogenous waste in the body? If not treated properly it can lead to ESRD. Symptoms of End Stage Renal Disease (ESRD) blood urea nitrogen (BUN) Phases of Acute Kidney Injury (AKI)

Phases of Acute Kidney Injury (AKI)

Nephrotic syndrome Can cause severe pain from the costovertebral angle of back to abdomen and lower groin. Caused by calcium struvite (caused by bacterial infection of upper urinary tract), uric acid, and cystine. Causes of Acute Renal Failure Which disorder is represented by damage to the glomerulus leading to hyper-permeability of large molecules, such as protein, into the urine? Secondary adrenal hyper-function

Which disorder is represented by damage to the glomerulus leading to hyper-permeability of large molecules, such as protein, into the urine?

Endothelial cell and basement membrane damage >>leading to loss of protein (albumin) >>leading to edema because of decrease oncotic pressure Pathophysiology of Nephrotic Syndrome Cystitis U/A findings of crystalluria and hematuria could mean... Neurogenic bladder incontinence

Pathophysiology of Nephrotic Syndrome

Exam 4: 216 Flashcards

-Irreversible, progressive disease process, numerous nephrons damaged -Kidneys unable to excrete waste products or control volume status -GFR is low -BUN is high -Most common causes are HTN and diabetes

Stage 1: GFR 90 or greater-normal GFR, mild to severe albuminuria Stage 2: GFR 60-89-mildly decreased GFR, mild to severe albuminuria Stage 3a: GFR 45-59-moderately to severely decreased GFR, mild to severe albuminuria Stage 3b: GFR 30-44-moderately to severely decreased GFR, mild to severe albuminuria Stage 4: GFR 15-29-severely decreased GFR, mild to severe albuminuria Stage 5: GFR <15-kidney failure, mild to severe albuminuria, dialysis treatment

oEncephalopathy: poor concentration, lethargy, stupor, coma oThrombocytopenia: d/t lysis of platelets. Symptoms are epistaxis, spontaneous bruising, gum bleeding. oUremic frost and fetor: perspiration and saliva are high in urea. oHyperparathyroidism: parathyroid stimulates release of calcium in bones. In ESRD there is low calcium, so parathyroid goes crazy trying to increase it. oHypertension: d/t high renin secretion. oHeart failure: d/t hypertension and hypervolemia. o Infertility, erectile dysfunction o Renal osteodystrophy: osteoporosis d/t lack of vitamin d. o Peripheral neuropathy o Edema: d/t lack of filtration of kidney; water accumulates. oHigh blood urea nitrogen (BUN) oHigh serum creatinine o Anemia: d/t lack of erythropoietin. Symptoms include weakness, dizziness, pallor.

Acute renal disease

1. Prerenal - sudden and severe drop in blood pressure (shock) or interruption of blood flow to the kidneys from severe injury or illness. **60% are pre-renal** 2. Intrarenal - Direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply. 3. Postrenal - Sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor, or injury.

• Decreased glomerular filtration of the blood in AKI leads to azotemia, high serum creatinine, and fluid retention

• Initial insult: condition that disrupts kidney function • Oliguria: low GFR, lack of urine output, fluid overload • Diuresis: large un-concentrated urine outflow • Recovery: healthy nephrons take over function of damaged nephrons; kidney function resumes

Nephrotic syndrome

o Glomerulonephritis o Diabetes o Autoimmune

Endothelial cell and basement membrane damage >>leading to loss of protein (albumin) >>leading to edema because of decrease oncotic pressure

oAlbuminuria oLow blood albumin level oEdema

oformation of stones, also called calculi, in the kidney. oRisk for developing - Dehydration, hypercalcemia, hyperparathyroidism, gout, high purine intake oCan lead to obstruction: Back up of urine in the kidney Called hydronephrosis and could lead to edema in the renal pelvis, restricted blood flow, compression of kidney tissue, ischemia and renal failure

Symptoms ● dysuria, urgency, frequency, bladder pain, incontinence, hematuria Findings ● +leukocyte esterase, nitrates, cloudy urine, bacteria in culture **In the elderly often presents with confusion, disorientation, and hypotension**

Symptoms ● Flank pain, chills, malaise — systemic Findings ● Fever, +CVA (costovertebral angle) tenderness, +UA, bacteria in culture

Lower urinary tract infection

• Lower UTI or kidney infection that went into bloodstream & leads to sepsis • Seen more often in the elderly or those who are physically vulnerable • Symptoms are atypical of acute bladder infections - symptoms are caused by bacterial endotoxins • Fever, chills, confusion, hypotension, if not treated lead to death

Urinary Tract Infection

Nephrolithiasis and urolithiasis

Diabetes or renal dysfunction caused by diabetes in the case of proteinuria

Liver disorder

-Inflammation of the Bladder not associated with a known bacteria: -Causes include infections (previous), autoimmunity, neurogenic sensitivity **same sx as UTI**

shows small tears and hemorrhages of a thinning bladder wall.

-Bladder wall shows one or more ulcers called Hunner ulcers -These ulcers are only seen with over-distention of the bladder

the inability to control the voiding of urine under physical stress such as running, sneezing, laughing, or coughing

condition caused by uncontrolled contraction or over activity of the detrusor muscle

the combination of stress incontinence and urge incontinence

involuntary loss of urine associated with overdistention and overflow of the bladder (Bladder never fully empties)

loss of nervous system control of bladder E.g. spinal cord injury

the person has bladder control but cannot use the toilet in time

Infection of kidney • Can result from obstruction of urinary pathway • Instrumentation • Infection can ascend up from bladder • Symptoms are generalized o Fever, chills, pain, CVA tenderness, frequency, dysuria

Infection of the bladder • Caused when bacteria enters the bladder - more common in females related to .... • In older men due to BPH • Common bacteria - o E-coli, Proteus, pseudomonas • More common in diabetes • Can be hospital acquired due to cauterization

o one of the most common urologic problems o Due to stones o Enlarged prostate (benign prostatic hypertrophy) o can lead to hydronephrosis and hydroureter

Neurogenic

Stress incontinence

Overflow

reakdown Product of muscle - excreted By kidneys - when blood level Increases means kidneys are Not functioning properly

1. U/A 2. 24 hour test decreased creatinine in urine means decrease in renal function

The amount of blood filtered by the glomerulus per minute - a decreased GFR indicates decrease renal function

Urea is a waste product - when blood level increases it indicates decrease renal function

Break down of Purine - Increased levels - poor kidney function

Nephrolithiasis

A technique in which an artificial kidney machine removes waste products from the blood

dialysis in which the lining of the peritoneal cavity acts as the filter to remove waste from the blood

**Do not take blood pressure in this arm!** -Best choice for hemodialysis -made by connecting an artery to a vein -optimal blood flow -lowest chance for infection **hear the bruit, feel the thrill!**

-Dx. Kidney stones -U/A or 24 hour urine: hematuria, crystalluria

-Dx: stress incontinence -Lab changes: none -caused by weak pelvic floor

-Dx: interstitial cystitis -U/A to r/o UTI -Scope to r/o ulcers -r/o autoimmunity

-Dx: chronic renal failure -Labs: GFR->low Creatinine->high BUN->high K+->high Ca->low Hemoglobin->low Platelets->low Vitamin d->low Erythropoietin->low

• Endocrine system consist of glands, specialized cell clusters, and hormones, which are chemical transmitters secreted by the glands in response to stimulation • Together with the CNS the endocrine system regulates the body's metabolic activities and maintains homeostasis

controls pituitary gland

"THE MASTER GLAND" the endocrine system's most influential gland under the influence of the hypothalamus, the pituitary regulates growth and controls other endocrine glands

Hypothalamus releases TRH>>>Anterior Pituitary releases TSH>>TSH stimulates thyroid gland>>thyroid follicles release T3 & T4>>increased T3 & T4 concentration in the blood (homeostasis restored)>>normal T3&T4 concentrations, normal body temperature (homeostasis), decreased T3&T4 concentration in blood or low body temperature (homeostasis disturbed)>>the cycle continues

Head of baby pushes against cervix—>nerve impulses from cervix transmitted to brain—>brain stimulates pituitary gland to secrete oxytocin—>oxytocin carried in bloodstream to uterus>>loop continues

Hypothalamus>Pituitary>End organ 1. TRH>TSH>T4&T3 2. CRH>ACTH>Cortisol 3. GnRH>LH&FSH>Estrogen Progesterone 4. GHRH>GH>Body cells to stimulate growth

• Autoimmunity ▫ Body manufactures antibodies that lead to inflammation of target endocrine organs. Autoimmunity can cause either hypo or hyper function • Chemical mediator dysfunction ▫ Such as chemotaxis in DM type 2 • Tumors ▫ Can lead to hypo or hyper function • Trauma/Ischemia ▫ Generally leads to hypofunction • Removal ▫ Leads to hypofunction

Primary disorder: dysfunction caused by the endocrine gland itself Secondary disorder: dysfunction caused by abnormal pituitary activity Tertiary disorder: dysfunction caused by a hypothalamic origin

Hypothalamus>low Pituitary>low End organ>high

Hypothalamus>high Pituitary>low End organ>low

Hypothalamus>low Pituitary>high End organ>high

Hypothalamus>low Pituitary>low End organ>high, T3, T4

Hypothalamus>low Pituitary>low End organ>low

Hypothalamus>high Pituitary>high End organ>low

Hypothalamus>high Pituitary>high End organ>high

Too little ADH (Vasopressin) from the posterior pituitary or lack of response from the kidneys to ADH>>Diabetes Insipidus>>The body loses water leading to: Dehydration, frequent urination and thirst Neurological symptoms, such as confusion

Too much ADH (Vasopressin) from the posterior pituitary leading the kidneys to retain water>>Syndrome of Inappropriate Antidiuretic Hormone (SIADH)>>The body holds onto water leading to: Fluid volume overload, hyponatremia, weakness, confusion, H/A

Release of too much GH (Somatotropin) from the anterior pituitary leading excessive growth>>Gigantism and Acromegaly>>Excessive growth of bones can take years to develop. Symptoms include large jaws and facial bones as well as hands, feet and long bones

Deficiency of thyroid hormone. Caused by varied factors: Autoimmune destruction of thyroid, congenital condition called cretinism, lack of iodine, or lack of stimulation due to lack of TSH from anterior pituitary>>Hypo-thyroid ism (i.e. Hashimoto's thyroiditis)>>Weight gain, lethargy, slow heart rate, decreased fertility, feeling cold, hair loss, constipation, goiter, Puffy face, severe symptoms called Myxedema

Excess of thyroid hormones. Caused by varied factors: Autoimmune stimulation of thyroid, thyroiditis, tumors of thyroid, too much iodine intake, excessive stim of TSH from anterior pituitary>>Hyper-thyroi dism (i.e. Grave's Disease)>>Heart palpitations, tachycardia, weight loss, fine brittle hair, tremors, anxiety, restlessness, feeling warm, exophthalmos, goiter, myxedema, thyroid storm which is life threatening

Related to decreased ACTH from the anterior pituitary, autoimmune destruction of the adrenal gland leading to decreased cortisol secretion, or injury or infarct of the adrenal gland All of these leads to decreased cortisol response to stress>>Adrenal Insufficiency (i.e. Addison's Disease)>>Lethargy, hypotension, N&V, anorexia, hypoglycemia, aldosterone imbalance leading to hyponatremia, hyperkalemia, darkening of skin and MM, personality changes, emotional lability

High levels of cortisol in the blood. Disease = pituitary produces large amounts of ACTH resulting in increased stim of cortisol Syndrome = When adrenals release too much cortisol or prolonged corticosteroid use>>Hyper-adrena lism (i.e. Cushing's Disease and Syndrome)>>Weight gain in central area of body, facial edema noted as "moon face", easy bruising, striae (stretch marks), hirsutism (excessive body hair), fat on cervicothoracic region called "dowager hump"

A protein hormone secreted by the pancreas that is essential for the metabolism of carbohydrates and the regulation of glucose levels in the blood.

A protein hormone secreted by pancreatic endocrine cells that raises blood glucose levels; an antagonistic hormone to insulin.

growth hormone, cortisol, epinephrine, progesterone, and estrogen

Pancreas produces insufficient insulin>>little or no insulin produced>>glucose levels increase -usually occurs in childhood

Pancreas produces sufficient insulin>>insulin produced is restart to use>>glucose levels increase

• Urine - glycosuria and ketonuria • Blood test - ▫ Capillary blood - finger stick normal 70-100mg/dL ▫ Venous - Hgb A1C normal < 5.7, ● In patient's with diabetes <6.5 (ADA recommendations) ▫ Islet Cell Antoantibodies ● Indicate type 1 DM ▫ C-peptide - when insulin is secreted so is c-peptide ● Low or absent c-peptide levels indicate type 1 DM

-Polyuria, polydipsia, polyphagia -weight loss or gain, thirst, hunger, blurry vision, etc.

Diabetic Ketoacidosis • High blood glucose • Lack of insulin to allow glucose into cells • As cells starve the body compensates by breaking down fat resulting in increased fatty acids which are converted to ketones (ketoacids) • Leads to a state of metabolic acidosis

• Kussmaul's respiration - hyperventilation as body attempts to compensates for metabolic acidosis through the respiratory system by blowing off CO2 • Ketone breath - Fruity distinct smell • Ketone body odor - Fruity distinct smell

Hyperosmolar Hyperglycemic Syndrome • High blood glucose • High insulin levels but cells are resistant • Cell starvation • Liver creates glucose • The blood is hyperglycemic and hyperosmolar • Because insulin is present fat is not broken down so minimal ketones present

-occurs due to treatment, lack of intake, increased exercise -shaky, sweaty, anxious, irritable, tachycardia, impaired vision, headache, weakness, fatigue

• 15X15 rule ▫ Treat with 15gm of Carbohydrates and recheck the blood glucose in 15 minutes ▫ Examples: ● 2-3 glucose tablets ● 6-8 lifesavers ● 4 oz of juice or low fat milk

-cerbrovascular disease: atherosclerosis of cerebral arteries, TIA, stroke -retinopathy: retinal hemorrhages, exudates, blindness -cardiovascular disease: atherosclerosis, HTN, coronary artery disease, MI -Nephropathy: renal impairment, renal failure -autonomic neuopathy: sympathetic and parasympathetic nervous dysfunction...e.g. decreased sweating, decreased compensatory mechanism in hypoglycemia (hypoglycemia unawareness), gastroparesis, bladder, bowel dysfunction, male ED -poor white blood cell function: immunosuppression, susceptibility to infections -peripheral artery disease: atherosclerosis of arteries in lower extremities, poor circulation, poor sensation, and poor wound healing result -peripheral neuropathy: burning, paresthesia, loss of sensation in distal extremities, possible motor weakness of feet

bleeding in the esophagus, stomach, or duodenum -causes: alcoholism, ulcers, etc -symptoms: bright red vomit or coffee ground blood

Black tarry stool

vomiting blood

a special chemical test to identify blood in the stool (feces). Blood in the stool may have many causes including cancer and hemorrhoids.

passage of fresh, bright red blood from the rectum

-difficulty swallowing -causes: neuromuscular (stroke, CVA, thyroid, esophogitis, strictures) -Symptoms: coughing, pain, choking, gagging

-gastroesophageal reflux disease -causes: LES (cardiac sphincter is weakened), positioning, obesity, pregnancy, etc. -symptoms: burning, cough, hiccups

•Common causes and risk • H-pylori, use of NSAIDs, ETOH, caffeine and smoking •Erosion of the protective mucosal lying of the GI tract •Epigastric and/or abdo pain 2-3 hours after eating

• Results as part of stomach protrudes through the esophageal hiatus • Hernia can move back and forth • Presents with symptoms of GERD

• Protrusion of a section of the small intestine through a weakened abdominal wall muscle • More common in men and in the inguinal area • Can present as reducible, incarcerated, or strangulated

•Irritation of GI tract by pathogen or chemical toxin •Common pathogens Norovirus, e-coli, Salmonella, Shigella, Clostridium difficile

increase in the osmotic load presented to the intestinal lumen because of diminished absorption

mucosal lining is inflamed, edematous, and unable to reabsorb fluid or nutrients.

occurs when an organism stimulates the intestine to secrete fluid and mucus.

caused by intestinal neuromuscular disorders.

Reaction to gluten intake • Autoimmune disorder leading to damage of the villi • While begins as an intolerance to gluten damage to villi causes malabsorption of essential nutrients. Like what?

Due to post surgical adhesions or scar tissue • Slows or stops peristalsis depending on extent of the obstruction • Bloating, vomiting, constant pain • Distention, hypoactive bowel sounds

Exam 4: 216

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